Mixed Methods Evaluation of the ‘Caring for Providers to Improve Patient Experience’ intervention

Abstract

AbstractObjectiveTo assess the impact of the “Caring for Providers to Improve Patient Experience (CPIPE)” intervention, which sought to improve person-centered maternal care (PCMC) by addressing two key drivers—provider stress and bias.MethodsCPIPE was successfully piloted over 6-months in two health facilities in Migori County, Kenya in 2022. The evaluation employed a mixed-methods pretest-posttest-non-equivalent-control-group design. Data are from surveys with 80 providers (40 intervention; 40 control) at baseline and endline, and in-depth-interviews with 20 intervention providers. We conducted bivariate, multivariate, and difference-in-difference analysis of quantitative data and thematic analysis of qualitative data.ResultsIn the intervention group, average knowledge scores increased from 7.8(SD=2.4) at baseline to 9.5(SD=1.8) at endline for stress(p=0.001), and from 8.9(SD=1.9) to 10.7(SD=1.7) for bias(p=0.001); perceived stress scores decreased from 20.9(SD=3.9) to 18.6(SD=5.3)(p=0.019), and burnout from 3.6(SD=1.0) to 3.0(SD=1.0)(p=0.001); with no significant change in the control group. Qualitative data indicated CPIPE had impact at multiple levels. At the individual level, it improved provider knowledge, skills, self-efficacy, attitudes, behaviors, and experiences. At the interpersonal level, it improved provider-provider and patient-provider relationships leading to a supportive work environment and improved PCMC. At the institutional level, it created a system of accountability for providing PCMC and nondiscriminatory care; and collective action and advocacy to address sources of stress.ConclusionCPIPE impacted multiple outcomes in the theory of change leading to improvements in both provider and patient experience, including for the most vulnerable patients. These findings will contribute to global efforts to prevent burnout and promote PCMC and equity.Clinical trial registrationClinicalTrials.gov Identifier:NCT05019131https://www.clinicaltrials.gov/study/NCT05019131?term=Afulani&checkSpell=false&rank=1