Interventions Co-designed by Providers and Clients for Improving Therapeutic Relationships in Maternal and Child Healthcare: A Human Centered Design Study in Rural Tanzania

Abstract

Abstract Background Evidence indicates that poor provider-client relationships within maternal and child health (MCH) continue to impact trust in formal health care systems, service uptake, continuity with care, and MCH outcomes. Objective The study aimed at co-designing an intervention package (prototype) for improving nurse-client relationships using a human-centred design (HCD) approach. Methods A 5-step HCD approach was employed: (1) community-driven discovery through qualitative descriptive research methods using 9 focus group discussions (FGDs) with nurses and clients and 12 key informant interviews (KIIs) with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough prototype model; (3) rough prototype validation through qualitative insight gathering using 6 FGDs with nurses and clients; (4) refinement and adaptation meetings with 14 nurses, 14 clients and 12 administrators; and (5) documentation and sharing of lessons learnt. Results From community-driven discovery, nurse contributors to poor nurse-client relationships included poor hospitality, lack of care, poor communication, negative attitude, and job dissatisfaction. Client contributors included nonadherence to procedures, negative attitudes, poor communication, inadequate education, poverty, and faith in traditional healers. Health system contributors were inadequate resources, poor management practices, inadequate policy implementation and the absence of an independent agency for gathering and management complaints. In response, three ideation and co-creating meetings resulted in 24 interventions. Seven (7) of these were rated as more acceptable and feasible in the local context and formed a rough prototype. During validation, there were some disagreements on the feasibility of curriculum and resource-related interventions. Refinement meetings resulted in a final prototype including four interventions: (i)promotion of patient-centred care; (ii) awards and recognition for nurses; (iii) strengthening complaints mechanisms and (iv) disciplinary measures for abusive nurses and clients. The lessons learnt have been shared through publications and institutional research meetings. Conclusions HCD approach provides a novel entry point for providers and clients to examine the problems and design interventions for strengthening their therapeutic relationships in MCH care. Researchers, practitioners, and policy developers are welcome to consider the emerging prototype as it was deemed acceptable and potentially feasible in rural African contexts.