Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. a qualitative evidence synthesis
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Authors
Danna, Valentina Actis
Bedwell, Carol
Wakasiaka, Sabina
Lavender, Tina
Issue Date
2020-10-12
Type
Article
Language
en_US
Keywords
Maternal Care , Health Empowerment , Individualised-Care , Three Delays Model , Qualitative Evidence Synthesis , Childbirth , Obstetric Care
Alternative Title
Abstract
Background:
The 3-Delays Model has helped in the identification of access barriers to obstetric care in low and middle-income countries by highlighting the responsibilities at household, community and health system levels. Critiques of the Model include its one-dimensionality and its limited utility in triggering preventative interventions. Such limitations have prompted a review of the evidence to establish the usefulness of the Model in optimising timely access to intrapartum care.
Objective:
To determine the current utility of the 3-Delays Model and its potential for supporting a solution-based approach to accessing intrapartum care.
Methods:
We conducted a qualitative evidence synthesis across several databases and included qualitative findings from stand-alone studies, mixed-methods research and literature reviews using the Model to present their findings. Papers published between 1994 and 2019 were included with no language restrictions. Twenty-seven studies were quality appraised. Qualitative accounts were analysed using the ‘best-fit framework approach’.
Results:
This synthesis included twenty-five studies conducted in Africa, Asia, Latin America and the Caribbean. Five studies adhered to the original 3-Delays Model’s structure by identifying the same factors responsible for the delays. The remaining studies proposed modifications to the Model including alterations of the delay’s definition, adding of new factors explaining the delays, and inclusion of a fourth delay. Only two studies reported women’s individual contributions to the delays. All studies applied the Model retrospectively, thus adopting a problem-identification approach.
Conclusion:
This synthesis unveils the need for an individual perspective, for prospective identification of potential issues. This has resulted in the development of a new framework, the Women’s Health Empowerment Model, incorporating the 3 delays. As a basis for discussion at every pregnancy, this framework promotes a solution-based approach to childbirth, which could prevent delays and support women’s empowerment during pregnancy and childbirth.
Description
Citation
Actis Danna, V., Bedwell, C., Wakasiaka, S., & Lavender, T. (2020). Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. A qualitative evidence synthesis. Global health action, 13(1), 1819052. https://doi.org/10.1080/16549716.2020.1819052
Publisher
Global Health Action