Browsing by Person "de Kok, Bregje"

Now showing 1 - 11 of 11

Achieving accountability through maternal death reviews in Nigeria: a process analysis
(OUP, 2017-06-28) de Kok, Bregje; Imamura, M.; Kanguru, L.; Owolabi, O.; Okonofua, F.; Hussein, J.
Abstract _ View references (35) Maternal death reviews (MDRs) are part of the drive to increase accountability for maternal deaths and reduce their occurrence by identifying barriers to effective, quality care. However, conducting MDRs well is difficult; staff commitment and establishing a blame free environment are key challenges. By examining the communication strategies used in MDRs this study sought to understand how MDR members implement policy imperatives (e.g. 'no blame, no name') and manage the inevitable sensitivities of discussing a client's death in a multidisciplinary team. We observed and recorded four MDRs in Nigerian teaching hospitals and used conversation and discourse analysis to identify patterns in verbal and non-verbal interactions. MDRs were conducted in a structured way and had multidisciplinary representation. We grouped discursive strategies observed into three overlapping clusters: 'doing' no-name no-blame; fostering participation; and managing personal accountability. Within these clusters, explicit reminders, gentle enquiries and instilling a sense of togetherness were used in doing no-name, no-blame. Strategies such as questioning and invoking protocol were only partially successful in fostering participation. Regarding managing accountability, forms of communication which limit personal responsibility ('pass the buck') and resist passing the buck were observed. Detailed, lengthy eye witness accounts of dramatic events appeared to reduce staff's personal accountability. We conclude that interactional processes affect the meaningfulness of MDRs. In-depth, critical analysis depends on resisting 'passing the buck' by practitioners and chairs especially, who are also key to fostering participation and extracting value from multidisciplinary representation. Our innovative methods provide detailed insights into MDRs as an interactional process, which can inform design of training aimed at enhancing MDR members' skills. However, given the multitude of systemic challenges we should also adjust our expectations of MDRs and the individual practitioners tasked to perform them in the name of enhancing accountability for maternal death reduction. 2017 The Author.
`Automatically you become a polygamist': `culture' and `norms' as resources for normalization and managing accountability in talk about responses to infertility
(2009-03) de Kok, Bregje
In the developing world, infertility is a serious problem. It leads to both psychological and social hardship, in part because childless marriages often result in divorce, men taking another wife or extramarital relationships. Such responses have been attributed to cultural norms that mandate procreation. However, there are theoretical, methodological and moral issues with treating cultural norms as behavioural determinants. They have been insufficiently acknowledged in health research. Therefore, I demonstrate an alternative discursive approach, which examines how people actively mobilize 'culture' or 'norms' in interactions, and the interpersonal functions thereby fulfilled (e.g. blaming or justifying). Analysis is presented of interviews on (responses to) infertility in Malawi. I show how respondents construct polygamy and extramarital affairs as culturally and normatively required, 'automatic' and normal solutions for fertility problems and play down people's accountability for these practices. These accounts and constructions appear to facilitate engagement in affairs and polygamy when people face fertility problems, which seems problematic from a health and gender perspective. Thus, detailed analysis of how people use 'culture' and 'norms' in situ is important because it provides insights into its potentially undesirable consequences. Moreover, such analysis provides a starting point for culturally and gender sensitive interventions, since it highlights people's agency, and creates a space to re-construct and change practices. © 2009 SAGE Publications.
Discursive Psychology and its potential to make a difference
(Palgrave MacMillan, 2012-04-17) de Kok, Bregje; Horrocks, C.; Johnstone, C.
Global maternal health: from women's survival to respectful care
(2014-12) de Kok, Bregje
Infertility and relationships: the importance of constructions in context
(2013-04) de Kok, Bregje
In low- and middle-income countries, infertility is a neglected but highly stigmatising condition, which often leads to extramarital affairs, polygamy and divorce. I conducted interviews in Malawi with women with a fertility problem and used discursive psychology to analyse how they described and constructed (extra)marital relationships. Surprisingly, several respondents constructed their relationships as good, and descriptions minimised the significance and blameworthiness of husbands' affairs. This contrasts with the literature's portrayal of conjugal relationship problems as among the main hardships that infertile women endure. Attention to participants' own orientations to relationship 'trouble' is important. Furthermore, discursive practices, such as not complaining or not blaming one's spouse for affairs, appear to limit possibilities for 'speaking out' and 'acting up'. Interventions could facilitate alternative accounts and constructions. This study illuminates local practices of family and intimacy, how people 'do' relationships and intimacy in interaction, and the shared expectations concerning marital relationships and social categories (eg, 'spouse') that the respondents draw on. This is important: sexual and reproductive health interventions should consider relationships and their context-specific meanings.
Interpersonal Issues in Expressing Lay Knowledge: A Discursive Psychology Approach
(2010) de Kok, Bregje; Widdicombe, Sue
This article examines lay knowledge about causes of infertility. We use discursive psychology to analyse semi-structured interviews with purposively sampled Malawians with a fertility problem. We observe that respondents deny knowledge of causes, sometimes emphatically, but this co-occurs with descriptions of potential causes. We show that these respondents thereby address problematic interpersonal issues: namely that one is not entitled to medical knowledge and that negative inferences that may be drawn about someone who knows particular causes of infertility. These findings shed new light on previous observations, and have implications for the study of lay knowledge.
It's a very complicated issue here': understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study
(Oxford University Press, 2016-09-10) Cook, Sinead; de Kok, Bregje; Odland, Maria Lisa
Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al.'s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al.'s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low- and middle-income country perspective. The Author 2016.
Joining-up thinking: Loss in childbearing from inter-disciplinary perspectives
(Elsevier, 2010-11) de Kok, Bregje; Hussein, J.; Jeffrey, P.
Paper adds to the growing body of evidence that children can acquire phonological systems before they are able to master the phonetic skills needed to convey the contrasts in that system
Socio-cultural factors, gender roles and religious ideologies contributing to Caesarian-section refusal in Nigeria
(2015-08-12) Ugwu, Nnanna U.; de Kok, Bregje
Abstract Background: The death of women from pregnancy-related causes is a serious challenge that international development initiatives, including the Millennium Development Goals, have been trying to redress for decades. The majority of these pregnancy-related deaths occur in developing countries especially in Sub-Saharan Africa. The provision of Emergency Obstetric Care (EmOC), including Caesarean section (CS) has been identified as one of the key ingredients necessary for the reduction of high maternal mortality ratios. However, it appears that creating access to EmOC facilities is not all that is required to reduce maternal mortality: socio-cultural issues in Sub-Saharan countries including Nigeria seem to deter women from accepting CS. This study seeks to explore some of the socio-cultural concerns that reinforce delays and non-acceptance of CS in a Nigerian community. Methods: This is a mixed method study that combined both qualitative and quantitative strategies of enquiry. The hospital's delivery records from 2006-2010 provided data for quantitative analysis. This quantitative data was supplemented with prospective data collected during one month. Semi-structured interviews, focus group discussions (FGD) and informal observations served as the sources of data on the qualitative end. Results: In total, 22 % of maternity clients refused CS and more than 90 % of the CSs in the focal hospital were emergencies which may indicate late arrival at the hospital after seeking assistance elsewhere. The qualitative analysis reveals that socio-cultural meanings informed by gender and religious ideologies, the relational consequences of having a C-section, and the role of alternative providers are some key factors which influence when, where and whether women will accept C-section or not. Conclusion: There is need to find means of facilitating necessary CS by addressing the prevailing socio-cultural norms and expectations that hinder its acceptance. Engaging and guiding alternative providers (traditional birth attendants and faith healers) who wield much power in their communities, will be important to minimize delays and improve cultural acceptability of CS. 2015 Ugwu and de Kok.
Supporting Pakistani and Chinese families with young children: perspectives of mothers and health visitors
(2015-05) Hogg, R.; de Kok, Bregje; Netto, G.; Hanley, J.; Haycock-Stuart, E.
Background: In the UK, public health nurses (health visitors) provide support and advice to families with young children, including those from minority ethnic communities. While the need for cultural sensitivity is being increasingly recognized, the factors which contribute to this sensitivity are poorly understood. The Pakistani and Chinese communities constitute the two largest minority ethnic groups in Scotland. This study explored Pakistani and Chinese women's experience of motherhood and of the health visiting service and public health nurses' experiences of working with Chinese and Pakistani mothers. Methods: Semi-structured individual interviews were carried out with 16 Pakistani and 15 Chinese mothers. Eight health visitors took part in two focus groups. The study was undertaken in an urban area of Scotland. Data were analysed thematically. Findings: Chinese and Pakistani mothers negotiate complex processes in order to ensure that their children maintain their own ethnic identity while fitting in with their peers in their adopted country. Health visitors were seen as supportive, although sometimes advice and information given was culturally inappropriate, and their role was often poorly understood. Health visitors were anxious to be sensitive to families' religious and cultural beliefs. Conclusions: Cultural sensitivity is an important factor in providing appropriate advice and help to Pakistani and Chinese families, and involves health visitors in considering views and practices on parenting which may differ across cultures, including their own. Family characteristics need to be understood on an individual basis, rather than making assumptions about clients' cultural norms and lifestyles. This is best achieved by exploring with mothers if they understand the advice and information they are being offered and also if it is appropriate to their cultural and religious beliefs. 2014 John Wiley & Sons Ltd.
Weighing the options for delivery care in rural Malawi: Community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants
(2019-04-02) Uny, Isabelle; de Kok, Bregje; Fustukian, Suzanne
To address its persistently high maternal mortality, the Malawi government has prioritized strategies promoting skilled birth attendance and institutional delivery. However, in a country where 80% of the population resides in rural areas, the barriers to institutional deliveries are considerable. As a response, Malawi issued Community Guidelines in 2007 that both promoted skilled birth attendance and banned the utilization of traditional birth attendants for routine deliveries. This grounded theory study used interviews and focus groups to explore community actors' perceptions regarding the implementation of this policy and the related affects that arose from its implementation. The results revealed the complexity of decision-making and delivery care-seeking behaviours in rural areas of Malawi in the context of this policy. Although women and other actors seemed to agree that institutional deliveries were safer when complications occurred, this did not necessarily ensure their compliance. Furthermore, implementation of the 2007 Community Policy aggravated some of the barriers women already faced. This innovative bottom-up analysis of policy implementation showed that the policy had further ruptured linkages between community and health facilities, which were ultimately detrimental to the continuum of care. This study helps fill an important gap in research concerning maternal health policy implementation in Low and middle income countries (LMICs), by focusing on the perceptions of those at the receiving end of policy change. It highlights the need for globally promoted policies and strategies to take better account of local realities.