Dissertation on Adapting and Piloting Respectful Maternity Care Study

This dissertation focuses on adapting and piloting respectful maternity care (RMC) within the context of Ravalpindi, Pakistan, utilizing a qualitative methodology grounded in grounded theory. The research involved in-depth interviews with 64 participants, including gynaecologists, nurses, health workers, hospital managers, and pregnant women, to gather insights into maternity care experiences in public sector hospitals. Data collection methods included focus group discussions and personal interviews, conducted in languages other than English and subsequently translated. The study explores themes related to the level of care, barriers to RMC implementation, patient privacy, differences between public and private services, and challenges faced by patients accessing RMC. The findings aim to inform improvements in maternity care practices and address issues such as mistreatment and lack of respect during childbirth.

Dissertation Adapting and
piloting respectful maternity
care

Table of Contents
Chapter 3 – Qualitative Methodology..............................................................................................3
Study Area...................................................................................................................................3
Study Design & Participants........................................................................................................3
Data Collection Activities............................................................................................................4
Data Analysis...............................................................................................................................7
CHAPTER 4 – RESULTS...............................................................................................................8
Themes associated with level, sub-themes and the categories..................................................8
Analysis of in-depth interview.......................................................................................................14
Theme1- In-depth Interview (IDI2) at managerial level................................................................14
Theme 2-Analysis of In-depth interview.......................................................................................17
2.1 Barriers associated with the implementation of RMC.............................................................17
2.2 Privacy of the patient in RMC.................................................................................................18
2.3 Difference in the public and private services in relation to RMC...........................................19
2.4 Issues faced by patient in visiting RMC..................................................................................24
REFERENCES..............................................................................................................................29

Chapter 3 – Qualitative Methodology
Study Area
The study was regulated in Ravalpindi, it is situated in Punjab, Pakistan. The area of
district Ravalpindi is divided within 7 Tehsils, the government is 3rd tier which is below the
provincial and federal levels. Ravalpindi have 223 hospitals in total which is situated in the
district areas.
The conducted study has come into contact with the public sector hospitals. These
hospitals were chosen because they can provide accurate information which is necessary for
analysing the way maternity care is carried out. These hospitals provided insights related to the
experience of the women who were visiting those hospitals as well as various worker of the
hospitals. The manager, gynaecologist, health care staff and various other people who are
involved in the hospitals were providing the necessary information for the study. The child birth
rate is more than the death rate, also this contains various females who are suffered from bad
maternity care which lead to death of child or the mother.
Study Design & Participants
The approach used in the study is Grounded Theory. Grounded theory is a type of
research method which allow the researcher for developing a theory that helps them to provide
an explanation about the issue (Chun Tie, Birks, and Francis, 2019). The important concern
related to the population is of substantive area and the manner in which it is concerned to
resolving or processing. This theory is mostly used during qualitative research as it helps to
understand the criteria in better manner. One of the main benefit of using grounded theory is that
it include Ecological Validity. Ecological validity is defined as the limit till which research
findings is represented accurately in the real world (Lambert, 2019). The research type is said so
because it is closely connected to the participants from real world.
This is a type of theory which is not connected to any previous theory, it is often new and
fresh. It provides various new potential for the discoveries of novel in science as well as various
new areas. This type of research provides various guidelines which are explicit as well as
sequential which helps in regulating the qualitative research. The grounded theory present
strategies which are specific for operating phases of inquiry which are analytical. Grounded

theory offers methods which help to streamline and integration of data collection as well as
analysis. The theory is suitable for the current research as it is related to the qualitative research.
Sometimes it happens that the researcher using grounded theory put their focus on
preparing hypothesis, replicability, reliability and variables. This will affect the findings of the
research as the focus will be distracted. It is also not acceptable to ignore the existing theories as
sometimes they provide insights which the author is not able to provide. The researcher should
provide importance to the existing literature. The theory provides various complex methodology
as well as terminology which will have confused the researcher. It will not provide any practical
orientation related to the area of research as well as data analysis.
There were around 64 participants who were interviewed. The Participants in the
qualitative survey were gynaecologist who were working at private clinic and Tehsil Head
quarter. There were various lady health worker and staff nurses working at Tehsil Head quarter
& District Head Quarter as well as pregnant females who were visiting the private hospitals.
Also, there were health worker, civil society member, health worker at lady health visitor,
hospital and participant at Tehsil Head quarter. These people were interviewed for gaining the
insights of various questions related to the care for maternity. These people are those who are
responsible for the care of the pregnant females either visiting or admitted.
Data Collection Activities
It is a process which helps the researcher to gather as well as measure the information
which is related to the variables of interest (Snyder, 2019). It is in established systematic fashion
which help to enable an answer which is mentioned in the research question. The study is
conducted on qualitative data which is collected through various focus groups discussion as well
as personal interviews. This data was collected by forming the questions which is relevant to the
information required (Pandey, and Pandey, 2021). It is because it will help us find the answer to
the research question related to the topic.
Study Population
The study populations consist of various health care workers as well as staff members.
This people were working in the Tehsil head quarter as well as district head quarter. This people
are the ones who can provide accurate information which is necessary for the research to get
complete. The population of the research also consist of various managers as well as females

who were visiting the hospitals for check up. This people were asked to provide their experience
in the hospitals so that they can grab the knowledge which is related to the public sector
hospitals. The people interviewed were informed that the privacy of their data will be
maintained, and various other information which was necessary for them to know before
providing information to the other person. The interview questions were providing various
information which will help while making the decision which will help to find the answers to the
question of which is necessary for the research. This people interviewed were the ones who came
into contact with the hospitals and know the necessary information which will help the others
while making any sort of decision. The population studied will be providing information which
is reliable for the researcher.
The study also include focus group discussion. In focus group researcher takes
participation in the people who are assembled for discussing on a particular topic (Zangirolami-
Raimundo, Echeimberg, and Leone, 2018). Here the researcher is able to get the necessary
feedbacks from various people who have been through the same situation. In this researcher gets
various sort of ideas which is beneficial for its final result. The data gathered from the focus
groups will provide both side of the maternity care facility which is good and bad. The people
will provide their experiences during the maternity care period or when they visit the hospitals.
There are various focus groups which will be attended by the researcher for collecting the
required data for the research. This will eventually help the researcher to compare the data which
is gathered from the interview as it will help to analyse the reliability of the data. Focus group
has answered various questions for the author which will eventually help him to complete the
report. There were various key informations which was gathered with the help of Interview as
well as focus groups (Mukherjee, 2019). These are the type which is suitable for the researcher
as it provides information which is necessary for the research.
Sampling Techniques
Sampling techniques helps the researcher for selecting the participants necessary in the
research or any set of population which can help to make statistical inferences (Bairagi, and
Munot, 2019). This helps the researcher to while estimating the characteristics of the necessary
population. The study has chosen 64 participants who are health care providers and working in
the maternity care hospitals. These participants also include the pregnant females who are

visiting the public hospitals for check up. This sample is chosen because they will be providing
the information which is accurate and will help in the research. Health care provider are situated
in the Tehsil Head Quarter as well as District Head Quarter. Among the participants there are 2
managers who are Human resource manager as well as hospital manager. This people will be
providing the information which is useful for conducting the research as the data gathered by
them will be reliable.
This people are working in the maternity care hospitals, so they can easily provide the
required information. Maternity care is important for the females as their lives are dependent on
the nursing staff. The information of these participants is not being disclosed because of the
privacy issue of those people. This people who are involved with the health care are the ones
who will be providing the information which is necessary for the research. This people will be
answering the questions which is fixed by the researcher suitable for answering the research
questions. Females who were interviewed were visiting the hospitals for their regular check up
and the information provided by them will help the researcher while making the decision which
is suitable for the research. This will eventually provide the insights which will help the
researcher for analysing the quality of care which is provided to the pregnant females.
Researcher has chosen this participant because the information collected from this participant
will be important for the accuracy of the research as they are providing. The data on which the
researcher can depend upon while arriving at the conclusion. The data will have various factors
which will provide the information regarding the quality of care undertaken by the researcher
(Kumar, 2018).
Data Collection
Information in the study is collected with the help of attending focus groups and
undertaking interview of various people who are responsible for the health care of pregnant
ladies. The data was also collected with the help of reviewing various previous studies which
helped in gaining more information about the study. The study was conducted on various levels
and analysed the abuse which the women are facing during their routine check up when they are
pregnant. This eventually show the things which they are facing during the process of giving
birth to a child.

The focus group discussion was conducted in language other than English. The
discussion was recorded by the interviewer and then it was written in the document in English
language to understand the responses of the patients in better manner. There were various
participants who had different point of view on certain topics. The discussion was conducted
with privacy to ensure that the feedback of those patients and their information was not disclosed
to anyone. It provided relief to the patient to ensure that there information will not be disclosed
to anyone. The personal interview was also conducted in language other than English, which was
also converted in document to understand their viewpoint. This interview was conducted
privately of various people such as health care staff, nurses, patients and various other. The
interview was recorded to understand the viewpoint in better manner after the interview is
conducted.
The study was conducted fact to face with the participants and their consent was taken in
written. After the approval the discussion was recorded to have the knowledge which will help in
the future. The responses of the participant were confidential and voluntary to ensure their safety.
The participants were informed that they can back out from answering the question and sharing
their viewpoint. This ensured that the participants will be comfortable while talking about their
issues. They were not obliged to provide answer to their question as there was no repercussions.
The interview recording was converted into a document and then it was stored safely to ensure
no one can get the information collected.
Data Analysis
For analysing the qualitative data inductive approach is used in which grounded theory is
used on the information collected with the interview during the process. Initially the responses
were recorded and then documented in English language then it was analysed with the help of
the theory. Some of the responses which were collected with the help of interview and focus
group discussion were quoted in the document to understand the concept in better manner. The
themes which were analysed with the help of focus group discussion and interview were guiding
the researcher in developing an initial code framework. After the coding it was compared with
the document made from the recording to compare the area which lack in the research. The
themes of the research is providing various information which is necessary to understand to the
things which pregnant women face in the hospitals.

CHAPTER 4 – RESULTS
Themes associated with level, sub-themes and the categories
Level-theme Perspectives
of service
user\
service
provider/
civil society
member
Sub-themes Categories Description
reference to
themes
Reference
to theme
Interview at
managerial level
Managers  Barriers in
implementation of
RMC
 Status of patient
 Difference in
public and private
services
 Policies of RMC
 Deficit reason for
policy
 Grievances
Redress
mechanisms in
 Negative
experience
 Emotions
 Responsibilities
 Judgemental
 Lack of
responsibilities.
Problems
associated with
the patient.
9

RMC and its
effects
 Demand status at
community level
 Strategies for
promoting RMC
 Staff training.
Barriers
associated with
the
implementation
of RMC
Service
provider
civil society
member.
 Privilege to
politician
 Physician not
assure proper time
 Lack of policies
 Lack of
responsibility
 Lack of support
Major barrier in
the
implementation of
RMC from
service user
perception.
3
Privacy of
patient in RMC
Service
provider
civil society
member.
 Physical
examination of
patient
 Abusive language
to staff
 Self-worth of
patient
 Unethical
behaviour
 Lack of ethics
 Discrimination
 Dignity
 Morals
Disturbance in the
privacy of patient.
4

Difference in
public and
private sectors
services
Service
user, service
provider
civil society
member.
 Extent of
difference.
 Issues faced by
patient
 Status of the
patient matters in
RMC
 Scenario at the
time of delivery
care
 Issues faced while
experiencing
public services
 Workload over
staff
 RMC and
government
policy
 Lack of RMC
initiatives
 Lack of
accessibility.
 Lack of strategies.
 Lack of
management
 Lack of
accountability
 Discrimination
Difference exist
among public and
private sector
services
8
Issues faced by Service  Practices of RMC  Lack of privacy Hurdles faced in 9

patient in visiting
RMC
user\
service
provider
 Privacy concern
 Behaviour of
doctors
 Deficit policy
 Pattern of
workload
 Financial crisis
 Unethical
practices
 Lack of care
 Abuse
 Lack of
accessibility
 Lack of availability
 Lack of
knowledge.
visiting RMC.
Right of patient Service
user\
service
provider
civil society
member.
 Selection of
doctor
 Cleanliness
 Post period care
 Proper
information
 Privacy protection
No motivation
Emotional fluctuation
Need for integration
The major rights
of the patient
5
Experience of
patient
Service user
civil society
 Experience after
delivery
Worst experience
Physical and mental

member.  Waiting time at
maternity care
services
 Lack of option
impact
Lack of interaction
Need for evolving
Suggestion Service
provider
 Proper monitoring
 Government
policies
 Accountability
 Proper procedure
in relation of
registering
complaints
 Focus on privacy
 More policies in
this context
 Creating
awareness
 Behaviour of
nurses
 Training practices
 Ethical behaviour
 Role of media
Need for strategies
Need for provision
Support towards patient
Creating awareness
Practices can be
improved in
RMC.
14