Effects of training health workers in cultural competence on satisfaction with maternity services among women in elgeyo-marakwet county, Kenya.

ABSTRACT

A culturally competent health workforce is recognized as a priority reform area in health management as well as in improving maternal healthcare indicators in vulnerable and marginalized settings. Yet modalities of integrating and reorienting healthcare services to meet the cultural needs of patients are rare. This study aimed at investigating the effect of training health workers in cultural competence towards satisfaction with maternity services among women of Elgeyo-Marakwet County. This was a cluster randomized controlled trial (CRT) blended with qualitative and quantitative data collection approaches. Clusters were randomized into intervention and control arms. Health workers in the intervention arm were sensitized on patient-centered maternal health care needs. Baseline and end line assessment (after six months) were carried with 758 women of reproductive age, 379 in each arm. Simple random sampling was applied. Data was collected using exit and mystery client surveys. Statistical Package for Social Science (SPSS) was used to analyze the data. The effect of the interventions was measured using standard mean difference (Cohen’s d) and ttest. An alpha cut of 0.05 tested the hypothesis. Qualitative data was analyzed through a process of data reduction, organization, and interpretation. Known companion, continued support, and naming critically influenced pregnancy and childbirth with a mean of 4.1, 3.9 and 3.2 respectively. Other important considerations are the choice of birthing position and placenta management with a mean of 3.1 and 2.9. The study revealed diverse and multiple women’s maternity needs and requirements. Cultural needs included the choice of delivery methods, placenta interpretation, placenta disposal, naming, and celebration. Esteem needs included value, respect, and friendliness. Physiological needs were labor room cleanliness, staff grooming, hygiene, and comfort. Psychological needs ranged from encouragement, assurance, empathy, and emotional support. Information and communication are also paramount. Before the intervention, there was no statistically significant difference (t (741) =0.106, p = 0.916) between the control and intervention group on the mean scores of quality of delivery rooms settings. The mean for intervention arm however improved to 4.41 ±0.673 from 4.13±0.738 while that of control remained steady. The mean change tinkered the differences between the two groups to significant t (756) =-1.1959, p = 0.002. The mean scores quality of prompt provision of maternity services between the two groups were indifferent prior to intervening t (749) = -0.380, p = 0.704 but significant thereafter t (756) = -5.214, p < 0.001. The intervention effect size was (F (1, 756) = 10.142, p = .001, ηp2 = 0.036). The difference between the groups in the scores of trust in provider was insignificant before t (692) = -957, p = 0.339 but significant later t (690) = -6.137, p = 0.001. The mean of the intervention improved to 4.26±0.698 from 4.05±0.727. The effect size was significant (F (1, 756) = 6.395, p = 0.012, ηp2 = .018) on trust scores. ANOVA showed that there was significant effect (F (1, 756) = 11.493, p < 0.001, ηp2 = .049) on satisfaction with provided information on delivery methods. With a mean of intervention group increasing from 3.55 ±1.056 to 3.94, ±0.894 following training of the health workers. The mean of control changed somewhat from 3.57±1.187 to 3.62 ± 1.149. The mean changes tweaked the group variance from insignificant t (725) =0.290, p = 0.771 to significant t (713) =-4.336 p