Trust offers a distinctive lens on facility responsiveness during labor and birth. Though acknowledged in prior literature, limited work exists linking conceptual and empirical spheres. This study explores trust in the maternity setting in Kenya through a theoretically driven qualitative approach. Focus groups (n = 8, N = 70) with women who recently gave birth (WRB), pregnant women, and male partners, and in-depth-interviews (n = 33) with WRB, frontline providers, and management, were conducted in and around a peri-urban public hospital. Combined coding and memo-writing showed that trust in maternity care is nested within understandings of institutional and societal trust. Content areas of trust include confidence, communication, integrity, mutual respect, competence, fairness, confidentiality, and systems trust. Trust is relevant, multidimensional, and dynamic. Examining trust provides a basis for developing quantitative measures and reveals structural underpinnings, repercussions for trust in other health areas, and health systems inequities, which have implications for maternal health policy, programming, and service utilization.
AbuyaT.WarrenC.NjukiR.MillerN.NdwigaC.MarangaA.. . . BellowsB. (2015). Exploring the prevalence of disrespect and abuse during childbirth in Kenya. PLoS Medicine, 10(4), e0123606. doi:10.1371/journal.pone.0123606
2.
ArmstrongK.McMurphyS.DeanL. T.MiccoE.PuttM.HalbertC. H.. . . SheaJ. A. (2008). Differences in the patterns of health care system distrust between blacks and whites. Journal of General Internal Medicine, 23, 827–833. doi:10.1007/s11606-008-0561-9
3.
BellowsB.KyobutungiC.MutuaM. K.WarrenC.EzehA. (2013). Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya. Health Policy and Planning, 28, 134–142. doi:10.1093/heapol/czs030
4.
BourbonnaisN. (2013). Implementing free maternal health care in Kenya. Nairobi, Kenya: Kenya National Commission on Human Rights.
5.
BovaC.RouteP. S.FennieK.EttingerW.ManchesterG. W.WeinsteinB. (2012). Measuring patient-provider trust in a primary care population: Refinement of the Health Care Relationship Trust Scale. Research in Nursing & Health, 35, 397–408. doi:10.1002/nur.21484
6.
BranchD. (2011). Kenya: Between hope and despair, 1963-2011. New Haven, CT: Yale University Press.
7.
Byford-RichardsonL.WalkerM.MuckleW.SpragueA.FergusS.WhiteR. R.. . . DickB. (2013). Barriers to access of maternity care in Kenya: A social perspective. Journal of Obstetrics and Gynaecology Canada, 35, 125–130. doi:10.1016/S1701-2163(15)31016-1
8.
CampbellO. M.CalvertC.TestaA.StrehlowM.BenovaL.KeyesE.. . . RonsmansC. (2016). The scale, scope, coverage, and capability of childbirth care. The Lancet, 388, 2193–2208. doi:10.1016/S0140-6736(16)31528-8
9.
Center for Reproductive Rights/Federation of Women Lawyers–Kenya. (2007). Failure to deliver: Violations of women’s human rights in Kenyan health facilities. New York: Author.
10.
CharmazK. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
11.
ChumaJ.OkunguV. (2011). Viewing the Kenyan health system through an equity lens: Implications for universal coverage. International Journal for Equity in Health, 10, Article 22. doi:10.1186/1475-9276-10-22
12.
CipollettaS.SperottoA. (2012). From the hospital organization to the childbirth practice: Italian women’s experiences. Journal of Reproductive and Infant Psychology, 30, 326–336. doi:10.1080/02646838.2012.707777
13.
CreswellJ. W. (2007). Qualitative inquiry & research design. Thousand Oaks, CA: Sage.
14.
EssendiH.MillsS.FotsoJ. C. (2010). Barriers to formal emergency obstetric care services’ utilization. Journal of Urban Health, 88, S356–S369. doi:10.1007/s11524-010-9481-1
15.
FreedmanL. P.RamseyK.AbuyaT.BellowsB.NdwigaC.WarrenC. E.. . . MbarukuG. (2014). Defining disrespect and abuse of women in childbirth: A research, policy and rights agenda. Bull World Health Organ, 92, 915–917. doi:10.2471/BLT.14.137869
16.
GiddensA. (1990). Consequences of modernity. Standford, CA: Stanford University Press.
17.
GilsonL. (2003). Trust and the development of health care as a social institution. Social Science & Medicine, 56, 1453–1468. doi:10.1016/S0277-9536(02)00142-9
18.
GilsonL. (2007). Acceptability, trust and equity. In MacIntyreG. H.MooneyD. (Eds.), Economics of health equity (pp.124-148). Cambridge, UK: Cambridge University Press.
19.
GilsonL.PalmerN.SchneiderH. (2005). Trust and health worker performance: Exploring a conceptual framework using South African evidence. Social Science & Medicine, 61, 1418–1429. doi:10.1016/j.socscimed.2004.11.062
20.
GlaserB. G.StraussA. L. (1967). The discovery of grounded research: Strategies for qualitative research. New York: Aldine De Gruyter.
21.
GrimenH. (2009). Power, trust, and risk. Medical Anthropology Quarterly, 23, 16–33. doi:10.1111/j.1548-1387.2009.01035.x
22.
HallM. A.DuganE.ZhengB.MishraA. K. (2001). Trust in physicians and medical institutions: What is it, can it be measured, and does it matter?The Milbank Quarterly, 79, 613–639. doi:10.1111/1468-0009.00223
23.
HonikmanS.FawcusS.MeintjesI. (2015). Abuse in South African maternity settings is a disgrace: Potential solutions to the problem. South African Medical Journal, 105, 284–286. doi:10.7196/SAMJ.9582
24.
HultonL. A.MatthewsZ.StonesR. W. (2007). Applying a framework for assessing the quality of maternal health services in urban India. Social Science & Medicine, 64, 2083–2095. doi:10.1016/j.socscimed.2007.01.019
25.
HupceyJ. E. (1998). Social support: Assessing conceptual coherence. Qualitative Health Research, 8, 304–318. doi:10.1177/104973239800800302
26.
HupceyJ. E. (2002). Maintaining validity: The development of the concept of trust. International Journal of Qualitative Methods, 1(4), 45–53. doi:10.1046/j.1365-2648.2001.01970.x
27.
HupceyJ. E.MillerJ. (2006). Community dwelling adults’ perception of interpersonal trust vs. trust in health care providers. Journal of Clinical Nursing, 15, 1132–1139.
28.
HupceyJ. E.PenrodJ.MorseJ. M.MitchamC. (2001). An exploration and advancement of the concept of trust. Journal of Advanced Nursing, 36, 282–293. doi:10.1046/j.1365-2648.2001.01970.x
29.
IzugbaraC. O.NgilangwaD. P. (2010). Women, poverty and adverse maternal outcomes in Nairobi, Kenya. BMC Womens Health, 10, Article 33. doi:10.1186/1472-6874-10-33
30.
KellyJ. J.NjukiF.LaneP. L.McKinleyR. K. (2005). Design of a questionnaire to measure trust in an emergency department. Academic Emergency Medicine, 12, 147–151. doi:10.1111/j.1553-2712.2005.tb00853.x
31.
Kenya National Bureau of Statistics, & ICF Macro. (2010). Kenya demographic and health survey 2008-09. Calverton, MD: Author.
32.
KoblinskyM.MatthewsZ.HusseinJ.MavalankarD.MridhaM. K.AnwarI.. . . van LerbergheW. (2006). Going to scale with professional skilled care. The Lancet, 368, 1377–1386. doi:10.1016/S0140-6736(06)69382-3
33.
KohnM. (2008). Trust: Self-interest and the common good. New York: Oxford University Press.
34.
KramonE.PosnerD. N. (2011). Kenya’s new constitution. Journal of Democracy, 22, 89–103. doi:10.1353/jod.2011.0026
35.
LapinskiM. K.RimalR. N. (2005). An explication of social norms. Communication Theory, 15, 127–147. doi:10.1111/j.1468-2885.2005.tb00329.x
36.
LoriJ.MunroM.MooreJ.FladgerJ. (2013). Lessons learned in Liberia: Preliminary examination of the psychometric properties of trust and teamwork among maternal healthcare workers. BMC Health Services Research, 13, Article 134. doi:10.1186/1472-6963-13-134
37.
LudemaJ. D.CooperriderD. L.BarrettF. J. (2006). Appreciative inquiry: The power of the unconditional positive question. In ReasonP.BradburyH. (Eds.), Handbook of action research (pp. 155–168). London: Sage.
38.
MannavaP.DurrantK.FisherJ.ChersichM.LuchtersS. (2015). Attitudes and behaviours of maternal health care providers in interactions with clients: A systematic review. Globalization and Health, 11(1), Article 36. doi:10.1186/s12992-015-0117-9
39.
MaxwellJ. A. (2005). Qualitative research design. Thousand Oaks, CA: Sage.
40.
McEvilyB.TortorielloM. (2011). Measuring trust in organisational research: Review and recommendations. Journal of Trust Research, 1, 23–63. doi:10.1080/21515581.2011.552424
41.
McMahonS. A.GeorgeA. S.ChebetJ. J.MoshaI. H.MpembeniR. N.WinchP. J. (2014). Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy Childbirth, 14, Article 268. doi:10.1186/1471-2393-14-268
42.
MorganD. L. (1997). Focus groups as qualitative research. Thousand Oaks, CA: Sage.
43.
MselleL.MolandK.MvungiA.Evjen-OlsenB.KohiT. (2013). Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania. BMC Health Services Research, 13, Article 174. doi:10.1186/1472-6963-13-174
44.
Nasong’oS. W.AyotT. O. (2007). Women in Kenya’s politics of transition and democratisation. In MurungaG.Nasong’oS. W. (Eds.), Kenya: The struggle for democracy (pp. 164–196). Dakar, Senegal: Council for the Development of Social Science Research in Africa (CODESRIA).
45.
ØstergaardL. R. (2015). Trust matters: A narrative literature review of the role of trust in health care systems in sub-Saharan Africa. Global Public Health, 10, 1046–1059. doi:10.1080/17441692.2015.1019538
46.
OzawaS.SripadP. (2013). How do you measure trust in the health system? A systematic review of the literature. Social Science & Medicine, 91, 10–14. doi:10.1016/j.socscimed.2013.05.005
47.
PellegrinoE. D. (1991). Trust and distrust in professional ethics. In PellegrinoE. D.VeatchR. M.LanganJ. P. (Eds.), Ethics, trust, and the professions: Philosophical and cultural aspects (pp. 69-92). Washington, DC: Georgetown University Press.
48.
RiewpaiboonW.ChuengsatiansupK.GilsonL.TangcharoensathienV. (2005). Private obstetric practice in a public hospital: Mythical trust in obstetric care. Social Science & Medicine, 61, 1408–1417. doi:10.1016/j.socscimed.2004.11.075
49.
RoterD. (2000). The enduring and evolving nature of the patient–physician relationship. Patient Education and Counseling, 39, 5–15. doi:10.1016/S0738-3991(99)00086-5
50.
SharmaS.SmithS.SonneveldtE.PineM.DayaratnaV. (2005, June). Formal and informal fees for maternal health care services in five countries: Policies practices and perspectives (Policy Working Paper Series No. 16). Washington, DC:Futures Group International, POLICY Project. Retrieved from http://pdf.usaid.gov/pdf_docs/PNADD338.pdf
51.
SheaJ. A.MiccoE.DeanL. T.McMurphyS.SchwartzJ. S.ArmstrongK. (2008). Development of a revised health care system distrust scale. Journal of General Internal Medicine, 23, 727–732. doi:10.1007/s11606-008-0575-3
52.
SheppardV. B.ZambranaR. E.O’MalleyA. S. (2004). Providing health care to low-income women: A matter of trust. Family Practice, 21, 484–491. doi:10.1093/fampra/cmh503
SmytheE.PayneD.WilsonS.PaddyA.HeardK. (2014). Revealing tact within postnatal care. Qualitative Health Research, 24, 163–171. doi:10.1177/1049732313519704
55.
ThiedeM. (2005). Information and access to health care: Is there a role for trust?Social Science & Medicine, 61, 1452–1462. doi:10.1016/j.socscimed.2004.11.076
56.
WarrenC.AbuyaT.ObareF.SundayJ.NjueR.AskewI.BellowsB. (2011). Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya. BMC Public Health, 11, Article 177. doi:10.1186/1471-2458-11-177
57.
WarrenC.NjukiR.AbuyaT.NdwigaC.MaingiG.SerwangaJ.. . . BellowsB. (2013). Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya. BMC Pregnancy and Childbirth, 13, Article 21. doi:10.1186/1471-2393-13-21
58.
ZirabaA. K.MadiseN.MillsS.KyobutungiC.EzehA. (2009). Maternal mortality in the informal settlements of Nairobi city: What do we know?Reproductive Health, 6, Article 6. doi:10.1186/1742-4755-6-6
