Substantial evidence shows that disrespect and abuse remain prevalent, primarily in low-income countries (LICs). A review of 65 studies, across 34 countries found that mistreatment presented as physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers and health system dysfunctions and constraints. Disrespectful care negatively impacts on childbirth experiences and actively deters women from attending health facilities, compromising care when services are available. Despite the plethora of studies examining respectful care, there is no consensus on the most appropriate tool to be used to measure this.
The main objective of this work is to use existing and new evidence to inform the development and testing of a new tool to measure respectful care in low income settings. The key questions are:
1. What is the current best evidence on existing measures of respectful care that can be administered in low income settings?
2. What is the most appropriate conceptual framework to underpin the development of a respectful care tool?
3. What is the optimum design and content for a culturally appropriate tool for measuring respectful care?
There will be two key phases to the students work:
Phase 1: Evidence synthesis
A systematic review will be conducted to synthesise the evidence related to measures of respectful maternal and newborn care. The evidence synthesis will use a mixed-methods approach in order to capture all relevant sources of information and to increase the applicability of this review. This broader narrative synthesis will include both quantitative and qualitative data, user views, and other relevant sources.
An integrated synthesis will be conducted; findings from quantitative and qualitative data will be systematically explored to determine the strengths and weaknesses of existing measures and to identify important conceptual issues.
Phase 2: Tool development and assessment
The new tool will be developed in four stages:
Stage 1: The student will supplement the findings from the evidence synthesis, with qualitative interviews with women to develop a conceptual framework to develop the new instrument. This framework will inform the domains to be included and the response categories to be used.
Stage 2: Question content and structuring will be developed with input from a community engagement and involvement group taking into account local language and cultural language nuances.
Stage 3: Standard psychometric methods will be used to assess acceptability, validity and reliability. Item acceptability will be assessed by assessing non-responses, endorsement frequencies and floor and ceiling effects. The tool will be assessed for internal consistency using Crohnbach’s Alpha coefficient and test-retest reliability. The tools validity will be assessed using content and construct validity.
Stage 4: The tool will be reviewed and refined according to the findings of stage 3 and piloted in two maternity units in Tanzania.
The project outcomes will be:
- A culturally tailored, validated and reliable tool to be used to assess respectful maternal and newborn care.
- Skills in evidence synthesis and questionnaire development.
Candidates are expected to hold (or be about to obtain) an Upper Second class Honours degree (or equivalent) in a related area / subject.
If you are interested in this project, please make direct contact with the Principal Supervisor to arrange to discuss the project further as soon as possible. You MUST also submit an online application form - choose PhD Midwifery. Full details on how to apply can be found on the GCRF website https://www.manchester.ac.uk/study/postgraduate-research/golden/gcrf/