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      Partnership-defined quality approach to companionship during labour and birth in East New Britain, Papua New Guinea: A mixed-methods study

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          Abstract

          Companionship during labour and birth is a critical component of quality maternal and newborn care, resulting in improved care experiences and better birth outcomes. Little is known about the preferences and experiences of companionship in Papua New Guinea (PNG), and how it can be implemented in a culturally appropriate way. The aim of this study was to describe perspectives and experiences of women, their partners and health providers regarding labour and birth companionship, identify enablers and barriers and develop a framework for implementing this intervention in PNG health facilities. A mixed methods study was conducted with five facilities in East New Britain, PNG. Data included 5 facility audits, 30 labour observations and 29 in-depth interviews with women who had recently given birth, partners and maternity care providers. A conceptual framework was developed drawing on existing quality care implementation frameworks. Women and partners wanted companions to be present, whilst health providers had mixed views. Participants described benefits of companionship including encouragement and physical support for women, better communication and advocacy, improved labour outcomes and assistance with workforce issues. Adequate privacy and space constraints were highlighted as key barriers to address. Of the women observed, only 30% of women had a companion present during labour, and 10% had a companion at birth. A conceptual framework was used to highlight the interconnected inputs required at community, facility and provincial health system levels to improve the quality of care. Key elements to address included attitudes towards companionship, the need for education and training and restrictive hospital policies. Supporting women to have their companion of choice present during labour and birth is critical to improving women’s experiences of care and improving the quality of maternal and newborn care. In order to provide companionship during labour and birth in PNG, a complex, intersecting, multi-faceted approach is required.

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          Three approaches to qualitative content analysis.

          Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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            The qualitative content analysis process.

            This paper is a description of inductive and deductive content analysis. Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method. When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge. Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
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              Plasma Hsp90 levels in patients with systemic sclerosis and relation to lung and skin involvement: a cross-sectional and longitudinal study

              Our previous study demonstrated increased expression of Heat shock protein (Hsp) 90 in the skin of patients with systemic sclerosis (SSc). We aimed to evaluate plasma Hsp90 in SSc and characterize its association with SSc-related features. Ninety-two SSc patients and 92 age-/sex-matched healthy controls were recruited for the cross-sectional analysis. The longitudinal analysis comprised 30 patients with SSc associated interstitial lung disease (ILD) routinely treated with cyclophosphamide. Hsp90 was increased in SSc compared to healthy controls. Hsp90 correlated positively with C-reactive protein and negatively with pulmonary function tests: forced vital capacity and diffusing capacity for carbon monoxide (DLCO). In patients with diffuse cutaneous (dc) SSc, Hsp90 positively correlated with the modified Rodnan skin score. In SSc-ILD patients treated with cyclophosphamide, no differences in Hsp90 were found between baseline and after 1, 6, or 12 months of therapy. However, baseline Hsp90 predicts the 12-month change in DLCO. This study shows that Hsp90 plasma levels are increased in SSc patients compared to age-/sex-matched healthy controls. Elevated Hsp90 in SSc is associated with increased inflammatory activity, worse lung functions, and in dcSSc, with the extent of skin involvement. Baseline plasma Hsp90 predicts the 12-month change in DLCO in SSc-ILD patients treated with cyclophosphamide.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – original draft
                Role: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                28 February 2022
                2022
                : 2
                : 2
                : e0000102
                Affiliations
                [1 ] Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
                [2 ] Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
                [3 ] Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
                [4 ] St Mary’s Hospital, Kokopo, Papua New Guinea
                [5 ] Nonga General Hospital, Rabaul, Papua New Guinea
                [6 ] Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
                [7 ] Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
                [8 ] Kirby Institute, University of New South Wales, New South Wales, Australia
                [9 ] Global Financing Facility, World Bank, Washington, DC, United States of America
                [10 ] Department of Medicine, University of Melbourne, Melbourne, Australia
                [11 ] Jhpiego, The Johns Hopkins University affiliate, Baltimore, Maryland, United States of America
                [12 ] Department of Paediatrics, Royal Hobart Hospital, Tasmania, Australia
                Simon Fraser University, CANADA
                Author notes

                The authors declare no competing interests.

                Author information
                https://orcid.org/0000-0001-9229-789X
                https://orcid.org/0000-0002-3137-4502
                https://orcid.org/0000-0001-8272-7614
                https://orcid.org/0000-0001-7796-1270
                https://orcid.org/0000-0002-4179-4682
                https://orcid.org/0000-0002-3214-7096
                https://orcid.org/0000-0001-5380-1619
                https://orcid.org/0000-0002-1018-7898
                https://orcid.org/0000-0003-0931-5474
                https://orcid.org/0000-0002-1044-4604
                https://orcid.org/0000-0003-1417-1524
                https://orcid.org/0000-0002-8247-7683
                Article
                PGPH-D-21-00642
                10.1371/journal.pgph.0000102
                10021905
                36962285
                43e27bd6-fccc-4ae0-8ba9-3bc7c6b6d5a8
                © 2022 Wilson et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 September 2021
                : 23 January 2022
                Page count
                Figures: 2, Tables: 1, Pages: 17
                Funding
                Funded by: National Health and Medical Research Council, Australia
                Award Recipient :
                Funded by: June Canavan Foundation
                Funded by: Gras Foundation
                Funded by: Bank South Pacific PNG
                Funded by: Steamships PNG Community Grant
                Funded by: Alistair Lucas Prize for Medical Research
                Funded by: Naylor Steward Ancillary Fund
                Funded by: Chrysalis Foundation
                Funded by: National Health and Medical Research Council, Australia
                Award Recipient :
                Funded by: National Health and Medical Research Council, Australia
                Award Recipient :
                Funding was provided by the Burnet Institute through philanthropic support from numerous private and business donors in Australia and PNG. Major funding was provided by June Canavan Foundation Australia; Gras Foundation, Australia; Bank South Pacific PNG Community Grant; Steamships PNG Community Grant; Alistair Lucas Prize for Medical Research; National Health and Medical Research Council (NHMRC) of Australia (Fellowships to CSE and JGB, Postgraduate Research Scholarship to AW); Naylor Steward Ancillary Fund, and the Chrysalis Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Burnet Institute is supported by an Operational Infrastructure Grant from the State Government of Victoria, Australia, and the NHMRC Independent Research Institutes Infrastructure Support Scheme.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Biology and Life Sciences
                Developmental Biology
                Neonates
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Neonatal Care
                Medicine and Health Sciences
                Pediatrics
                Neonatology
                Neonatal Care
                Medicine and Health Sciences
                Health Care
                Neonatal Care
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
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                People and places
                Geographical locations
                Europe
                European Union
                United Kingdom
                Medicine and Health Sciences
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                Health Education and Awareness
                Custom metadata
                The datasets generated and/or analysed during the current study are not publicly available due to potential confidentiality concerns. Additional information can be made available from the Scientific Integrity Officer at Burnet Institute, ( admin@ 123456burnet.edu.au ), on reasonable request. These restrictions are per the Papua New Guinea, Institute of Medical Research, Institutional Review Board.

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