Midwives’ Adherence to Protocols in the Management of Pre-Eclampsia/ Eclampsia in the Accra Metropolis

Abstract

Ensuring quality for patient care, evidence for practice, and uniformity of care were the reasons for developing protocols and guidelines. Even though protocols designed for managing pre-eclampsia and eclampsia are appropriately initiated, adherence to these protocols has been reported to be poor. Midwives are crucial in the implementation of protocols designed to improve maternal health outcomes. However, little is known concerning the utilization of protocols by midwives. In Ghana, there is limited empirical information about midwives’ behaviour towards the use of protocols when dealing with cases of pre-eclampsia and eclampsia. This study sought to investigate the determinants of protocols adherence by midwives in the Accra Metropolis. In this cross-sectional, descriptive study, a census of 235 midwives working in government hospitals within the Accra metropolis, were surveyed. Data was collected using the Planned Behaviour questionnaire consisting of two sections, the demographics (section A) and according to the constructs of the Decomposed Theory of Planned Behaviour (section B). Data was analysed using SPSS version 23.0. Both descriptive and inferential techniques were used. A confidence level of 95% and a p-value < 0.05 were used. A total response rate of 100% was achieved. Majority of the respondents were female (n= 233, 99.1%). The mean age of respondents was 33.4 ± 6.98 and a majority held a diploma in midwifery (59.6%, n=140). Most of the respondents (88.0%, n=206) had under 10 years’ work experience in the unit. The two top ranks were senior staff midwife (33.6%, n=79) and staff midwife (33.2%, n=78). The results showed high mean scores for the various constructs, attitude (5.92 ± 0.89), subjective norms (5.17 ± 1.47), perceived behavioural control (5.13 ± 1.02), behavioural intention (5.72 ± 1.25), behaviour (4.79 ± 1.52). There was a positive significant relationship between attitude, subjective norms, perceived behavioural control, behavioural intention, and behaviour. Subjective norms and behavioural intention were the two most significant predictors, with subjective norms being the highest contributor. Age, attitude, subjective norms, perceived behavioural control, and behavioural intention explained 23.4% of the variance in behaviour. Behavioural intention partially mediated the association between subjective norms and adherence to protocols when managing pre-eclampsia and eclampsia. Midwifery practice needs to change towards quality improvement to improve maternal care by adhering to protocols. Hence, it is essential to prepare midwives by supporting, transferring the needed knowledge, and skills required for protocol adherence.