Barriers to patient-centered communication faced by both providers and women during antenatal, labour and postnatal care in rural health centers in Mzimba district in Malawi

Abstract

This study aimed at identifying and analyzing barriers to patient-centered communication (inter-group context) faced by both providers and women during Antenatal, Labour and Postnatal care in rural health facilities in Malawi as well as to analyzing findings of these barriers for similarities and differences that may be reconciled to decrease intergroup communication barriers between midwives and expectant mothers, that may help to create effective patient centered communication. Qualitative research method was used and 28 one on one interviews were conducted with midwives, antenatal and postnatal women. Content analysis was used to analyse data. Results showed that midwives don't have effective communication skills due to lack of on job communication trainings. The majority of midwives are aware of barriers that affects patient-centered communication and ways in which patientcentered communication can be improved however pressure of work as a result of shortage of staff limit them to effectively facilitate health education sessions with women in rural health centers. Also, because of pressure of work, midwives adjust their communication behaviours to diverge women's communication behaviours. On the other hand, women go to the hospital to access care with already pre-existing socio-historic context in terms of social cultural norms and values. Women have their own perception about intergroup communication behaviours and view midwives as their bosses. Women are not aware of patients' bill of rights and responsibilities and as a result they fail to demand care that addresses their needs form providers. This is worsened by their low levels of education and attitude of providers that make them feel inferior and afraid to participate in their own care. As a result, women take a nonaccommodative stance and just want to get other services other than the information and go home. From the results, patient-centered communication can be improved by equipping midwives with effective communication skills, improving staffing level of midwives per shift and understanding the social historical context in which communication is taking place.