Improving person-centred maternity care in Sri Lanka through co-creation: Utilising women's perceptions and...

There is a lack of studies documenting the utilisation of different views of person-centred maternity care (PCMC), such as maternal perceptions, views of health professionals, and women's advocates, to co-create interventions to improve the quality of care (QoC) in Sri Lanka.

The study was conducted at a referral maternity care centre in Colombo. It involved 87 stakeholders in four phases. We conducted the study in phases to optimize logistics and feasibility. Therefore, it was conducted in a phase wise manner.

Perceptions of PCMC among 39 mothers who delivered vaginally were explored through focus group discussions (FGDs).

Delphi rounds with 25 healthcare providers were conducted to identify and prioritise interventions. Phase III: Intervention priorities were revised based on feedback from a group of 23 women's advocacy group (WAG), using the Nominal Group Technique. Phase IV: the Nominal Group Technique was utilised to obtain the views and consensus of the women included in Phase I.

Phase I revealed five key topics:1) care and attention; 2) companions in labour; 3) respect, dignity, privacy, and communication; 4) awareness of autonomy; and 5) general safety and cleanliness. In Phase II, ten possible interventions to improve PCMC were identified, with improving staff communication skills and empowering women on their rights being the highest priorities. In Phase III, the WAG revised the priority list, with the top priorities being improving infrastructure and the organisation of care and appointing more staff. In Phase IV, the majority (94 %) of the women agreed that the proposed prioritised interventions would improve maternal healthcare services.

This study revealed gaps in PCMC but demonstrated that in a setting like Sri Lanka, views of service users, healthcare providers, and advocacy groups can be successfully used to co-create context-specific interventions for improving QoC. We recommend further implementation research to obtain data on the feasibility, sustainability, and challenges of the identified interventions.

There is limited evidence documenting the utilisation of different views in improving person-centred maternity care in LMIC.

A participatory approach involving care seekers, WAG representing the public, and healthcare providers was useful in co-creating a list of prioritised interventions to improve the quality of maternity care services in a low-resource setting.

The findings highlight the importance of further exploration and engagement with local stakeholders, including healthcare users, providers, and advocacy groups, to co-create context-specific interventions to improve PCMC. This study's methods can serve as a model for identifying and prioritising such interventions in similar settings.