title: A community-based participatory research approach to explore community perceptions of the quality of maternal-newborn health services in the Dominican Republic.
abstract: OBJECTIVE
  to understand both men's and women's beliefs and attitudes regarding public maternity and newborn services, care and quality.
  
  
  METHODS
  qualitative, cross-sectional, retrospective study with an observation arm, using community-based participatory research as both the mechanism of enquiry and catalyst for change.
  
  
  METHODS
  four urban neighbourhoods in the Dominican Republic, selected in collaboration with the Provincial Medical Public Health Director and the partnering local public hospital.
  
  
  METHODS
  adolescent women (15-20 years of age), adult women (21-49 years of age) and adult men (>19 years of age) from the four neighbourhoods were recruited to participate in focus sessions, personal interviews and/or antenatal observations. A total number of 137 participants were recruited: 27 males, 51 adolescent females and 59 adult females. The attrition rate was 17% (n=23). Dominican and US midwives and nurses, as well as community leaders, comprised the research team.
  
  
  RESULTS
  following informed consent, self-reported demographics and obstetric history were collected. Twelve focus groups and 12 individual interviews were recorded and transcribed, then qualitatively analysed for content and interpretation of salient themes. Antenatal observations were performed by community leaders to identify patterns of antenatal health-care delivery and utilisation. The main over-riding theme uncovered by the research was 'no me hace caso', or that women and men accessing the maternal health system did not feel valued. The significant amount of time required to receive care was interpreted by the participants as a lack of respect. Finally, the idea of 'cuña' emerged, in which participants noted special treatment for those with social connections to health-care providers. Presentation to the hospital was challenging but resulted in hospital volunteers joining the community volunteer group to collaborate on improving services.
  
  
  CONCLUSIONS
  this study, conducted in the Dominican Republic, illustrates international collaboration between university researchers, maternity service providers and community members. Community-based participatory research may be an effective mechanism to unite community members and health providers in the common mission to improve maternal-newborn health services.
authors.affiliation: Lillian Carter Center for International Nursing, Center for Research Maternal-Newborn Survival Nell Hodgson, Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA. jennifer.foster@emory.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Foster
authors.forename: Rosa
authors.initials: R
authors.lastname: Burgos
authors.forename: Carmen
authors.initials: C
authors.lastname: Tejada
authors.forename: Ramona
authors.initials: R
authors.lastname: Cáceres
authors.forename: Asela T
authors.initials: AT
authors.lastname: Altamonte
authors.forename: Lydia J
authors.initials: LJ
authors.lastname: Perez
authors.forename: Frank R M
authors.initials: FR
authors.lastname: Noboa
authors.forename: Marilyn F
authors.initials: MF
authors.lastname: Urbaez
authors.forename: Annemarie
authors.initials: A
authors.lastname: Heath
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Hilliard
authors.forename: Fidela
authors.initials: F
authors.lastname: Chiang
authors.forename: Priscilla
authors.initials: P
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D055812:Community-Based Participatory Research; D003466:Cultural Characteristics; D004293:Dominican Republic; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008430:Maternal-Child Health Centers / Q000458:organization & administration*; D008880:Midwifery / Q000458:organization & administration; D011247:Pregnancy; D011369:Professional-Patient Relations; D012938:Social Perception; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult