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Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe

Robbins, T, Hanlon, C, Kelly, AH, Gidiri, MF, Musiyiwa, M, Silverio, SA, Shennan, AH and Sandall, J (2021) Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe. BMC Pregnancy and Childbirth, 21 (1). ISSN 1471-2393

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Open Access URL: https://doi.org/10.1186/s12884-021-04186-6 (Published version)


Background: Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. Methods: We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. Results: Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. Conclusions: Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.

Item Type: Article
Uncontrolled Keywords: Humans; Pre-Eclampsia; Health Knowledge, Attitudes, Practice; Residence Characteristics; Pregnancy; Qualitative Research; Cross-Cultural Comparison; Ethiopia; Zimbabwe; Haiti; Female; Conditioning, Psychological; Health Belief Model; Decision-making in pregnancy; Delays in care-seeking; Ethiopia; Haiti; Hypertensive disorders in pregnancy; Pluralism; Pre-eclampsia; Zimbabwe; Conditioning, Psychological; Cross-Cultural Comparison; Ethiopia; Female; Haiti; Health Belief Model; Health Knowledge, Attitudes, Practice; Humans; Pre-Eclampsia; Pregnancy; Qualitative Research; Residence Characteristics; Zimbabwe; 1110 Nursing; 1114 Paediatrics and Reproductive Medicine; 1117 Public Health and Health Services; Obstetrics & Reproductive Medicine
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RG Gynecology and obstetrics
Divisions: Psychology (from Sep 2019)
Publisher: BMC
SWORD Depositor: A Symplectic
Date Deposited: 06 Dec 2022 11:37
Last Modified: 06 Dec 2022 11:37
DOI or ID number: 10.1186/s12884-021-04186-6
URI: https://researchonline.ljmu.ac.uk/id/eprint/18302
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