Organisational and individual readiness for change to respectful maternity care practice and associated factors in Ibadan, Nigeria: a cross-sectional survey.

Abstract

This study assessed health providers' organisational and individual readiness for change to respectful maternity care (RMC) practice and their associated factors in Ibadan Metropolis, Nigeria. A cross-sectional survey using standardised structured instruments adapted from the literature. Nine public health facilities in Ibadan Metropolis, Nigeria, 1 December 2019-31 May 2020. 212 health providers selected via a two-stage cluster sampling. Organisational readiness for change to RMC (ORC_RMC) and individual readiness for change to RMC (IRC_RMC) scales had a maximum score of 5. Multiple linear regression was used to identify factors influencing IRC_RMC and ORC_RMC. We evaluated previously identified predictors of readiness for change (change valence, informational assessments on resource adequacy, core self-evaluation and job satisfaction) and proposed others (workplace characteristics, awareness of mistreatment during childbirth, perceptions of women's rights and resource availability to implement RMC). Data were adjusted for clustering and analysed using Stata V.15. The providers' mean age was 44.0±9.9 years with 15.4±9.9 years of work experience. They scored high on awareness of women's mistreatment (3.9±0.5) and women's perceived rights during childbirth (3.9±0.5). They had high ORC_RMC (4.1±0.9) and IRC_RMC (4.2±0.6), both weakly but positively correlated (r=0.407, 95% CI: 0.288 to 0.514, p<0.001). Providers also had high change valence (4.5±0.8) but lower perceptions of resource availability (2.7±0.7) and adequacy for implementation (3.3±0.7). Higher provider change valence and informational assessments were associated with significantly increased IRC_RMC (β=0.40, 95% CI: 0.11 to 0.70, p=0.015 and β=0.07, 95% CI: 0.01 to 0.13, p=0.032, respectively), and also with significantly increased ORC_RMC (β=0.47, 95% CI: 0.21 to 0.74, p=0.004 and β=0.43, 95% CI: 0.22 to 0.63, p=0.002, respectively). Longer years of work experience (β=0.08, 95% CI: 0.01 to 0.2, p=0.024), providers' monthly income (β=0.08, 95% CI: 0.02 to 0.15, p=0.021) and the health facility of practice were associated with significantly increased ORC_RMC. The health providers studied valued a change to RMC and believed that both they and their facilities were ready for the change to RMC practice.