Reframing the Three Delays framework
Factors influencing referrals to facilities by matrones in rural Haiti
Bibliographic Data
| ID | 21880058 |
|---|---|
| Authors | Milenka Jean-Baptiste (0000-0001-6773-7689, University of North Carolina at Chapel Hill), Christophe Millien (0000-0001-8590-812X, University of Sierra Leone), Pierre Ricard Pognon (University of Sierra Leone), Meredith Casella Jean-Baptiste (0000-0002-5082-2841, University of North Carolina at Chapel Hill, corresponding author) |
| Year | 2023 |
| Volume | 8 |
| Issue | 11 |
| Pages | e011957 |
| Publication date | 2023-11-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | BMJ Global Health (JOURNAL) |
| Journal identifiers | ISSN: 2059-7908 • E-ISSN: 2059-7908 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/bmjgh-2023-011957 |
| PMID | 37967901 |
| OpenAlex | W4388706379 |
| Language | EN |
| Citations received | 3 |
| References cited | 34 |
In Haiti, there has been limited research on the experiences of traditional birth attendants/matrones when they decide to refer and accompany pregnant women to the facility for giving birth. Understanding this contextualised experience could help to strengthen programming aimed at improving maternal, neonatal, and child health (MNCH) outcomes in rural Haiti. This paper describes the qualitative findings from seven focus group discussions (FGDs) with matrones regarding their experience of referring pregnant women to facilities in Haiti’s Central Plateau. Each FGD was conducted in Haitian Kreyol and audio recorded. Recordings were transcribed, translated to English, and thematically analysed. A conceptual model visualising factors influencing matrone decision-making was then developed using an adapted version of the Three Delays framework. Findings from this study show that matrones face a complex, multilayered web of intertwining factors related to attitudes and beliefs around their role, resource availability, and perceptions around quality of care and treatment. Each factor corresponds to a delay in the Three Delays framework. The factors can occur at the same time or each can occur individually at different times, and influence the decision to refer. The complexity of factors identified reflects the need to reassess the Three Delays framework so that it accounts for the intertwining, cyclical complexities faced by those trying to access the facility amidst the backdrop of both time and the community/social contexts. Results further reflect the need for strengthened health systems that better facilitate matrone facility-based referrals, improving outcomes for all parties involved and bridging the gap between homes/ communities and facilities. This calls for better integration of the matrones into the formal health system to systematically strengthen the continuum of MNCH health services provided from home to facility
Business · Cognitive reframing · Conceptual framework · Environmental health · Focus group · Health facility · Health services · Political science · Population · Public relations · Qualitative research · Sociology · Breastfeeding Practices and Influences · Child Nutrition and Water Access · Computer Science · Global Maternal and Child Health · Medicine · Nursing · Psychology · Social Psychology · Marketing
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| Unique citing works | 3 |
|---|---|
| Citations per year | 3 |
| Citation span | 2025 - 2026 (2) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 3 |