Self-Reported Provision of Person-Centered Maternity Care Among Providers in Kenya and Ghana: Scale Validation and Examination of Associated Factors

Background: Person-centered maternity care (PCMC), which refers to care that is respectful and responsive to women’s preferences needs, and values, is core to high-quality maternal and child health. Provider report of PCMC is a potentially valid means of assessing the extent of PCMC and contributing factors. Methods: We used data from two cross-sectional surveys with 236 maternity providers from Ghana (N=150) and Kenya (N=86) to assess the psychometric properties of a provider-reported PCMC scale, and to examine factors associated with provision of PCMC. Analysis included factor analysis to assess construct validity and Cronbach’s alpha to assess internal consistency of the scale; descriptive analysis to assess extent of PCMC; and bivariate and multivariable linear regression to examine factors associated with PCMC. Findings: The 9-item provider-reported PCMC scale has high construct validity and reliability representing a unidimensional scale with a Cronbach’s alpha of 0·72. The average standardized PCMC score for the combined sample was 66·8 (SD=14·7). PCMC decreased with increasing report of stress and burnout. Compared to providers with no burnout, providers with burnout had lower average PCMC scores (β= -7·30, 95%CI:-11·19, -3·40 for low burnout and β=-10·86, 95%CI:-17·21, -4·51 for high burnout). Burnout accounted for over half of the effect of perceived stress on PCMC. Interpretation: The provider PCMC scale is a valid and reliable measure of provider self-reported PCMC and highlights inadequate provision of PCMC in Kenya and Ghana. Provider burnout is a key driver of poor PCMC that needs to be addressed to improve PCMC. Funding: NICHD and UCSF Bixby Center Declaration of Interest: We declare no competing interests. Ethical Approval: This study was approved by the UCSF Committee for Human Subjects, the Kenya Medical Research Institute Scientific and Ethics Review Unit, and the Navrongo Health Research Center Ethics Review Unit.