Research Article: Development spots in communication during the management of the intrapartum period: An interpretive multiple case study in a developing context

Date Published: July 31, 2017

Publisher: AOSIS

Author(s): Doreen K.M. M’Rithaa, Susan R. Fawcus, Margaretha de la Harpe, Mikko Korpela.


Health care activities are influenced by information communication between women during pregnancy, birth and motherhood and skilled birth attendants (SBAs) and further, between the health care workers during the continuum of care. Therefore, effective information communication processes (ICP) within and between health care facilities are a requirement for appropriate management of patients or clients. The management of the intrapartum period requires swift responses while managing critical information required for further referral and management processes. The involvement of multiple actors at different times with the same client carries the risk of communication breakdown at different points and at different levels of care. The information communicated during the intrapartum period is critical and should be accurate, timely and more importantly appropriate to enable better maternal and neonatal outcomes.

The purpose of this article is to discuss the complexities around ICP identified within a developing context that influence the management of the intrapartum period.

Multi-method, multiple case study approach was used to analyse two case studies. Only the challenges from one case study (A) are discussed in this article. In-depth interviews were conducted with the SBAs. The role of observer-as-participant was utilised during the observation; field notes and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data.

The findings identified challenges with information and communication that influenced the management of the intrapartum period.

This study exhibited the challenges identified as development points that can influence the management of the intrapartum period. These challenges were also identified as desirable changes from the present state depending on the perspective of the actor.

Partial Text

Identification of risks and abnormalities during the management of labour and birth requires effective information communication processes (ICP) by the skilled birth attendants (SBAs) within and between heath care organisations. The World Health Organization defines an SBA as:

The research adopted a multi-method qualitative multiple case study approach with embedded units of analysis in order to understand the complexities involved in the ICP within a developing country context. In this article, we discuss the challenges that emerged from one case study (A).

The main themes were deduced from the activity-driven information systems development (ADISD) model.12,13 Understanding activities in the present state allowed the researcher to envision the complexities of ICP while anticipating development spots towards a desired state.12,13 The themes were deduced from the objectives while the categories emerged from the data coding and categorising process. The theme ‘challenges to ICP’ had subthemes, which included challenges with information and challenges with communication. Those are discussed in this article.

As illustrated in Figure 2, inadequate data collection influenced communication of the collected information either during handovers or consultation processes. Inappropriate information communication systems such as the flow of phone calls, unavailability of the referral doctors and unreliable tools for communication such as telephones resulted in ineffective communication.

This study follows the discussion of the article published14,15 by the author on the actual and expected ICP during the management of the intrapartum period. The identification of challenges allowed the highlighting of development spots to improve information communication. While exploring this, the researchers were able to gain insight into the complexities associated with the communication of information during the intrapartum stage, and a myriad of challenges was identified within two realms: challenges with information and challenges with communication.

The challenges faced with the ICP were illuminated as desires for change. These challenges were related to either collection of information, documentation of the information, retrieval of the information and communication of the information. This resulted in a chain of frustration (Figure 1) among the SBAs and a sense of mistrust among them. The expression of challenges was reflected from either an optimistic or pessimistic view of reality (the half empty or half full position). Most of these challenges were thus illuminated as development spots.




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