Medical education implication on knowledge, attitude, practices and barriers to implementation of non-pharmacological pain management during labor

Abstract

Background: Health care providers have a key role in pain management. Health care providers often use non-pharmacological measures to facilitate comfort for patients within the hospital setting. However, guidelines for use of these measures are commonly inadequate or absent. The medical education implication of knowledge, attitude, practice and barriers is important in addressing consequence of how the mother’s labor pain is going to be managed. If the training is not comprehensive enough, there is a likelihood of discrepancy in labor pain management. Knowledge, attitude, practice and barriers can affect the quality of care provided to a pregnant mother in labor, especially when pain during labor has to be addressed. Objectives: The objective was to determine the medical education implication of the health care providers’ knowledge, attitude, practices and barriers regarding non-pharmacological pain management during labor in Moi Teaching and Referral Hospital, Eldoret and Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. Methods: This study employed a non-experimental cross-sectional descriptive survey design. The total sample size was 266 and study population included the health care providers. The tool consisted of self-administer structured questions to assess the knowledge, 3 point Likert scale to identify the attitude and checklist to determine the practice and barriers for using non-pharmacological pain management during labor. Data were summarized using frequencies, percentage, mean and standard deviation. Chi-square test was used to test the relationship between demographic characteristics and implementation of non-pharmacological management of pain during labor in teaching hospitals. Mann Whitney U-test was used to compare mean differences between the study sites in terms of attitude, practice and barriers. Chi-square test of independence was used to check for significant relationship between knowledge level and study site. Findings are presented in form of tables, charts, graphs and narrative. Results: Eighty six percent of the healthcare providers had inadequate level of knowledge on non-pharmacological management of pain during labor. Health care providers had a positive attitude towards non-pharmacological pain management during labor. All participants responded that majority of health care providers practice/encourage massage, breathing exercise, different position and encourage the relatives to supporting the laboring women. In terms of the health care system related barriers, 92(34.6 %) of the participants responded that the main barrier was lack of time. For health care provider related barrier, 75(28.2%) of the participants responded that it is lack of knowledge and of patient related barriers, 85(32%) of the participant responded that the main barrier was patient unwillingness. There was a significant difference in mean rank in terms of practice and barriers to non-pharmacological management of pain during labor (p<0.05). Health care providers from Eldoret had higher mean rank compared to those from Kisumu. Conclusion: Majority of the healthcare providers 230(86.5%) had inadequate knowledge of non-pharmacological pain management during labor. Health care providers had a positive attitude towards non-pharmacological pain management during labor. Most of the health care providers practiced massaging, breathing exercise and encourage different laboring positions during labor. The main barriers were lack of time, knowledge and patient unwillingness. The management of mothers’ pain in labor was uncomprehensive. Recommendations: Training aspects should focus more to the health care providers about various complementary and alternative therapies for pain management in labor; health care providers understand the importance of reduction of pain perception during labor and develop skills in providing efficient practice for effective pain management during labor; collaborate with governing bodies to formulate standard policies and protocol to emphasize care during labor. Finally, to improve the curriculum for non-pharmacological pain management during labor.