RT Journal Article
SR Electronic
T1 Modeling Pathways to Describe How Maternal Health Care Providers' Mental Health Influences the Provision of Respectful Maternity Care in Malawi
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2300008
DO 10.9745/GHSP-D-23-00008
VO 11
IS Supplement 1
A1 Burnett-Zieman, Brady
A1 Warren, Charlotte E.
A1 Chiundira, Felistas
A1 Mandala, Edina
A1 Kachale, Fannie
A1 Mchoma, Christina Heather
A1 Mboma, Alexander
A1 Kamanga, Martha
A1 Kazembe, Abigail
YR 2023
UL http://www.ghspjournal.org/content/11/Supplement_1/e2300008.abstract
AB Key MessagesWithout identifying and addressing burnout among maternal health (MH) providers, efforts to achieve respectful maternity care (RMC) will not be reached. Providers report being emotionally exhausted and depersonalizing their clients, and one-tenth experience depression, post-traumatic stress disorder (PTSD), or suicidal ideation.We found correlations between mental health factors and RMC. A path analysis indicates that emotional exhaustion and depression appear to directly influence RMC; PTSD and depression have secondary effects, which are mediated through exhaustion and depression.The path analysis also shows that having positive, supportive working relationships with facility managers is strongly associated with improved RMC. Moreover, positive working relationships may also protect MH providers against some of the more pernicious effects of burnout.Key ImplicationAddressing burnout is critical to improving RMC in Malawi and elsewhere. Policymakers and health managers should recognize how burnout is shaped by providers' day-to-day experiences, as well as coincident mental health conditions, including PTSD and depression.Introduction:Maternal health (MH) providers may experience traumatic events, such as maternal or fetal death, that can contribute to stress and burnout. Past trauma, poor working relationships, and under-resourced environments not only affect providers' own emotional well-being but also reduce their ability to provide respectful maternity care (RMC).Methods:Data were collected in mid-2021 as a cross-sectional survey with 302 MH providers working in 25 maternities in 3 districts in Malawi to measure burnout, depression, and post-traumatic stress disorder (PTSD). We present a pathway model describing how these factors interact and influence RMC. We used the provider-reported person-centered maternity care scale to measure RMC; the Maslach Burnout Inventory, which examines emotional exhaustion, depersonalization, and professional accomplishment; and standard validated screening tools to measure the prevalence of depression and PTSD.Results:Although levels of burnout varied, 30% of MH providers reported high levels of exhaustion, feelings of cynicism manifesting as depersonalization toward their clients (17%), and low levels of professional accomplishment (42%). Moderate to severe depression (9%) and suicidal ideation within the past 2 weeks (10%) were also recorded. Many (70%) reported experiencing an event that could trigger PTSD, and 12% reported at least 4 of 5 symptoms in the PTSD scale. Path analysis suggests that depression and emotional exhaustion negatively influence RMC, and depersonalization is mediated through depression. PTSD has no direct effect on RMC, but increased PTSD scores were associated with increased burnout and depression scores. Positive relationships with facility managers were significantly associated with increased RMC and decreased emotional exhaustion and depersonalization.Conclusion:Burnout will continue to be a challenge among MH providers. However, pragmatic approaches for improving teamwork, psychosocial, and managerial support for MH providers working in challenging environments may help mitigate burnout, improve MH provider well-being, and, in turn, RMC for women seeking MH services.