BACKGROUND Recently, a growing body of literature has established that disrespect and abuse during delivery is prevalent around the world. This complex issue has not been well studied through the lens of behavioral science, which could shed light on the psychological dimensions of health worker behavior and how their micro-level context may be triggering abuse. Our research focuses on the behavioral drivers of disrespect and abuse in Zambia to develop solutions with health workers and women that improve the experience of care during delivery. METHODS A qualitative study based on the behavioral design methodology was conducted in Chipata District, Eastern Province. Study participants included postpartum women, providers (staff who attend deliveries), supervisors and mentors, health volunteers, and birth companions. Observations were conducted of client-provider interactions on labor wards at two urban health centers and a district hospital. In-depth interviews were audio recorded and English interpretation from these recordings was transcribed verbatim. Data was analyzed using thematic analysis and findings were synthesized following the behavioral design methodology. RESULTS Five key behavioral barriers were identified: 1) providers do not consider the decision to provide respectful care because they believe they are doing what they are expected to do, 2) providers do not consider the decision to provide respectful care explicitly since abuse and violence are normalized and therefore the default, 3) providers may decide that the costs of providing respectful care outweigh the gains, 4) providers believe they do not need to provide respectful care, and 5) providers may change their mind about the quality of care they will provide when they believe that disrespectful care will assist their clinical objectives. We identified features of providers' context - the environment in which they live and work, and their past experiences - which contribute to each barrier, including supervisory systems, visual cues, social constructs, clinical processes, and other features. CONCLUSIONS Client experience of disrespectful care during labor and delivery in Chipata, Zambia is prevalent. Providers experience several behavioral barriers to providing respectful maternity care. Each of these barriers is triggered by one or more addressable features in a provider's environment. By applying the behavioral design methodology to the challenge of respectful maternity care, we have identified specific and concrete contextual cues that targeted solutions could address in order to facilitate respectful maternity care.

中文翻译：

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赞比亚提供尊重的产妇护理的障碍：通过行为科学视角进行的定性研究的结果。

背景技术近来，越来越多的文献表明，分娩过程中的不尊重和虐待行为在世界各地普遍存在。这个复杂的问题尚未通过行为科学的视角得到充分研究，这可以揭示卫生工作者行为的心理维度以及他们的微观背景如何引发虐待。我们的研究重点是赞比亚不尊重和虐待的行为驱动因素，以便与卫生工作者和妇女一起制定解决方案，改善分娩期间的护理体验。方法 在东部省奇帕塔区进行了基于行为设计方法的定性研究。研究参与者包括产后妇女、提供者（参与分娩的工作人员）、主管和导师、健康志愿者和分娩陪伴者。对两个城市卫生中心和一家地区医院产房的客户与提供者互动进行了观察。深入访谈被录音，这些录音的英文翻译被逐字转录。使用主题分析对数据进行分析，并根据行为设计方法综合结果。结果 确定了五个关键的行为障碍：1) 提供者不考虑提供尊重性护理的决定，因为他们相信自己正在做他们期望做的事情，2) 由于虐待和暴力，提供者没有明确考虑提供尊重性护理的决定是正常化的，因此是默认的，3) 提供者可能会认为提供尊重护理的成本超过收益，4) 提供者认为他们不需要提供尊重护理，以及 5) 提供者可能会改变他们对他们所提供的护理质量的看法。当他们相信不尊重的护理将有助于他们的临床目标时，他们会提供。我们确定了提供者背景的特征（他们生活和工作的环境以及他们过去的经历），这些特征导致了每个障碍，包括监督系统、视觉提示、社会结构、临床过程和其他特征。结论 在赞比亚奇帕塔，客户在临产和分娩过程中受到不尊重护理的经历很普遍。提供者在提供尊重的产妇护理方面遇到一些行为障碍。这些障碍中的每一个都是由提供商环境中的一个或多个可寻址功能触发的。通过将行为设计方法应用于尊重产妇护理的挑战，我们确定了有针对性的解决方案可以解决的具体具体背景线索，以促进尊重产妇护理。