{"id":"https://openalex.org/W4410440873","doi":"https://doi.org/10.21203/rs.3.rs-6615286/v1","title":"Provider coping strategies and behaviours in overcoming challenges during maternity healthcare delivery in positive and negative outlier facilities in Kenya: An explanatory sequential mixed-methods feasibility study","display_name":"Provider coping strategies and behaviours in overcoming challenges during maternity healthcare delivery in positive and negative outlier facilities in Kenya: An explanatory sequential mixed-methods feasibility study","publication_year":2025,"publication_date":"2025-05-16","ids":{"openalex":"https://openalex.org/W4410440873","doi":"https://doi.org/10.21203/rs.3.rs-6615286/v1"},"language":"en","primary_location":{"id":"doi:10.21203/rs.3.rs-6615286/v1","doi":"https://doi.org/10.21203/rs.3.rs-6615286/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-6615286/v1","pdf_url":"https://www.researchsquare.com/article/rs-6615286/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"},"volume":null,"type":"preprint","indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.researchsquare.com/article/rs-6615286/latest.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5071393677","display_name":"Francis G. Muriithi","orcid":"https://orcid.org/0000-0002-2314-5611","observed_orcids":["https://orcid.org/0000-0002-2314-5611"]},"institutions":[{"id":"https://openalex.org/I79619799","display_name":"University of Birmingham","ror":"https://ror.org/03angcq70","country_code":"GB","type":"education","lineage":["https://openalex.org/I79619799"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Francis G Muriithi","raw_affiliation_strings":["University of Birmingham"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Birmingham","institution_ids":["https://openalex.org/I79619799"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5010917534","display_name":"Pamela Makabong\u2019o","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Pamela Makabong\u2019o","raw_affiliation_strings":["Independent Qualitative Researcher"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Independent Qualitative Researcher","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5087134744","display_name":"Alfred Onyango Osoti","orcid":"https://orcid.org/0000-0002-2049-3100","observed_orcids":["https://orcid.org/0000-0002-2049-3100"]},"institutions":[{"id":"https://openalex.org/I12859529","display_name":"University of Nairobi","ror":"https://ror.org/02y9nww90","country_code":"KE","type":"education","lineage":["https://openalex.org/I12859529"]}],"countries":["KE"],"is_corresponding":false,"raw_author_name":"Alfred Osoti","raw_affiliation_strings":["University of Nairobi"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Nairobi","institution_ids":["https://openalex.org/I12859529"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5088116355","display_name":"Zahida P. Qureshi","orcid":"https://orcid.org/0000-0003-4223-3227","observed_orcids":["https://orcid.org/0000-0003-4223-3227","https://orcid.org/0000-0003-1764-3136"]},"institutions":[{"id":"https://openalex.org/I12859529","display_name":"University of Nairobi","ror":"https://ror.org/02y9nww90","country_code":"KE","type":"education","lineage":["https://openalex.org/I12859529"]}],"countries":["KE"],"is_corresponding":false,"raw_author_name":"Zahida P Qureshi","raw_affiliation_strings":["University of Nairobi"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Nairobi","institution_ids":["https://openalex.org/I12859529"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5011467466","display_name":"Adam Devall","orcid":"https://orcid.org/0000-0001-5632-079X","observed_orcids":["https://orcid.org/0000-0001-5632-079X"]},"institutions":[{"id":"https://openalex.org/I79619799","display_name":"University of Birmingham","ror":"https://ror.org/03angcq70","country_code":"GB","type":"education","lineage":["https://openalex.org/I79619799"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Adam Devall","raw_affiliation_strings":["University of Birmingham"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Birmingham","institution_ids":["https://openalex.org/I79619799"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5087495070","display_name":"Arri Coomarasamy","orcid":"https://orcid.org/0000-0002-3261-9807","observed_orcids":["https://orcid.org/0000-0002-3261-9807"]},"institutions":[{"id":"https://openalex.org/I79619799","display_name":"University of Birmingham","ror":"https://ror.org/03angcq70","country_code":"GB","type":"education","lineage":["https://openalex.org/I79619799"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Arri Coomarasamy","raw_affiliation_strings":["University of Birmingham"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Birmingham","institution_ids":["https://openalex.org/I79619799"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5020215892","display_name":"Alice Norah Ladur","orcid":"https://orcid.org/0000-0001-7151-3135","observed_orcids":["https://orcid.org/0000-0001-7151-3135"]},"institutions":[{"id":"https://openalex.org/I194839184","display_name":"Liverpool School of Tropical Medicine","ror":"https://ror.org/03svjbs84","country_code":"GB","type":"funder","lineage":["https://openalex.org/I194839184"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Alice Norah Ladur","raw_affiliation_strings":["Liverpool School of Tropical Medicine"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Liverpool School of Tropical Medicine","institution_ids":["https://openalex.org/I194839184"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":3,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11389","display_name":"Maternal and fetal healthcare","score":0.8500999808311462,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11389","display_name":"Maternal and fetal healthcare","score":0.8500999808311462,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10209","display_name":"Global Maternal and Child Health","score":0.08699999749660492,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10629","display_name":"Health Policy Implementation Science","score":0.017000000923871994,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/positive-deviance","display_name":"positive deviance","score":0.890999972820282},{"id":"https://openalex.org/keywords/maternal-mortality","display_name":"maternal mortality","score":0.75},{"id":"https://openalex.org/keywords/maternity-care-providers","display_name":"maternity care providers","score":0.9480000138282776},{"id":"https://openalex.org/keywords/coping-strategies","display_name":"coping strategies","score":0.843999981880188},{"id":"https://openalex.org/keywords/power-distance","display_name":"power distance","score":0.5049999952316284},{"id":"https://openalex.org/keywords/clinical-hierarchy","display_name":"clinical hierarchy","score":0.7229999899864197},{"id":"https://openalex.org/keywords/clinical-guideline-adherence","display_name":"clinical guideline adherence","score":0.9010000228881836},{"id":"https://openalex.org/keywords/preventable-maternal-deaths","display_name":"preventable maternal deaths","score":0.8820000290870667},{"id":"https://openalex.org/keywords/resource-limited-settings","display_name":"resource-limited settings","score":0.7319999933242798},{"id":"https://openalex.org/keywords/kenya","display_name":"Kenya","score":0.8240000009536743}],"concepts":[{"id":"https://openalex.org/C3018457447","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Healthcare delivery","level":3,"score":0.6635743975639343},{"id":"https://openalex.org/C79337645","wikidata":"https://www.wikidata.org/wiki/Q779824","display_name":"Outlier","level":2,"score":0.6010928750038147},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4576496183872223},{"id":"https://openalex.org/C2992232542","wikidata":"https://www.wikidata.org/wiki/Q20862341","display_name":"Maternity care","level":3,"score":0.45686691999435425},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4120790958404541},{"id":"https://openalex.org/C73282008","wikidata":"https://www.wikidata.org/wiki/Q1759895","display_name":"Coping (psychology)","level":2,"score":0.4111686050891876},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.3933577239513397},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.3354877531528473},{"id":"https://openalex.org/C105795698","wikidata":"https://www.wikidata.org/wiki/Q12483","display_name":"Statistics","level":1,"score":0.15895012021064758},{"id":"https://openalex.org/C70410870","wikidata":"https://www.wikidata.org/wiki/Q199906","display_name":"Clinical psychology","level":1,"score":0.1153673529624939},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.10837173461914062},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.07610434293746948},{"id":"https://openalex.org/C33923547","wikidata":"https://www.wikidata.org/wiki/Q395","display_name":"Mathematics","level":0,"score":0.061985671520233154}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.21203/rs.3.rs-6615286/v1","doi":"https://doi.org/10.21203/rs.3.rs-6615286/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-6615286/v1","pdf_url":"https://www.researchsquare.com/article/rs-6615286/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.21203/rs.3.rs-6615286/v1","doi":"https://doi.org/10.21203/rs.3.rs-6615286/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-6615286/v1","pdf_url":"https://www.researchsquare.com/article/rs-6615286/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":1.0},{"display_name":"Reduced inequalities","id":"https://metadata.un.org/sdg/10","score":0.4000000059604645}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[{"id":"https://openalex.org/G3079557126","display_name":"University of Birmingham - to evaluate the effectiveness and cost-effectiveness of early detection and \u2018first response\u2019 treatment of PPH through a bundle of care in a cluster...","funder_award_id":"INV-001393","funder_id":"https://openalex.org/F4320306137","funder_display_name":"Bill and Melinda Gates Foundation"}],"funders":[{"id":"https://openalex.org/F4320306137","display_name":"Bill and Melinda Gates Foundation","ror":"https://ror.org/0456r8d26"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4410440873.pdf","grobid_xml":"https://content.openalex.org/works/W4410440873.grobid-xml"},"referenced_works_count":44,"referenced_works":["https://openalex.org/W1976770755","https://openalex.org/W1979290264","https://openalex.org/W2019469924","https://openalex.org/W2085028749","https://openalex.org/W2125425586","https://openalex.org/W2147364604","https://openalex.org/W2152129467","https://openalex.org/W2168391307","https://openalex.org/W2176333851","https://openalex.org/W2219927710","https://openalex.org/W2708310967","https://openalex.org/W2768037361","https://openalex.org/W2953356786","https://openalex.org/W2980965860","https://openalex.org/W2996617870","https://openalex.org/W3003429708","https://openalex.org/W3009290186","https://openalex.org/W3030451951","https://openalex.org/W3035516268","https://openalex.org/W3087659073","https://openalex.org/W3109311981","https://openalex.org/W3175548623","https://openalex.org/W4286007853","https://openalex.org/W4303980583","https://openalex.org/W4311284130","https://openalex.org/W4324030585","https://openalex.org/W4375949635","https://openalex.org/W4387970140","https://openalex.org/W4389101364","https://openalex.org/W4389744459","https://openalex.org/W4390146977","https://openalex.org/W4390414842","https://openalex.org/W4391962059","https://openalex.org/W4396575397","https://openalex.org/W4398191376","https://openalex.org/W4401394898","https://openalex.org/W4403834745","https://openalex.org/W4408135097","https://openalex.org/W4408249334","https://openalex.org/W4408580555","https://openalex.org/W4408894432","https://openalex.org/W4409160998","https://openalex.org/W4409191670","https://openalex.org/W4409197077"],"related_works":["https://openalex.org/W2050639260","https://openalex.org/W4389101364","https://openalex.org/W3152664894","https://openalex.org/W4411641409","https://openalex.org/W6920909127","https://openalex.org/W4414355483","https://openalex.org/W4309460112","https://openalex.org/W6902157594","https://openalex.org/W2115319225","https://openalex.org/W4322765030"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Maternal":[2],"mortality":[3],"in":[4,7,70,108,112,305,331],"Kenya,":[5],"as":[6,75,245],"many":[8],"sub-Saharan":[9,71],"African":[10],"countries,":[11],"remains":[12],"unacceptably":[13],"high":[14],"despite":[15],"ongoing":[16],"efforts":[17],"to":[18,27,44,54,91,135,148,193,241,257,259,318,323],"reduce":[19,327],"it.":[20],"Exploration":[21],"of":[22,48,66,143,182,226,281,302],"alternative":[23],"and":[24,36,62,94,116,140,160,168,177,200,202,207,217,255,263,267,274,292,313,326,333,336],"complementary":[25],"approaches":[26],"improving":[28],"maternal":[29,56,68,329],"health":[30,57],"is":[31,39],"required.":[32],"One":[33],"such":[34,244],"underexplored":[35],"underutilised":[37],"approach":[38,53,147,287],"Positive":[40,51,145,285],"Deviance.":[41],"We":[42],"aimed":[43],"explore":[45,136],"the":[46,64,121,141,150,171,227,284],"feasibility":[47,142],"using":[49,73,130,158],"a":[50,76,144],"Deviance":[52,146,286],"improve":[55,324],"outcomes":[58,325],"following":[59],"post-partum":[60,100],"haemorrhage":[61,101],"accelerate":[63],"reduction":[65],"preventable":[67,328],"deaths":[69,330],"Africa,":[72],"Kenya":[74,306,332],"case":[77],"study.":[78],"Methods":[79],"A":[80],"two-stage,":[81],"exploratory,":[82],"explanatory":[83],"sequential":[84],"mixed-methods":[85],"design,":[86],"beginning":[87],"with":[88,170,195],"quantitative":[89],"analysis":[90,155,167,181],"identify":[92],"positive":[93,115,197,216,273],"negative":[95,118,204,218,275],"outlier":[96,219,233,276],"facilities":[97,187,234],"based":[98],"on":[99],"(PPH)":[102],"rates.":[103],"The":[104],"study":[105],"was":[106,156,288],"conducted":[107,157],"four":[109],"secondary-level":[110],"hospitals":[111],"Kenya:":[113],"two":[114,117,196,203],"outliers.":[119],"In":[120],"qualitative":[122],"phase,":[123],"43":[124],"maternity":[125,303],"care":[126,304],"providers":[127,301],"were":[128,212,230,269,294],"interviewed":[129],"semi-structured":[131],"key":[132],"informant":[133],"interviews":[134],"challenges,":[137,237],"coping":[138,265,311],"strategies,":[139],"tackling":[149],"challenges":[151,211,222,298],"they":[152],"face.":[153],"Thematic":[154],"Braun":[159],"Clarke\u2019s":[161],"method,":[162],"followed":[163],"by":[164,300],"deductive":[165],"framework":[166,173,229],"mapping":[169],"\u20184S\u2019":[172,228],"(Staff,":[174],"Stuff,":[175],"Space,":[176],"Systems).":[178],"Results":[179],"Quantitative":[180],"PPH":[183],"data":[184],"from":[185,191],"14":[186],"revealed":[188],"rates":[189],"ranging":[190],"8.9%":[192],"23.5%,":[194],"outliers":[198,205],"(8.9%":[199],"10.1%)":[201],"(24.3%":[206],"23.5%)":[208],"identified.":[209,231],"Most":[210,297],"shared":[213],"across":[214,223],"both":[215,272],"facilities.":[220,277],"Shared":[221,262],"all":[224],"aspects":[225],"Negative":[232],"faced":[235,299],"unique":[236,264,310],"particularly":[238],"those":[239],"related":[240],"human":[242],"factors":[243],"high-power":[246],"distance,":[247],"hierarchies":[248],"hindering":[249],"clinical":[250,260],"escalation,":[251],"conflicting":[252],"staff":[253],"opinions,":[254],"failure":[256],"adhere":[258],"guidelines.":[261],"behaviours":[266,312],"practices":[268,314],"identified":[270],"at":[271],"While":[278],"only":[279],"30%":[280],"participants":[282],"felt":[283],"feasible,":[289],"potential":[290],"facilitators":[291],"barriers":[293],"highlighted.":[295],"Conclusion":[296],"are":[307],"shared;":[308],"however,":[309],"can":[315],"be":[316],"harnessed":[317],"develop":[319],"tailored,":[320],"local":[321],"solutions":[322],"similar":[334],"low-resource":[335],"underserved":[337],"settings.":[338]},"counts_by_year":[],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2025-05-17T00:00:00"}