Data analysis
Qualitative data was analyzed using thematic analysis using the major themes of interest: knowledge/awareness, behavior/practice, barriers, and improvements. These themes were selected in advance in order to fulfill the aim of this study. Data of the FGDs were analyzed using whole groups (i.e., nurse-midwives and doctors). After familiarization with FGDs and interviews, open coding was conducted by KW using the software MAXQDA version 12. Codes were analyzed for patterns and systematically combined into subthemes. Quotes are indicated whether they were from antenatal women, postpartum women or healthcare providers. Descriptive analysis was performed on quantitative data using Microsoft Office Excel 365 ProPlus with the aim of substantiating the qualitative data.
Results
Baseline characteristics
Eighteen women in the ANC clinics, 28 post-delivery women and three ANC nurses were interviewed. In addition, 25 skilled birth attendants (six registrar doctors and 19 nurse-midwives) participated in four FGDs; one group with six registrars and three groups with nurse-midwives (consisting of five, eight and six participants). This selection was considered a good reflection of the entire staff. The health providers also completed the questionnaire (n=28). Characteristics of women and health providers are summarized in table 1. The median age for ANC and postpartum women was 28.3 [Interquartile range (IRQ): 19-41] and 26.2 [IQR: 19-37] years respectively. The majority of participating women at least finished primary education and were unemployed (housewives). Gravidity and parity were equal in both groups of women. Due to purposeful sampling, half of the postpartum women experienced adverse perinatal outcomes. The majority of staff members had one to five years of experience in labor care (table 1). As expected, the nurse-midwives performed admission assessment of women in labor.
An overview of themes and subthemes is presented in figure 1.