Status of providing women-centered care by midwives and providing strategies to promote and improve women-centered care in Tabriz, Iran: A sequential explanatory mixed method study

Abstract

Abstract Background: As a central construct of being ‘with woman,’ woman-centered care (WCC) is well-grounded as the cornerstone of the midwifery profession. This concept underpins the philosophy of midwifery care not only in delivery services but in all professional fields of midwifery. Considering the pivotal role played by midwives in providing WCC, discovering and identifying associated factors will serve as a sound basis for designing interventions to improve the quality of WCC. Thus, the present study aims to a) determine the status of WCC and its associated factors for midwives working in urban health centers and public and private hospitals in Tabriz, b) explain the perception of midwives and pregnant, postpartum women in relation to WCC and the barriers and facilitators of achieving it and c) providing solutions to improve and promote women-centered care. Methods: This study is a mixed method study with sequential explanatory approach. The design of study in the quantitative phase was cross-sectional, and in this phase, the psychometric characteristics of the woman centred care-midwife self report scale and its associated factors were determined in the midwives of Tabriz city. The sampling method in the quantitative phase was census-sampelling and 575 midwives working in urban health centers, public hospitals (Al-Zahra, Taleghani, Imam Ali Artesh and Al-Ghadir Naja) and private hospitals (Shahriar, Shams, Behbod and Valiasr International) of Tabriz city were included in the study. The required data was collected by distributing socio-demographic and job characteristics questionnaire and woman-centered care scale-midwife self-report (WCCS-MSR). To determine the factors associated with WCC, an independent t-test or one-way analysis of variance (ANOVA) was used in bivariate analysis, and a generalized linear model (GLM) was employed in multivariate analysis to control possible confounding variables. In the qualitative phase, to explain the perception of midwives and pregnant, postpartum women regarding WCC and the obstacles and facilitators of achieving it from the perspective of 15 midwives working in urban health centers, public and private hospitals in Tabriz city and 10 pregnant and postpartum women under the coverage of these midwives was explored. Data were collected using in-depth individual interviews and note-taking, and data analysis was performed using conventional content analysis. Then, in the delphi phase, based on the data obtained in the quantitative and qualitative phases of the study and the results of literature review and view points of expert panel, solutions were presented to improve and promote WCC. Results: The results of the quantitative phase showed that the WCC-MSR is valid and reliable scale among Iranian midwives. The mean (standard deviation) of midwives’ total WCCS-MSR score was 215.90 (27.44), ranging from 40 to 280. Midwives obtained the highest total mean ‘Meets the unique needs of the woman’ (MUN_W) score in the range of obtained scores from (2.8-100), in the range of obtainable scores from (0-100). According to the GLM, the total mean WCCS-MSR score of single [β (95% CI): 23.02 (7.94 to 38.10)] and married [β (95% CI): 21.28 (6.83 to 35.72)] midwives was significantly higher than that of divorced midwives after adjusting the demographic and job characteristics of midwives. Also, the total mean WCCS-MSR score of midwives with sufficient income was significantly higher than those with insufficient income [β (95% CI): 8.94 (0.12 to 17.77). In addition, the total mean WCCS-MSR score of midwives with less than five years of work experience [β (95% CI): -7.87 (-14.79 to -0.94)], and midwives with official-experimental employment status [β (95% CI): -17.99 (-30.95 to -5.02)], was significantly lower than those with more than five years of work experience and contractual employment status. The results of the qualitative data in midwives led to the formation of 11 main categories, which include effective communication, professional competence, holistic person-centered care, shared decision-making, continuous care, compliance with professional and ethical values, promotion of health literacy of clients, empathy with clients, barriers to WCC, Facilitating factors in providing WCC and the benefits of WCC. Also, the results of the qualitative phase from the point of view of pregnant women and postpartum women led to the extraction of 9 main categories, which include effective midwife-woman interaction, person-centered care, shared decision-making, efforts to ensure the client's rights, maintaining the client's independence, improving the client's health literacy, barriers to WCC, Facilitators of WCC and the benefits of WCC. Finally, the results of the delphi phase led to the presentation of 89 WCC statements in the form of 7 main categories, including recommendations related to ethical values in WCC, recommendations related to professional competence in WCC, recommendations related to occupational and regulatory laws in WCC, recommendations related to Training of women and midwives in WCC, recommendations related to labor, pregnancy and childbirth in WCC, policy-making and executive recommendations in WCC, and social recommendations in WCC. Conclusions: The findings indicated that marital status, level of income, years of practice, and employment status were significantly related to WCC provided by midwives. To improve the quality of WCC, it does not seem logical to expect midwives to offer it without encountering obstacles and identifying associated factors. Also, it is recommended that the solutions presented from the current study be made available to policy makers and planners to design interventions with a women-centered care approach.