Data from: Categorizing and assessing comprehensive drivers of provider behavior for optimizing quality of health care

Inadequate quality of care in healthcare facilities is one of the primary
causes of patient mortality in low- and middle-income countries, and
understanding the behavior of healthcare providers is key to addressing
it. Much of the existing research concentrates on improving
resource-focused issues, such as staffing or training, but these
interventions do not fully close the gaps in quality of care. By contrast,
there is a lack of knowledge regarding the full contextual and internal
drivers–such as social norms, beliefs, and emotions–that influence the
clinical behaviors of healthcare providers. We aimed to provide two
conceptual frameworks to identify such drivers, and investigate them in a
facility setting where inadequate quality of care is pronounced. Using
immersion interviews and a novel decision-making game incorporating
concepts from behavioral science, we systematically and qualitatively
identified an extensive set of contextual and internal behavioral drivers
in staff nurses working in reproductive, maternal, newborn, and child
health (RMNCH) in government public health facilities in Uttar Pradesh,
India. We found that the nurses operate in an environment of stress,
blame, and lack of control, which appears to influence their perception of
their role as often significantly different from the RMNCH program’s
perspective. That context influences their perceptions of risk for
themselves and for their patients, as well as self-efficacy beliefs, which
could lead to avoidance of responsibility, or incorrect care. A limitation
of the study is its use of only qualitative methods, which provide depth,
rather than prevalence estimates of findings. This exploratory study
identified previously under-researched contextual and internal drivers
influencing the care-related behavior of staff nurses in public facilities
in Uttar Pradesh. We recommend four types of interventions to close the
gap between actual and target behaviors: structural improvements, systemic
changes, community-level shifts, and interventions within healthcare
facilities.