A Model to Enhance the Continuity of Postnatal Care by Primary Caregivers in Selected Districts of Limpopo Province

Abstract

Postnatal women are discharged within six hours after delivery and it is documented that about three quarters of neonatal and maternal deaths occur during the first week of life, of which about half of the deaths occur in the home environment during the immediate postnatal care period. The continuity of postnatal care by primary caregivers need to be explored. This study sought to develop a model to enhance the continuity of postnatal care by primary caregivers in the selected districts of Limpopo Province of South Africa. The convergent parallel mixed method was used where explorative, descriptive and contextual qualitative approaches were run concurrently with the descriptive quantitative approach. For the qualitative approach, non-probability purposive sampling was used to select 18 primary caregivers from the selected districts of Limpopo Province. Qualitative data were collected through in-depth one-to-one interviews and analysed through Tesch’s open-coding method. Trustworthiness was ensured through credibility, confirmability, dependability and transferability. For the quantitative approach, non-probability sampling was used to sample 100 midwives at designated health facilities of the selected districts. Data were collected through the Likert scale questionnaire and analysed through the Statistical Package for the Social Sciences (SPSS) version 25.0. Reliability and validity of the instrument was ensured through systematic literature review and a pilot study. Both quantitative and qualitative data analysis yielded three main themes as follows: facilitators to continuity of postnatal care by primary caregivers; barriers to continuity of postnatal care and perceptions of primary caregivers regarding the interactions with midwives on the continuity of postnatal care. In the discussion of findings, qualitative findings were supported by quantitative findings. Based on the findings of phases 1 and 2, Walker & Avant’s method was followed to conduct concept analysis of the core concept. Concept analyses formed bases for the development of a model for continuity of postnatal care by primary caregivers. The model was validated with 19 participants consisting of managers and midwives from the Vhembe District health care facilities. The group validated the actionable plans using a closed-ended checklist to verify whether the action plans were congruent with practice. The results were analysed through simple descriptive statistics where the data were summarised using frequency distributions. The results indicated that the actionable plans could be applicable to practice and may need slight modification to suite the institutional needs prior operationalization. Recommendations were made on Maternal and Child Health Directorate, midwives and primary caregivers. Topics for further research were also suggested.