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The past two decades have witnessed a transition from in-patient hospital admission and care to community and home based care (C&HBC) due to the surge in chronic health conditions in most of southern Africa, including Zimbabwe. The purpose for this study was to explore whether C&HBC met the expectations of clients enrolled in such a programme. A mixed-method approach, combining qualitative and quantitative data collection and analysis, was used. Data from both approaches, qualitative and quantitative, were collected concurrently. Equal weighting was allocated to both sets of data. Interviews and focus group discussions were used to collect data from home-based care clients, family care givers and health providers. Quantitative data were collected from clients and primary caregivers using questionnaires. Specific data entry templates were developed for the purpose of entry and analysis in NVivo. Data were synthesised and analysed according to themes. Quantitative data were collated and entered into a CSPro data entry template, before being exported to MS excel and to the Statistical Package for Social Sciences (SPSS) version 20.0 for analysis. The quantitative questions were pre-coded before data collection and analysis. The unmet expectations included financial assistance, improved nutrition, availability of medications and improved access to health care providers. [ABSTRACT FROM AUTHOR]

Women attending public and private sector health facilities in Africa have reported abuse and neglect during childbirth, which carries a risk of poor health outcomes. We explored from the midwives' perspective the influence of an educational intervention in changing the attitudes, behaviour and practices of a group of midwives in Zimbabwe, using transformative learning theory as the conceptual framework. The twelve-week educational intervention motivating for Respectful Maternity Care consisted of a two-day workshop and five follow-up sessions every two weeks. Thematic analysis was conducted on eighteen reflective journals written by the midwives with member-checking during follow-up discussions and a further one-day participative workshop a year later. The midwives reported being more women-centred, with involvement of birth companions and use of different labour positions, stronger professional pride and agency, collaborative decision-making and less hierarchical relationships which persisted over the year. Their journal narratives included examples of treating birthing women with more compassion. Some categories aligned with the phases of transformative learning theory (self-examination of prior experience, building of competence and self-confidence into new roles and relationships). Others related to improving communications and effective teamwork, providing role-models of good behaviour, use of scientific knowledge to inform practice and demonstrating competence in management of complex cases. This study shows that innovative educational initiatives have the potential to change the way midwives work together, even in challenging physical environments, leading to a shared vision for the quality of service they want to provide, to improve health outcomes and to develop life-long learning skills., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ray et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)