Table 4 Barriers to communication and autonomy
Theme | Sub-theme | Representative quotations |
|---|---|---|
Work environment | Perceived lack of time | “It is the time when you have so many patients and when they ask questions you will not get time to answer them.” (C17) |
Language barriers | “Most of the nurses are not Luos and our women who come to this facility mainly know Luo alone so when the nurse is speaking to them in Swahili, they feel like the nurse is despising them or disrespects them. They end up nick naming them that ja Kisii [person from Kisii] is the one on duty, am not going for my clinics as she will look down upon me.” (NC12) | |
Stress and burnout | “This mother has come with a language barrier and this person worked within the 8 h but too much work, so due to the irritability and the stress involved in it, that is when you find that instead of calling Emily Emily I call her ‘you mother’.” (C4) | |
Facility culture | “People have set some things, we believe, it’s now a trend. I don’t know what facility you can go and find a staff introducing herself to the client like am so and so, I have never seen it.” (C8) | |
Provider knowledge, intentions, and assumptions: | Inadequate provider knowledge and skill | “Sometimes, even if the patients does have the courage to ask a question, providers may not be able to answer those questions effectively because they may not understand what the need of the relative or the mother is.” (C3) |
Forgetfulness and unconscious behaviors | “Yes but sometimes I usually do forget, [Laughs] you might come and you find when the line is so long … sometimes you can forget…greeting them you cannot forget, but introducing our names sometimes we do forget.” (C38) | |
Self-protection and comfort | “Because when you introduce yourself, someone can come and say that you are the one who treated him badly and yet you were not the one.” (NC2) | |
Assumptions about women’s knowledge and expectations | “It is the assumptions that people have that they have been here for long and they are known by most of the clients.” (C11) | |
Women’s ability to demand or command effective communication and respect for their autonomy: | Women’s lack of participation | “It is just fear, but the staffs cannot refuse to respond, like she may just but be scared from the fact that he is a doctor that is why she feels small before him and can’t ask whatever question that they have.” (NC15) |
Women’s empowerment and provider bias | “In most cases, you know such like patients they are too inquisitive, demanding so you will spend so much time with them when compared to the others who are not aware of what is going on.” (C32) |