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Table 4 Provider Attitudes towards patients (approachability)

From: Patient and provider perspectives on how trust influences maternal vaccine acceptance among pregnant women in Kenya

Subtheme Quote
HCP Perspective
Impact of attitudes towards patients “The other reason [barrier] could be maybe the way you talk to them when they come for their clinic here. For instance, if you talk to them rudely, they may not come back her.”
“I think that is attributed the service we provide. We talk to them politely. Even if the client is unhappy with you, you must find a way of working towards that. In my facility, we sometimes provide tea, snacks and water for clients.”
“The nurse kept accosting the patient about the time of coming for ANC clinic and her age. A lot of words were told to this the teenage mum that made me doubt if she would dare come back for the services though eventually got the services and ANC book provided.”
“For one is the attitude of the caregiver, the availability of the vaccines and the availability of time and staff. If we are many we will shorten the waiting time. And my attitude also if I have a poor attitude, I will discourage them but if it is good, they will encourage others to come”
Evolution of patient-provider relationship “Uptake depends on the attitude of the healthcare provider. Most mothers have issues at home and how you handle them matters a lot. When a mother walks into your clinic, they are walking to someone they believe in their heart will help them. The information you give this mother may change or break her. I believe it is all about the attitude and approach towards these clients and the education you give them.”
“These cultural practices are still there but there was a lot of force from the administration chiefs ensuring they are given by force, which should not be the case. The community should be taught then consent after understanding and receive the vaccines.”
“Some of them [providers] would be hindrances because they would not engage mothers when they are making decisions concerning vaccines dates. Some will put vaccine date to their convenience without considering the mother’s side. Those are open hindrances. There are some people who say on giving vaccines on specific working days without taking care of mothers who work from Mondays to Fridays.”
Patient’s desire for information “They will say it is new, we want to know its constituents.”
“They normally ask the importance of those vaccines, how the vaccines help them, if there is any adverse effects and what would be done in such a situation.”
“They ask on why we give the vaccines and what they prevent against. Therefore, whenever we give vaccine, we first seek their consent, give the reason for administering and talk about their importance.”
Effect of Time -constraints on education “For now, I can say they do not get enough time since I am alone, overwhelmed and take shortest time possible with them. They do not get enough time.”
“So I am the type of person who has to give the mother the information she needs. So I cannot know whether my colleague in the other room is giving that information. Sometimes I cannot blame them because you find that three benches are already full and all the women are waiting for that one person to attend them. You will find that things there are not going as intended. The education is usually not there as such. But if we had enough time... so even if there is no ample time you have to give information of the very important things which the mother has to take home from that room.”
“I think that is the only challenge because for vaccines we have everything we need like syringes and the like. If we can get additional staff, then it would help us a lot because I may take shortest time with clients since people waiting at the queue are very many thus making me rush and where I would have explained more about pregnancy may not be possible.”
“I think the most important is the human resources because if you are only one person, you become overwhelmed. Most of our clinics are usually overwhelmed especially on Thursdays and Mondays. This happens especially in the child welfare clinic where you have to take care of immunization for children and at the same time pregnant mothers. It is hectic. That is where quality is compromised because you hurry to clear the queue.”
“So you find that the nurse has a lot of work because she has to be here, she has to be in the OPD (Outpatient department) and also coordinate all the activities in the hospital. And this being a sub-county facility, she has to attend to all the visitors who come because we have the sub county officers. So the nurse will not find enough time to attend to the clients so it makes the clients to wait for long. We have to finish the other side and come to help this sides. So if you are in a position to add us one or two or more it will be good because this is a health center and it cannot be managed by two people.”
Pregnant women perspective
Importance of provider attitudes on trust as expressed by facility choice “I focus on the reputation of the hospital and the way the doctors treat people.”
“I look at how patients are being treated. You will come to a certain hospital after you have heard people praising it.”
“P : The staff here are very kind and attend to us well. Their services are also good.
I : What about [name] Hospital?
P : Sometimes the nurses are very harsh which makes us feel uncomfortable”
“You know there are places that you can go to and you are attended to in a hurry and maybe you have a particular problem. Instead of somebody listening to you, he/she starts despising you.”
I : What is it that will motivate you to go for vaccine?
P : Pregnant mothers are sometimes turned away from hospitals when they go to deliver if they never attended the antenatal clinic.”
Accessibility “Well actually the distance from our home to this place is quite long, but I have no choice but to come here. Clinic services for pregnant women are available only in a large facility like this and not in small health centers and dispensaries like the one in our location.”
I:“In case you become sick, and you want to go to the hospital, what can you put into consideration?
P : When I become sick and I want to go to the hospital?
I : Yes.
P : I must have means of transport to the hospital. (Laughs).”
“However, this side you must be sick is when you come or when your day for clinic reaches is when you come, a times you are sick and the place is far you will just be force to persevere.”
“I just go to the hospital that is close to me.”
“Yes, this general hospital is closer to me than the others are.”
“I : Okay, and what do you do if you get sick?
P : I go to the hospital
I : Which hospital?
P : Any that is close to me”
“You go to the nearest hospital when you are sick.”
I : why this one? What attracts you here?
P : It is near where I stay”
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