Effect of an Educational Intervention on Patients’ Rights Awareness among pregnant women attending Antenatal Care Clinics in Kirinyaga County, Kenya

Abstract

Patients' rights are a fundamental human right and is a global health concern in health services delivery. The majority of maternal health intervention programmes across sub-Saharan Africa have focused on improving coverage of skilled birth attendance and emergency obstetric and newborn care however there has been a lack of focus on interventions and programmes that seek to provide comprehensive and individualized care for women and their babies before and after childbirth. Pregnant women frequently experience abuse, which may significantly contribute to maternal morbidity and mortality. In 2020, 95% of maternal deaths in the world occurred in low and lower-middle-income countries, Kenya’s maternal mortality rate stands at 355 per 100,000 births which is significantly higher than the WHO's SDG target goal 3.1 of less than 70 per 100,000 by 2030. Awareness of the patients’ rights increases maternal health literacy. The study’s main objective was to determine the effect of an educational intervention on patients’ rights awareness among pregnant women attending antenatal clinics. Educational intervention involved the use of health talks and bookmarks where a mixed method with a quasi-experimental quantitative arm study design that utilized convergent parallel was employed with two health centers purposively sampled. The study targeted 168 respondents where convenience sampling was used to sample pregnant women attending ANC clinics and purposive sampling for health care providers. An interviewer administered semi structured questionnaire, a key informant interview and focus group discussion guide were used to collect qualitative and quantitative data at pre-intervention and post-intervention phases. Quantitative data were analyzed using SPSS version 26.0, with chi-square used to assess associations and variables that were included into the multivariable model to show the effect of the intervention. Qualitative findings were transcribed and analyzed thematically using NVIVO version 12. Ethical approvals were sought from SERU. Majority of the participants 66(68%) were between the ages of 18-30years, married 74(77%), and had attained secondary education 54(56%). The level of awareness of patient rights was 19(19.8%) Of those who had knowledge of patient rights, 60(68.4%) of them reported that healthcare providers were their source of information. The quantitative analysis demonstrated pregnant women in the intervention group reported higher proportions of good awareness 40(41.7%) compared to the control group 15(20.8%, χ² = 8.11, df = 2, p = 0.017). Similarly, tertiary education and three or more ANC visits were strongly associated with good awareness (χ² = 18.566, p = 0.017 and χ² = 19.035, p = 0.015, respectively). There was a significant improvement in awareness of patient rights from 19(19.8%) to 61(67.8%) at post-intervention. The multiple linear regression model demonstrates that the intervention significantly enhances perceived quality of care and patient rights awareness, with a 6.314-unit increase for the intervention group and an additional 6.806-unit increase over time (DiD effect). Significant variables include education level (β = 1.643, p = 0.001), ANC visits (β = 1.770, p = 0.002), and service quality (β = 0.845, p < 0.001. From the qualitative findings, pregnant women acknowledged the role of HCP in sensitizing ANC clients, the need to translate the PRC into local languages and frequent monitoring of implementation for efficiency. In conclusion, healthcare provider-led health education proved effective in improving the knowledge of patient rights and awareness. With these findings, the study underscores the importance of integrated continuous sensitizations using translated educational materials which are sustainable. The Ministry of Health should scale up interventions, implement regular training and develop educational materials to sustain these initiatives.