Explore the vast range of titles available.

Pregnant adolescents often face social, emotional and physical challenges, compounded by inadequate support. Drawing on a Straussian grounded theory approach, we explored the social processes and perspectives that influence adolescent pregnancy experiences in Zambia. Semi-structured interviews were conducted with adolescents ( n  = 26), partners ( n  = 8), parents/legal guardians of adolescents ( n  = 8), healthcare workers ( n  = 6), and key stakeholders ( n  = 5). Data were subjected to open, axial and selective coding, and a core category ‘Support me like a child, respect me like an adult’ , generated. Bronfenbrenner’s socio-ecological framework was also used as a theoretical lens to aid understanding of the social interactions between three interlinked categories feeling vulnerable and alone , age discrimination , and lack of agency and autonomy . Narratives highlighted social disapproval, influenced by cultural values, beliefs and social norms. Trying to navigate systems and spaces in which adolescents (and others) believed they did not belong, was illuminated. The need for an inclusive and supportive environment in which adolescents can feel cared for whilst also being respected for their own positionality and decisions, is critical.

BackgroundQuality of maternal and newborn care is integral to positive clinical, social and psychological outcomes. Respectful care is an important component of this but is suboptimum in many low-income settings. A renewed energy among health professionals and academics is driving an international agenda to eradicate disrespectful health facility care around the globe. However, few studies have explored respectful care from different vantage points.MethodsWe used Strauss and Corbin’s grounded theory methodology to explore intrapartum experiences in Tanzania and Zambia. In-depth interviews were conducted with 98 participants (48 women, 18 partners, 21 health-providers and 11 key stakeholders), resulting in data saturation. Analysis involved constant comparison, comprising three stages of coding: open, axial and selective. The process involved application of memos, reflexivity and positionality.ResultsFindings demonstrated that direct and indirect social discrimination led to inequity of care. Health-providers were believed to display manipulative behaviours to orchestrate situations for their own or the woman’s benefit, and were often caring against the odds, in challenging environments. Emergent categories were related to the core category: respectful care, an added extra, which reflects the notion that women did not always expect or receive respectful care, and tolerated poor experiences to obtain services believed to benefit them or their babies. Respectful care was not seen as a component of good quality care, but a luxury that only some receive.ConclusionBoth quality of care and respectful care were valued but were not viewed as mutually inclusive. Good quality treatment (transactional care) was often juxtaposed with disrespectful care; with relational care having a lower status among women and healthcare providers. To readdress the balance, respectful care should be a predominant theme in training programmes, policies and audits. Women’s and health-provider voices are pivotal to the development of such interventions.

This study assessed a) the impact of playing the Dignity board game on participants’ understanding of respectful maternal and newborn care and b) participants’ perceptions of how the game influenced their subsequent practice in Malawi and Zambia. Nurse-midwives’ poor understanding of respectful maternal and newborn care can lead to substandard practice; thus, effective education is pivotal. Used in several disciplines, game-based learning can facilitate skills acquisition and retention of knowledge. a quasi-experimental study, using mixed-methods of data collection. Data were collected between January and November 2020. Nurse-midwives (N = 122) and students (N = 115) were recruited from public hospitals and nursing schools. Completion of paper-based questionnaires, before and after game-playing, assessed knowledge of respectful care principles and perceptions around behaviours and practice. Face-to-face interviews (n = 18) explored perceived impact of engaging with the game in clinical practice. Paired and unpaired t-test were used to compare scores. Qualitative data were analysed and reported thematically. The study was completed by 215 (90.7 %) participants. Post-test scores improved significantly for both groups combined; from 25.91 (SD 3.73) pre-test to 28.07 (SD 3.46) post-test (paired t = 8.67, 95 % confidence interval 1.67–2.65), indicating an increased knowledge of respectful care principles. Nurse-midwives performed better than students, both before and after. In Malawi, the COVID pandemic prevented a third of nurse-midwives’ from completing post-game questionnaires. Qualitative findings indicate the game functioned as a refresher course and helped nurse-midwives to translate principles of respectful care into practice. It was also useful for self-reflection. The Dignity board game has the potential to enhance understanding and practice of respectful maternal and newborn care principles in low-resource settings. Integration into nursing and midwifery curricula and in-service training for students and healthcare workers should be considered.