Table 1 Types of disrespectful and abusive care as categorized by Bohren and colleagues in their systematic review [5]. Each is paired with the systems-level drivers of this care (Propagating Factors) and specific supports that care navigators can provide in order to address them (Care Navigator Roles)
| Type | Propagating Factors | Care Navigator Roles |
|---|---|---|
| 1) Physical, sexual, or verbal abuse |
Normalization of patient abuse Role modeling of behaviors by superiors |
Mitigate through emotional support Deter through mediation |
| 2) Discrimination |
Social inequalities and segregation Lack of consequences and oversight for discriminatory treatment |
Advocate for incorporation of traditional birthing practices Use cultural capital to identify both with patients and providers |
| 3) Failure to provide professional standard of care (including patient’s autonomy) |
Medical paternalism High patient volume Hierarchy of hospital staff Lack of mechanisms to measure and improve quality of care |
Advocate for appropriate and timely care Assist providers in obtaining patient consent Take steps to protect patients’ dignity (ex: shielding while changing into gown in public exam room) Educate patients and hospital staff on mothers’ rights |
| 4) Poor communication |
Language barriers Lack of training on effective communication |
Translate between patients and providers Report back to family and traditional midwife |
| 5) Poor rapport |
Social stratification Burnout-motivated behaviors |
Act as cultural broker Provide emotional and labor support |
| 7) Health system constraints |
Provider frustration due to lack of resources Lack of basic resources to provide care Uncomfortable working conditions |
Provide economic support for medical needs Contextualize limitations faced by medical providers for patients and family |
| 8) Health system conditions | Excessive bureaucracy Inadequate support staff | Navigate complex work flows Coordinate care across settings (ex: between rural health post and hospital) Cultivate relationships with frontline health workers |
