IN-DEPTH INTERVIEW WITH SKILLED PROVIDER
Respondent ID:
Type of Skilled Provider:
Name:
ENM
MD
Midwife
Other (circle)
Address/Location:
Community-Based
Facility-Based
Location (near/far):
Hours Worked (Day Shift/Night Shift/Other):
Number of Years in Practice:
Distance of Provider Home to Facility:
Skilled Provider Ideal Behaviors:
• Accept/ support concept and practice of home visit by “informed EPPV” (early
postpartum visitor) for early postpartum check x 2-3.
•
Willingly Accept referrals from informed EPPV.
•
Provide quality early postpartum care for those women and families who do present
for care.
•
Recognize and treat/refer if necessary early postpartum maternal and newborn
danger signs.
•
Inform/Provide/ Support routine preventive EPP health behaviors for new mother
and newborn.
•
Suggest/identify appropriate “linkworker” informed early postpartum home visitor
(preferred provider).
•
Or, if home visits found not to be acceptable, suggest/identify preferred location for
EPP linkworker.
Research Objectives:
Overall Objective:
To identify factors that contribute to patterns of early postpartum care seeking behavior
among recently delivered women; and to test the concept of introducing early postpartum
home visitors.
Specific Objectives:
1. To document the content and practice of routine maternal and newborn early
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postpartum (EPP) caregiving at household level from skilled provider perspective.
2. To document the skilled provider perception of current level of
family/household/community caregiver awareness of maternal and newborn EPP
danger signs; and of the specific dynamics of family EPP careseeking decisionmaking when complications and emergencies occur, with special focus on “triggers to
action.”
3. To document the content and practice of routine maternal and newborn early
postpartum (EPP) caregiving as currently practiced by skilled providers.
4. To document the level of awareness of maternal and newborn EPP danger signs
among skilled providers; and dimensions of EPP care practiced by skilled providers
when complications and emergencies occur, with special focus on “triggers to action.”
5. To explore skilled provider perspective on factors that influence TBAs and other
community caregivers decision to seek EPP care outside the home, and factors in
family acceptance of TBA or other referral for additional EPP care.
6. To identify family/household/individual barriers and potential motivators to improved
utilization of EPP care.
7. To determine the acceptability and feasibility of the concept of EPP home visits, and
of informed early postpartum care visitors or “EPP linkworkers” among skilled
providers at facility level.
8. To determine preferred EPP care provider or linkworker, preferred EPP care source
or linkworker location, and content of EPP care/counseling among skilled providers at
facility level.
7. To document the nature and extent of the social networks of social networks of skilled
care providers; and how these social networks might be best used to rapidly spread
information about improved early postpartum care practices among their peers and
the medical community- at- large.
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QUESTIONS PER TOPIC AREA
Skilled Provider Perceptions of Family and Community EPP Practice
Notes for the Interviewer
Key ideas to explore:
How do skilled providers themselves perceive:
•
Content and practice of routine maternal and newborn early postpartum (EPP)
caregiving at household level?
•
Family/household/community caregiver awareness of maternal and newborn EPP
danger signs?
•
Specific dynamics of family EPP careseeking decision-making when complications
and emergencies occur, with special focus on “triggers to action”?
We will compare this to what families say they actually know and do, and identify “gaps.”
ƒ Where do you think women in your district prefer to give birth now? Why? Where do
their families prefer they give birth? Why?
ƒ Who do you think women prefer to attend the birth now? Why? Who do their families
prefer to attend the birth? Why?
ƒ What do you think women would say are the good things about being assisted by a
TBA? Why would they say that?
ƒ What do you think women would say are the good things about being attended by a
skilled provider? Why would they say that?
ƒ Why do you think many women continue to be assisted by TBAs instead of getting
skilled attendance?
ƒ What would help women to get skilled attendance at birth and in the first and second
weeks after birth?
Perceptions on Use of Skilled Care for Obstetric Emergencies
ƒ
Do you think many women and their families recognize obstetric complications and
emergencies? Do they understand the need for immediate access to skilled care?
Why do you say that?
ƒ
Do you think TBAs recognize obstetric complications and emergencies? Do they
understand the need for immediate access to care? Why/why not?
ƒ
Why do you think women may not seek skilled care in the case of normal births that
have no problems?
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ƒ
Why do you think women may not get skilled care in time when there are obstetric
emergencies?
ƒ
After a woman without problems gets to a skilled provider or arrives at the facility,
what happens? Are there delays that keep her from getting skilled care? Why do
you say that?
ƒ
After a woman with obstetric complications or emergencies gets to a skilled provider
or arrives at the facility, what happens? Does anything keep her from getting care
immediately? Why do you say that? What do you think would help women get faster
care in facilities? Better care?
ƒ
What do you think women and families would say they like about skilled care given in
facilities now? What do you think they would say they do not like?
ƒ
What do you think TBAs would say they like about skilled care given in facilities
now? What do you think they would say they do not like?
Perceptions on Use of Routine Immediate/Early Postpartum Care
ƒ
When do you think most maternal deaths happen? Why?
ƒ
When do you think the majority of newborn deaths happen?
ƒ
When do you think a woman without problems should get skilled care after birth?
How soon? How many times? Do you think some are being missed?
ƒ
What do you think postpartum care for a woman should include?
ƒ
Is early postpartum care now taking place in your community/facility? In what way ?
ƒ
Is there a special name for that time, the few days right after birth? (medical technical
name vs. lay name)
ƒ
Is there a special name people use to call the woman during that time? For the new
baby?
ƒ
Are there special things that new mothers do for themselves, or that others do for
them, during the first days and weeks after birth? What, when, why?
ƒ
For the baby? Are there special things to do for the baby during this time? Who does
it? What, when, why?
ƒ
Even when the mother and baby are fine, do they get a check-up right after birth?
ƒ
Who is the best person to check-up on the mother? to check on the baby? Where
does this happen usually? How soon after do they come? Does someone call them
to come?
ƒ
Who else usually comes to see new mothers and the baby during the week or two
after birth? Why, for what?
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ƒ
Are there any types of people who are not allowed to visit after birth? Why?
ƒ
Does anyone tell new mothers that it is important that she and the new baby should
be checked right after the birth and again during the first few weeks after? Who,
when, what do they tell them?
ƒ
Do YOU think it is necessary that new mothers and the new baby should be checked
right after the birth and again during the first few weeks after?
ƒ
Does anyone from the health facility, a skilled provider, ever visit at home after birth?
Why/ why not?
ƒ
Can new mothers leave the house during the first days after birth? Why/why not?
When can they leave?
Perceptions on Careseeking in EPP Emergencies
ƒ
What if there is a birth-related problem with the woman during that time (give
example of OB problem), can a woman leave the house then? Why/why not?
ƒ
If a woman can’t leave the house, then what would a woman with problems right
after birth do (days after, one week after, two weeks after - any difference)? Who
helps them? How? Where? Why?
ƒ
How do women or others in her household know (recognize) that there is a problem?
ƒ
Who do new mothers tell if they think there is a problem after birth? Why/why not?
ƒ
What if there is a problem with the new baby during that time (give example of
neonatal problem), can a new mother leave the house then? Why/why not?
ƒ
If a woman can’t leave the house, then what would a new mother with a newborn
with problems after birth do? Who helps them? How? Where? Why?
TEST CONCEPT: EPP Visitor/Linkworker
Notes for the Interviewer
Key ideas to explore:
•
•
•
•
ƒ
Conditions of acceptability of EPP visitor/linkworker concept?
Preferred EPP care provider?
Preferred EPP care location?
Preferred content of EPP care maternal/newborn?
If women and families could have a choice and select anyone, whom do you think
they would prefer to make this visit to your home to check on mother and new baby?
If no problem/ if problem. Why?
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ƒ
Is any (skilled) care available routine/emergency for new mothers or new babies at
any health facility near them? Far from them? At ANY other (skilled) care source?
Why would they use/not use these kinds of care?
ƒ
What about other kinds of care (unskilled/traditional/other)? Why would they use/not
use these kinds of care?
ƒ
Do you think women would go out to visit someone trained in the days and weeks
following birth if there were no health problems for mother/baby for a routine check?
Why/ why not? Who? Where? Is this difficult?
ƒ
Do you think women would go out to visit someone trained if there are health
problems for mother/baby? Why/ why not? Who? Where? Is this difficult?
ƒ
What kind of care do you think they would like you or other type of care provider to
provide? Why? Is there any kind of care you think they would NOT want during that
time right after birth?
ƒ
Do you think skilled providers are able to improve the care they give for childbirth
and the time right after? Can you think of ways to improve it?
Provider View of Conditions of Service/Quality of Obstetric Care
Notes for the Interviewer
Key ideas to explore:
•
•
Beliefs of the quality of service provided for routine obstetric care, emergency
obstetric care and early postpartum care?
Personal definitions of quality services?
Thank you for talking to us about women and families’ use of services. Now we want to
talk about how you feel about providing the services, the work that you do.
We know that as skilled providers you are supposed to provide services for normal
births, services for complications and emergencies, and early postpartum care.
ƒ
For normal births:
¾ Do you think the services are good quality? Why/why not?
¾ Do you think you are able to do those things? Why/why not?
¾ What are some good things that help you to get things done?
¾ Are there any bad things about trying to do skilled attendance? Difficult things?
¾ What things would you like to help make it easier?
¾ Are things the same in other facilities as here? Is this what other people would
say? Why/why not?
¾ If you or your daughter gave birth, where would you go? Why?
ƒ
For obstetric complications and emergencies:
¾ Do you think the services are good quality? Why/why not?
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Do you think you are able to do those things? Why/why not?
What are some good things that help you to get things done?
Are there any bad things about trying to do skilled attendance? Difficult things?
What things would you like to help make it easier?
Are things the same in other facilities as here? Is this what other people would
say? Why/why not?
¾ If you or your daughter had complications, where would you go? Why?
¾
¾
¾
¾
¾
ƒ
For early postpartum care:
¾ Do you think the services are good quality? Why/why not?
¾ Do you think you are able to do those things? Why/why not?
¾ What are some good things that help you to get things done?
¾ Are there any bad things about trying to do skilled attendance in early
postpartum? Difficult things?
¾ What things would you like to help make it easier?
¾ Are things the same in other facilities as here? Is this what other people would
say? Why/why not?
¾ If you or your daughter had a baby, where would you go? Why?
ƒ
What do you think women and families say about the care they get at your facility?
Social Support/Social Networks/ Communication Channels
Notes for the Interviewer
Key ideas to explore:
•
•
Most influential peer role models and authority figures?
Regular contacts and networks of skilled providers?
ƒ
How do you fit into the skilled care team in the community? In the facility?
ƒ
Do you have regular meetings or information sharing with other skilled providers in
the community and/or facility? What? How often?
ƒ
Do you have other times to meet or socialize with other skilled providers in the
community and/or facility? When? How often?
ƒ
Is there one person who you like to share /talk with the most?
ƒ
Do you think information about linking with “unskilled providers” or improved obstetric
practices could be shared through any of these opportunities? How?
ƒ
Do you have any other ideas about how community “unskilled providers” could be
linked to skilled providers well so that skilled providers would accept and welcome?
Thank you.
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