Pre-post implementation survey of a multicomponent intervention to improve informed consent for caesarean section in Southern Malawi

Abstract

Objective: Surgical informed consent is essential prior to caesarean section, but potentially compromised by insufficient communication. We assessed the association between a multicomponent intervention and women's recollection of information pertaining to informed consent for caesarean section in a low-resource setting, thereby contributing to respectful maternity care.

Design: Pre-post implementation survey, conducted from January to June 2018, surveying women prior to discharge.

Setting: Rural 150-bed mission hospital in Southern Malawi.

Participants: A total of 160 postoperative women were included: 80 preimplementation and 80 postimplementation.

Intervention: Based on observed deficiencies and input from local stakeholders, a multicomponent intervention was developed, consisting of a standardised checklist, wall poster with a six-step guide and on-the-job communication training for health workers.

Primary and secondary outcome measures: Individual components of informed consent were: indication, explanation of procedure, common complications, implications for future pregnancies and verbal enquiry of consent, which were compared preintervention and postintervention using χ² test. Generalised linear models were used to analyse incompleteness scores and recollection of the informed consent process.

Results: The proportion of women who recollected being informed about procedure-related risks increased from 25/80 to 47/80 (OR 3.13 (95% CI 1.64 to 6.00)). Recollection of an explanation of the procedure changed from 44/80 to 55/80 (OR 1.80 (0.94 to 3.44)), implications for future pregnancy from 25/80 to 47/80 (1.69 (0.89 to 3.20)) and of consent enquiry from 67/80 to 73/80 (OR 2.02 (0.73 to 5.37)). After controlling for other variables, incompleteness scores postintervention were 26% lower (Exp(β)=0.74; 95% CI 0.57 to 0.96). Recollection of common complications increased with 0.25 complications (β=0.25; 95% CI 0.01 to 0.49). Recollection of the correct indication did not differ significantly.

Conclusion: Recollection of informed consent for caesarean section changed significantly in the postintervention group. Obtaining informed consent for caesarean section is one of the essential components of respectful maternity care.

Keywords: caesarean section; informed consent; maternal medicine; medical ethics; quality in health care; tropical medicine.

Figure 1

Flow chart of study design. CS, caesarean section.