Nurses’ and clients’ experiences of co-designing solutions to improve provider-client relationships in maternal and child healthcare: A human-centred design study in rural Tanzania

doi:10.21203/rs.3.rs-3019827/v1

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Research Article

Nurses’ and clients’ experiences of co-designing solutions to improve provider-client relationships in maternal and child healthcare: A human-centred design study in rural Tanzania

https://doi.org/10.21203/rs.3.rs-3019827/v1

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Journal Publication

published 02 Mar, 2024

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Background

There has been a persistent increase in clients’ dissatisfaction with providers’ competencies in maternal and child healthcare (MCH). Existing interventions have failed to address the complexity of provider-client relationships. Therefore, targeted, contextualized innovative solutions that place providers and clients at the forefront as agents of change in optimizing intervention design and implementation are needed. The study team adopted a co-design approach where MCH nurses, clients, and stakeholders partnered to design an intervention package to improve provider-client relationships in rural Tanzania.

Objective

This paper explored nurses’, clients’, and MCH stakeholders’ experiences of participation in a co-design process to generate interventions to strengthen nurse-client relationships in Shinyanga.

Methods

A qualitative descriptive design was used. Thirty semi-structured key informant interviews were conducted in the Swahili language with purposefully selected nurses, clients, and MCH stakeholders. The inclusion criterion was participation in synthesis, ideation, and creative workshops as part of the co-design of an intervention package to strengthen nurse-client relationships. Data were transcribed and translated simultaneously, managed using NVivo, and analyzed thematically.

Results

Three main themes emerged from the analysis. 1) Key learnings from participation in the co-design process, which included knowledge that: both nurses and clients contributed to tensions within their relationships; the benefits of good nurse-client relationship extended beyond nurses and clients to the health sector; and improvement of nurse-client relationships requires interventions targeting nurses, clients, and the health sector. 2) Co-design offered a promising strategy for addressing many challenges facing the health sector beyond interpersonal relationships because it is innovative and brings together parties and end-users impacted by the problem and generates acceptable interventions that contribute to enhanced satisfaction. 3) Co-design promoted co-learning of new skills and knowledge among participants, which influenced changes in their behaviours and practices, even before the implementation of the generated solutions.

Conclusion

End-users’ experiences of co-design suggest it provides a novel entry point for strengthening provider-client relationships and addressing other health sector challenges. In co-design, clients are invited to partner with providers and stakeholders in designing highly acceptable and feasible interventions. Researchers and interventionists should consider embracing a co-design approach to address health service delivery challenges.

user centred-design

design thinking

user participation

provider-patient relationships

This is the first study to examine nurses’ and clients’ (end-users) experience of participation in co-designing solutions for improving their nurse-client relationships in rural Tanzania.
Nurses’ and clients’ experiences suggest that human-centred design provides a novel entry point for strengthening provider-client relationships and addressing other health sector challenges.
In human-centred design, clients are invited to partner with providers and stakeholders to explore the challenges and design highly acceptable and feasible interventions.
We argue that researchers and interventionists should consider embracing a co-design approach to generate context-specific and relevant solutions for addressing health service delivery challenges.

The healthcare system in rural African countries continues to face complex problems that negatively impact service uptake, continuity of care and non-adherence to medications and advice among clients. A major challenge is poor interactions between providers and clients in therapeutic care. Previous studies indicated there had been a persistent increase in clients’ dissatisfaction with providers’ interpersonal and perceived technical competencies in maternal and child healthcare (MCH) in recent years [1–8]. Most clients’ dissatisfaction was rooted in perceived technical and behavioural incompetencies among providers [1–8]. This dissatisfaction with interpersonal and technical aspects of care continues to erode client trust in the formal healthcare system and contributes to poor healthcare service uptake, return for care, and MCH outcomes [9–10].

Various efforts have been made to address clients’ dissatisfaction using healthcare governance instruments such as policies, service charters, facility committees, complaints mechanisms, and actions of professional bodies; however, their effectiveness is not well-established [11]. As a result, political interventions, including employment termination, appear to remain the cornerstone of addressing this complex problem, which tend to exacerbate tensions between clients and providers [11–13]. There have also been attempts to implement competence-based interventions with a focus on improving providers’ communication skills and patient-centered care, along with patient literacy, information seeking, participation, and questioning skills. However, these efforts are often implemented on an ad hoc basis and yield unsatisfactory results [11]. The fact that existing interventions have failed to address the complexities of provider-client relationships along the MCH continuum appears to be overlooked. Other challenges that add to the complexity of nurse-client relationships include clients’ socio-economic vulnerability, poor health literacy, and behaviors; providers’ competence and behaviors; and health system challenges. This complexity necessitates novel, contextualized, and innovative solutions that place providers and clients at the forefront of intervention designs and implementation [14]. New and innovative interventions to improve the provision of high quality and satisfactory care are needed, especially in resource-constrained settings [14–16]. Ideally, to address challenges affecting the nurse-client relationship, an incremental process from intervention design to evaluation of effectiveness should be embraced. This would allow flexibility while using a standardized process that has the potential to be applied in diverse settings.

In this context, Aga Khan University invited nurses, clients, and MCH stakeholders to partner in the design of acceptable interventions to strengthen relationships using a human-centred design (HCD) approach. HCD is an innovative approach to problem-solving that leverages insights from the end users of new products, services, and experiences to develop best-fit solutions that are rapidly prototyped and iteratively refined [17]. HCD is thought to facilitate improvements in client, provider, and community satisfaction, as well as increased efficiency and collaboration in public health intervention development and implementation processes [17–19]. Furthermore, an HCD approach may result in more successful and sustainable interventions compared with traditional problem-solving approaches used in healthcare and public health [14]. The HCD approach embraces a system-wide outlook by considering interactions of factors at different levels and harmonizing individual interests to form collective interests when developing solutions. This article explored nurses’, clients’, and stakeholders’ experiences of participation in a co-design process to develop interventions to strengthen nurse-client relationships in MCH settings in rural Tanzania using HCD. The findings are expected to generate evidence for researchers and interventionists to consider using HCD in developing solutions for complex problems impacting the healthcare system in low-income rural contexts.

Design

The protocol for this study has been published elsewhere [20]. Briefly, this study used a qualitative descriptive design. After examining factors contributing to poor therapeutic relationships [4], nurses, clients, and other stakeholders were invited to participate in developing an intervention package (prototype) with the potential to improve nurse-client relationships in the study setting. Data on participants’ experiences with the HCD process were later gathered through semi-structured key informant interviews (KIIs).

Settings

This study was conducted in Shinyanga, which is a region located in Tanzania’s Lake Zone that is predominantly inhabited by Bantus. A previous study [11] presented a detailed description of the region. Briefly, Shinyanga is a low-income region. It is administratively divided into five districts: Shinyanga Municipal Council (MC), Shinyanga District Council (DC), Kishapu DC, Kahama MC, and Kahama DC. The rationale for choosing Shinyanga for the co-design process was twofold. First, the region is predominantly inhabited by those of Sukuma ethnicity, who share a range of socio-cultural beliefs and practices with minimal diversity. Because of its near homogeneity, the region is a perfect example of many other rural regions of Tanzania. Second, despite several capacity building interventions, local data indicated there were major concerns about poor nurse-client relationships in MCH [11]. Within this region, Shinyanga MC was purposefully selected because people in these districts have access to both the formal healthcare system (mostly public and some private and faith-based facilities) and traditional care [11].

Co-Design Process

A transdisciplinary team of purposefully selected MCH nurses and midwives, clients, administrators, and other relevant stakeholders gathered for 3 days during April and May 2022 to define the challenges affecting nurse-client relationships in Shinyanga MC. The team examined the findings of a preliminary study [4] to inform the design of an interventional package (prototype) that had the potential to improve nurse-client relationships, with consideration of acceptability and feasibility. On the first day, a synthesis meeting was held to review the findings of a qualitative study that examined contributors of poor nurse-client relationships [20] and share insights, experiences, and questions to generate a deeper understanding of the challenges of nurse-client relationships in Shinyanga. The second day involved an ideation meeting to brainstorm and generate “how might we” questions to facilitate the development of ideas for a potential solution. On the third day, a prototype meeting was held to evaluate the ideas generated, with consideration of pros, cons, and feasibility. This was followed by a co-creation meeting to develop an initial (rough) prototype model(s) as well as elements crucial to model testing (e.g., features, modality, responsible person). A total of 24 interventions were developed. However, the rating process resulted in seven interventions that were considered to have potential feasibility and acceptability. These included interventions for (i) awards and recognition of nurses; (ii), disciplinary measures for nurses and clients; (iii) re-invention of the complaints mechanism; (iv) improving client-centred care; (v) improving the nursing curriculum; (vi) strengthening leadership; and (vii) improving healthcare resources. These proposed interventions underwent further validation and testing.

Sample size and participant recruitment

A team of 30 purposefully selected participants (10 nurses, 10 clients, and 10 stakeholders) who participated in the co-design meetings were invited to KIIs after the co-design meetings. Recruitment of nurses and clients for the co-design meetings started with a courtesy visit to the Shinyanga District Medical Officer for approval to visit the purposefully selected healthcare facilities. A list of nurses, clients, and stakeholders who participated in the initial study together with their phone contacts was generated. Next, the research assistants reached out to these individuals, and those who expressed interest were selected to take part in the co-design process. Although equal representation is not a primary focus in qualitative studies [21], the level and ownership of the facility (public, private, and faith-based; dispensary, health centre, and district hospital) were considered during participant enrollment for co-design meetings. No age preference or inclusion criteria were set for this qualitative inquiry other than having participated in the co-design meetings, meaning they were a nurse working in MCH for at least 2 years, a client currently attending MCH clinics that had completed at least three visits in a year, or an MCH service administrator in Shinyanga.

Data collection tool

A semi-structured guide for the KIIs was developed and translated through a consultative process involving experts at Aga Khan University. The English version of the interview guide was translated into the Swahili language then back-translated to English and checked for conceptual equivalence. Questions in the interview guide covered participants’ experiences of the co-design process, key learnings from the process, how they would use the skills gained through participation in co-design, and any recommendations. The interview guide was pre-tested in pre-selected settings. After pre-testing, the guide was refined to ensure readiness for use in the actual data collection process.

Three research assistants with Diplomas in health sciences were recruited and trained on the HCD process and techniques about this study. Close and supportive supervision of the research assistants was implemented throughout data collection and analysis to ensure data quality.

Data collection

The semi-structured KIIs were held in the first week after the co-design meetings. Before the KIIs, participants were given information about this study and the risks and benefits of participation (an information sheet was part of the interview). Verbal consent for the interview and voice recording was sought in advance and recorded as part of the interview. Next, an interview session lasting approximately 30–40 minutes was conducted with consideration of participants’ time and venue preferences. Because of COVID-19, all participants and research assistants were provided with face masks and hand sanitizer, and social distancing was maintained throughout the interviews.

Data management and analysis

Data were analyzed using thematic analysis as described by Braun and Clarke [22]. A stepwise approach was used for deductive thematic analysis of the interview transcripts. First, the research team examined the research questions and generated several themes based on consensus. This resulted in an analytical matrix of the main themes and subthemes. Individual transcripts and phrases (codes) representing participants’ responses to investigators’ probes were then exported to relevant themes and related subthemes in NVivo (QSR International Version 12). A consensus-based approach was used by the research team to determine whether to include codes that did not fit within the developed subthemes and themes, or discard those that were subjectively and objectively deemed of no critical value to this study. The data were then exported to MS Word for report generation.

Participants’ demographics

This study involved 30 participants (90% female), with most participants aged 21–30 years. Most participants were seeking or providing care at a health centre (40%) (Table 1).

Table 1

Participants’ demographics (N = 30)
		N	%
Participant category	Nurses Clients Stakeholders	10 10 10	33 33 33
Gender	Female Male	27 3	90 10
Age, years	21–30 31–40 41–50 > 50	18 9 2 1	60 30 7 3
Level of the facility of practice/care seeking	Hospital Health centre Dispensary	8 12 10	27 40 33
Ownership of facility of practice/care seeking	Public Private Faith-based	17 8 5	57 27 16

Key learnings from participation in the co-design process

Although the focus was on generating an intervention to strengthen nurse-client relationships, participants appeared to have benefited by learning through engagement in the co-design process. The descriptions of key learnings after participation in the co-design process were similar across participant groups. Key learnings included an acknowledgement that first, both nurses and clients contributed to tensions in their relationships. This suggested that designing impactful solutions required bringing both parties together. Second, the benefits of good nurse-client relationships (e.g., improved trust, friendship, and shared decision-making) extended beyond nurses and clients to the health sector. Third, the improvement of nurse-client relationships required interventions that targeted nurses, clients, and the health sector. There was broad consensus that interventions that targeted nurses could include awards and recognition to build their morale, improvement and timely payment of salaries and allowances and improvement of the nursing curriculum. Similarly, interventions focused on clients may include education on their rights and client-centred care. In addition, interventions focused on the health sector may include increasing human resources for health and ensuring the availability of medical supplies. Some participants commented:

“Through participation in this [co-design] process, I came to be aware of the challenges that make providers not able to provide friendly services to their clients, and that these challenges arise from either the nurse, client, or inadequate resources.” (Nurse, Health Center)

“I learned that as a client, I have my rights and that having a good relationship with my nurse can create trust and friendship that can facilitate nurses to give me appropriate care and build nurses’ confidence and morale.” (Client, Dispensary)

“I learned that improving nurse-client relationship needs addressing the challenges faced by nurses such as delayed payment…but also awarding those who perform well. I also learnt that we need to educate clients on their rights and provide client-centred care. We also need to ensure the availability of an adequate number of nurses and medicines.” (MCH Leader)

Co-design as a promising strategy for addressing challenges in the healthcare sector.

There was consensus among participants that co-design was a promising strategy for addressing many challenges facing the health sector beyond interpersonal relationships. The justifications for considering co-design as promising were fourfold. First, co-design was an innovative approach that offered an opportunity for parties impacted by the problem to meet and generate interventions that were acceptable for all. There was also consensus that co-design tapped into the individual experiences, perspectives, and insights of parties involved in a challenge, which facilitated the development of impactful solutions. Second, co-design was regarded as facilitating peace of mind among participants because they were fully engaged in developing solutions. Third, co-design was regarded as being highly likely to result in feasible and acceptable solutions. Almost all nurses, clients, and MCH leaders considered co-design as “simple,” “effective,” “friendly,” and resulting in “feasible” solutions. Nurses suggested that co-design facilitated consensus building, satisfaction, and acceptance of the emerging solutions, which was critical for successful implementation. Fourth, co-design was considered to facilitate change in behaviours and practices among participants as they gained new knowledge and skills during their engagement in the co-design process. In other words, co-design offered a co-learning opportunity for participants as they interacted to analyze problems and generate solutions. Consequently, more than half of the participants suggested that “other healthcare partners needed to embrace co-design in addressing healthcare challenges” instead of coming up with prescribed solutions. Some participants commented:

“This is a very innovative approach, and it is an effective approach for addressing the challenges in the health sector because people from either side meet, discuss and agree on the solution. The participants learnt that in the process, their relationship improves as they meet.” (Client, Hospital)

“This is a very good approach because it brings insights of the people who are affected by the problem. For example, nurses and clients can sit and develop solutions that can bring positive change. This is because, the solutions they develop touch everyone directly, which is very important for successful implementation.” (Nurse, Dispensary)

“Co-designing is very innovative because everyone is fully engaged in giving insights to improve health services. They build a consensus together, for example, nurses, clients and leaders are fully engaged…other partners need to consider this approach instead of coming up with pre-determined solutions that may not be successful.” (MCH Leader)

The co-design process is a driver of commitment to change behaviours and practices.

Participants described a range of commitments to becoming agents of behaviour change and practice by putting into use the key learnings from their participation in the co-design process. Nurses described becoming more cognizant of their weaknesses, areas for improvement, and commitment to developing good relationships with their clients by changing their behaviours and practices. Most nurses committed themselves to providing better health services, improving efficiency, upholding clients’ rights, avoiding client discrimination, adhering to nursing ethics, and increasing closeness with their clients. Furthermore, nurses were committed to taking a sensitization role by educating peers who did not take part in the co-design process on the benefits and strategies for developing good nurse-client relationships, as well as educating clients on how to improve therapeutic relationships. Clients committed themselves to become agents of change by arriving early at the MCH clinic, adhering to established service delivery procedures, describing their medical problems more clearly, and respecting and developing closeness with the nurses. Clients also committed to taking a sensitization role by giving feedback about the process to community leaders and educating their peers who did not take part in the co-design process on how to minimize tensions with nurses. MCH leaders are committed to changing their leadership practices by fulfilling their duties effectively, upholding equity and staff rights, adhering to established guidelines, and using discussions and consensus to resolve nurse and client conflicts. Furthermore, leaders committed to taking a sensitization role by educating providers on how to strengthen their relationship with clients, using meetings to influence the implementation of solutions generated, conducting mentorship to providers on good customer care, and continued monitoring of clients’ complaints.

“Participation helped me to know the things I have been doing wrong. I will strive to offer quality care and adhere to nursing ethics…I will offer care without discrimination and ensure that I respect and uphold the rights of my clients…I will also encourage my peers to adhere to nursing ethics and fulfil their responsibilities effectively so that we can have a good relationship with our clients.” (Nurse, Dispensary)

“From now, I will start arriving at the facility early, use friendly language towards nurses and offer clear information…I will use the skills I gained to educate my fellow clients and surrounding community on how to build good relationships with our providers…” (Client, Health Center)

“The knowledge and skills I gained here will help me as a leader to fulfil my leadership role equitably…not discriminating my staff…offer mentorship to my staff and closely monitor complaints so that we can have good customer care to our clients.” (MCH Leader)

Collectively, these accounts indicated that participants gained a great deal of knowledge and skills through participating in the co-design process. Participants acknowledged that co-design was a potentially effective strategy for addressing healthcare challenges beyond the nurse-client relationships because parties impacted by the problem would use the solution fully and engage in its development. Consequently, a suggestion was made for other implementation partners to consider co-design in addressing health service delivery challenges.

The purpose of this study was to examine participants’ experiences in the engagement of co-design as a solution for improving provider-client relationships in MCH settings in rural Tanzania. Nurses, midwives, and other MCH stakeholders were invited to partner with the researchers to explore the contributors to and develop a prototype for the complex problem of nurse-client relationships in Shinyanga. During the co-design phase, synthesis and ideation meetings were held to brainstorm and evaluate possible solutions, which led to the development of a contextualized rough prototype to address poor nurse-client relationships. As this study is the first to embrace the HCD approach in strengthening provider-client relationships, tapping into nurses’ and clients’ experiences is a critical step in generating evidence for the use of co-design in addressing interpersonal challenges in the healthcare sector.

The findings indicated that participation in the co-design process facilitated learning among nurses, clients, and MCH stakeholders. Participants became more cognizant that tensions in therapeutic relationships were caused by both providers and clients. They also developed an understanding that the benefits of good provider-client relationships extended to the broader health sector. Similar findings have been reported in previous studies on therapeutic relationships, where providers’ and clients’ contributions were widely documented [11, 21, 23–25]. For example, a previous study in a similar setting indicated that a good and trusting relationship between providers and clients contributed to healthcare-seeking behaviors, disclosure, adherence, and continuity with care among clients, and also increased confidence, work morale, and reputation among nurses [11]. In addition, this increased the income and societal reputation of healthcare facilities and the health sector. This implied that addressing tensions in therapeutic relationships requires tapping into the experiences, insights, and perspectives of providers, clients, and key health sector stakeholders through partnerships in developing acceptable solutions. This may explain the key learning that improvement of nurse-client relationships in the study setting required interventions that targeted nurses, clients, and the health sector.

Furthermore, the present findings indicated that co-design was widely acknowledged as a promising approach for addressing many challenges facing the health sector beyond interpersonal relationships. This was because co-design was an innovative approach and also offered an opportunity for parties impacted by the problem to meet and generate acceptable interventions for all concerned. Co-design was considered to facilitate “peace of mind” among participants because they were fully engaged in analyzing the problem and generating solutions that considered individual experiences, perspectives, and insights. Consequently, co-design was regarded as a simple, friendly, and effective way to develop feasible and acceptable solutions. These findings resonated with previous scholarly insights about co-design processes. As a central aspect of HCD, co-design is considered to facilitate improvements in client, provider, and community satisfaction, as well as increase efficiency and collaboration in public health intervention development and implementation processes [17–19, 26]. The approach takes a system-wide outlook by considering interactions of factors at different levels and harmonizing individual interests to form collective interests when developing solutions. Intrinsic to the co-design process is the fact that end-users jointly understand a problem, act on it, and learn from working collaboratively to contest power relationships and effect change. The co-design approach is a highly adaptive and creative approach to problem-solving and enables the team to understand the problem and ensure that all relevant stakeholders are at the forefront as solution designers [26] more deeply. Consequently, the emerging solution package (prototype) can be more successful and sustainable compared with traditional problem-solving approaches in healthcare and public health [17].

A key aspect of co-design is that it cements learning among participants that may consequently shape their behaviours and practice, even before the emerging solution has been implemented [26]. This emerged strongly in this study, as almost all participants affirmed that co-designing facilitated acknowledgement of “things they have been doing wrong” and they had gained new knowledge and skills as they interacted to analyze problems and generate solutions. As a result, all participants committed to become agents of change by changing their behaviors and practices. For example, nurses described becoming more aware of their weaknesses and being committed to developing good relationships with their clients by providing better health services, improving efficiency, upholding clients’ rights, avoiding client discrimination, adhering to nursing ethics, and increasing closeness with their clients. Nurses are also committed to sensitizing and educating their peers and clients on the benefits of and strategies for improving therapeutic relationships. Clients committed to changing behaviours that contributed to tensions in their relationships, as well as educating fellow clients on how to improve their relationships with their nurses. Similarly, MCH leaders committed to changing their leadership practices to more favourable and non-discriminatory practices as well as providing mentorship for providers and closely monitoring client complaints. As a result of this acknowledgement, participants overwhelmingly recommended the adoption of the co-design approach among other implementing partners in addressing challenges in the health sector instead of adopting pre-developed solutions that may not be successful.

Limitations

This study had some limitations. The co-design approach used nurses as an exemplar of providers to partner with clients and MCH stakeholders to co-develop a prototype for strengthening interpersonal relationships in MCH in a rural setting. However, patients interact with a multidisciplinary team of providers in healthcare settings. Conducting a similar study with clients and stakeholders partnering with other providers (e.g., doctors) and in a different setting may yield different experiences and insights. However, as this is the first such study in this context, further inquiries may extend beyond the nursing profession and rural contexts. Furthermore, the co-design approach appeared to be a new concept for many healthcare sector stakeholders. Therefore, capacity building on the co-design steps may be needed for researchers and health sector actors before it can be fully employed as a tool for generating solutions for complex challenges in the healthcare system. Finally, bringing together end-users of the solution or people directly impacted by the challenge may have significant financial implications. However, there is an increasing number of international organizations that are willing to fund interventions embracing co-design approaches for generating solutions to address healthcare challenges.

In conclusion, end-users experiences of the co-design approach suggest that it provides a novel entry point for strengthening provider-client relationships and addressing other health sector challenges, as clients are invited to partner with providers and stakeholders in the design of highly acceptable and feasible interventions. The co-design process provides a co-learning opportunity which facilitates understanding of areas that need improvement, and influences change in behaviours and practices among participants, thereby making them agents of change before an emerging solution has been implemented. Therefore, researchers and interventionists need to embrace the co-design approach in addressing health service delivery challenges.

HCD: Human-centered design

MCH: Maternal and child health

KII: Key informant interview

Ethics approval and consent to participate

All methods and procedures about this study were carried out in accordance with relevant guidelines and regulations. The study received ethics clearance from the National Institute for Medical Research (Certificate No: NIMR/HQ/R.8a/Vol. IX/3906), and local approval from the regional and municipal medical officers in Shinyanga. At the health facility level from which nurses and clients were accessed, verbal approval was sought from managers of the selected facilities after providing letters from the district medical officers and copies of ethical clearance. We ensured responsible conduct of the research by obtaining written informed consent from all participants before participation. It is important to note that the principal investigator was certified in health service research by the Collaborative Institutional Training Initiative. This study did not directly or indirectly expose nurses and clients to any diagnosis or treatment. As safeguards, all study responses were confidential, and data analysis and reporting were conducted at an aggregated level within Shinyanga Region. In addition, all data gathered were only used for the present research. Because of the COVID-19 pandemic, face masks, sanitizer, and social distancing were used to mitigate infection transmission during fieldwork activities.

Consent for publication

Not applicable.

Data Availability Statement

The dataset(s) supporting the conclusions of this article are) included within the article (and its additional file(s)). Additional data on the HCD process that are not part of the published article will be available on request from the AKU through the corresponding author (KI). Some data may not be publicly available for ethical reasons (i.e., information that could compromise the privacy of research participants)

Conflict of interest

None declared.

Funding

The study was funded by the University Research Council of the Aga Khan University

Acknowledgements

The authors acknowledge financial support from the Aga Khan University Research Council for this novel project. We thank the National Institute for Medical Research, and the Regional Medical Officer and Municipal Medical Officer in Shinyanga for approving the conduction of this project. We also thank Ms Zabibu Mruttu, Ms Lucia Mungo and Elibariki Petro for their support in data collection as research assistants. We also thank Ms Audley Holmes for her editorial support.

Author contribution

K.I. designed the study, solicited funding, and developed the initial draft of the manuscript. E.S.P. and E.N-M. participated in the project conception and design. All authors critically reviewed the manuscript and provided input for improvement.

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No competing interests reported.

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published 02 Mar, 2024

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Nurses’ and clients’ experiences of co-designing solutions to improve provider-client relationships in maternal and child healthcare: A human-centred design study in rural Tanzania

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Journal Publication

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Abstract

Background

Objective

Methods

Results

Conclusion

CONTRIBUTION TO THE FIELD

BACKGROUND

METHODS

Design

Settings

Co-Design Process

Sample size and participant recruitment

Data collection tool

Data collection

Data management and analysis

RESULTS

Participants’ demographics

Key learnings from participation in the co-design process

DISCUSSION

Limitations

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

Status:

Journal Publication

Version 1