Post-discharge care for babies born small or sick in Kenya: understanding healthcare provider challenges and redesigning documentation to support care

Thesis

Low-and-middle-income countries (LMICs) have a high burden of small and sick newborns. Previous research has focused on care received within hospitals, but there are growing concerns over poor outcomes after discharge. More attention is needed on post-discharge care to improve delivery and lead to better outcomes. My thesis specifically examines how post-discharge care continuity for babies born small or sick may be better supported within the Kenyan health system.

I conducted a scoping review on interventions used to improve post-discharge care continuity in LMICs, followed by empirical research including 180 hours of ethnographic observations, 19 qualitative interviews and five participatory workshops with healthcare providers in two county referral hospitals in Kenya. I supplemented this with interviews with mothers and key informants. I used reflexive thematic analysis to analyse my data, and the goal-directed design process to guide redesign of a hospital form (discharge summary).

My scoping review extended an established care continuity typology to highlight the importance of relationships between mothers and family members or people within the community (“interpersonal continuity”). My empirical work showed healthcare providers faced numerous continuity challenges, including poor documentation, multiple providers involved in care journeys with poor linkages between them, and time and staffing constraints leading to interns conducting tasks with minimal supervision. Viewing postdischarge care continuity as a sociomaterial practice enabled examination of the assemblage of human, material and institutional components necessary for the enactment of care continuity. Based on this analysis, I redesigned the discharge summary form with healthcare providers, focusing on their priorities (intuitive for interns to fill in, and concise for paediatricians to follow after discharge).

Continuity of post-discharge care is complex. Other interventions are needed in addition to form redesign, such as creating a role for care coordination post-discharge and improving support mechanisms for mothers.

Authors: Grewal, G

• DOI: 10.5287/ora-nbadnpkkr
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: continuity of care; small or sick newborns; LMIC; documentation