title: Health workers' perceptions of obstetric critical incident audit in Thyolo District, Malawi.
abstract: OBJECTIVE
  To assess perceptions held by health workers in a Malawian district about obstetric critical incident audit. Insight into factors contributing to participation and endorsement may help to improve the audit process and reduce facility-based maternal and neonatal mortality and morbidity.
  
  
  METHODS
  This study involves semi-structured interviews with 25 district health workers, a focus group discussion and observation of audit sessions in health facilities in Thyolo District, Malawi, between August 2009 and January 2010. Data were analysed with maxqda 2010.
  
  
  RESULTS
  Findings were categorized into four major areas: (i) general knowledge of audit, (ii) participation in local audit and feedback sessions, (iii) the ability to reproduce the local audit cycle and (iv) effects and outcomes of audit and feedback. All health workers were familiar with the concept of audit and could reproduce the local cycle. Most health workers classified audit as an instructive and helpful tool to improve the quality of their work, provided that it is performed in a manner that enhances motivation and on-the-job learning.
  
  
  CONCLUSIONS
  Contradictory to recent reports from other African settings, which showed negative effects of audit on health workers' motivation, staff in this district considered audit and feedback valuable tools to enhance the quality of the care they provide. Audit has become part of the professional routine in the district, and its educational value was considered its most important appeal.
authors.affiliation: Department of Medical Humanities, EMGO+ Institute, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Bakker
authors.forename: Thomas
authors.initials: T
authors.lastname: van den Akker
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mwagomba
authors.forename: Rex
authors.initials: R
authors.lastname: Khukulu
authors.forename: Marianne
authors.initials: M
authors.lastname: van Elteren
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000293:Adolescent; D000328:Adult; D054869:Clinical Audit; D003150:Community Health Workers / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D017144:Focus Groups; D006801:Humans; D008295:Malawi; D008297:Male; D008428:Maternal Mortality; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy; D058996:Quality Improvement; D012938:Social Perception; D013192:Staff Development / Q000379:methods / Q000458:organization & administration / Q000592:standards / Q000639:trends; D011795:Surveys and Questionnaires