Mothers' experiences with newborn quality of care in neonatal intensive care units in Ghana. A qualitative study utilising WHO quality of care standards.

BackgroundWorld Health Organization (WHO) has established standards to improve the quality of care for sick and small newborns in healthcare facilities. However, improving newborn survival depends not only on compliance with evidence-based clinical practices but also on how families experience the care provided during hospital admission.ObjectiveThis study explored mothers' experiences and perceived challenges of quality neonatal care in neonatal intensive care units (NICUs) in Ghana using the WHO experience of care standards.MethodsThis study was conducted in six health facilities across the northern, middle, and coastal geographical belts of Ghana. A qualitative descriptive design was utilised. The study applied framework-guided codebook thematic analysis to examine the experiences of 46 mothers. The WHO (2020) Standards for improving quality of care for sick and small newborns in health facilities guided the study, with a focus on the experience of care domain. Standards 4 (Effective communication and caregiver participation), 5 (Respect and preservation of dignity), and 6 (Provision of support) were involved.ResultsFour themes emerged, namely effective communication and meaningful caregiver participation; respect and preservation of dignity; provision of support; perceived challenges to quality neonatal care and participants' suggested recommendations. Mothers reported both positive and negative experiences. Effective communication and meaningful caregiver involvement fostered trust and improved positive caregiver-healthcare professional relationships. Disrespectful behaviour, intemperate language, lack of privacy, and breaches of confidentiality caused feelings of embarrassment and humiliation. These aspects of quality of care were affected by health system gaps, including inadequate staffing, poor accommodation facilities, and a lack of post-discharge follow-ups.ConclusionGaps in the experience of care persist in Ghana, not because standards are lacking, but because of challenges in implementation. Without system-level support, the implementation of the WHO standard on respectful, participatory neonatal care will remain a challenge. These findings underscore the universal challenge, particularly for low- and middle-income countries, of transferring global standards into everyday practice.