Table 1 Mapping of behavioral drivers to interventions

Providers believe they are already doing everything they are supposed to do

Training, supervision and feedback is focused on clinical treatment and health risks and does not address respectful care

X

X

X

There are clinical algorithms and guidelines, including visual cues in the facility, but nothing which provides clear guidelines for how to give good care

X

X

Pain is seen as a natural birth experience—the provider had a painful delivery, has attended many painful deliveries, and the bible says that labor is painful

X

X

X

Provider has attended many deliveries and developed a “feel” for how care is provided

X

X

Harsh treatment is considered normal

Provider experienced violence as a child as a form of discipline

X

Training and clinical experience of provider reinforces that clients need rigid, forcefully delivered commands and interventions

X

X

Providers believe they do not need to provide respectful care

There are no serious consequences to providers who engage in disrespectful or abusive behavior

X

X

Client clothing or appearance makes them seem low-income, or they are considered to be a community member of lower status

X

X

X

Provider has never interacted with the client before delivery and the client is behaving erratically or not following instructions

X

X

X

Providers perceive that the costs of respectful care outweigh the gains

Maternal or infant death results in an audit, placing an emphasis on clinical practices

X

X

Providers do not receive salient information or feedback on the impact of respectful or disrespectful care on health outcomes

X

X

Providers believe that disrespectful care will assist their clinical objectives

Client does not follow provider instructions in part due to lack of rapport, extreme pain and fatigue

X

X

X