Philosophiae Doctor - PhD / Childbirth is a multifaceted experience that is usually influenced by several factors that could result in an unsatisfactory or satisfactory childbirth experience. These factors include quality of support during labour of which Continuous Labour Support (CLS) is a part; it has been identified as a positive contributor to maternal health. Although CLS has been recommended by the World Health Organization (WHO), lack of a framework has also been an impediment to its implementation in Nigerian hospitals. The purpose of this study is to develop a culturally congruent Continuous Labour Support framework for women in Nigeria. The study adopted a concurrent mixed method design to gain information from various dimensions for the study. The study populations included pregnant women, nurse-midwives and health policy-makers in Ondo state, Nigeria, who were selected through simple random sampling using computer-generated tables for the quantitative strand of the study. For the qualitative strand, participants were selected using a purposeful sampling method. The study was conducted in two phases. Phase 1 focused on the assessment of the perceptions, attitudes and preferences of all groups of participants. Collected quantitative data was analysed using descriptive and inferential statistics through the use of the Statistical Package for Social Science (SPSS) Version 21. Qualitative data was analysed using Tesch's Method of Content Analysis. Findings the study shows that the pregnant women had positive perceptions and attitudes towards CLS from a familiar, close and trusted person, in public health facilities. Findings from the midwives revealed that pregnant women's family members are not usually involved in women's care during labour in public health facilities. However, nurse-midwives expressed satisfaction with the few occasional/discretional occasions on which the practice had been implemented, and the majority showed positive perceptions and attitudes to the introduction of CLS from a person of the woman's choice, in public health facilities. Findings from interviews with the policy-makers affirmed family support system during labour as a cultural expectation and a traditional practice at home but alien to the hospital. The policy-makers also expressed a positive standpoint on the introduction of CLS by persons of the woman’s choice from her social network, in the public hospital. Phase 2 of the study involved the development of the culturally congruent Continuous Labour Support framework for women in south-west Nigeria. The framework was developed using the Model Development Approach by Walker and Avant (2005, 2011). Findings from processes with all stakeholders in Phase 1 of the study were synthesised with literature review, using concept identification and classification. The concepts in this study were identified, described and developed through synthesis of data from questionnaire, the focus group and individual interviews of all stakeholders. Concept classification, description and validation was achieved through the six vantage points of surveying activity listed by Dickoff et al, (1968) in consultation the selected expert reviewers in maternal and child care. The developed framework was followed by a detailed description, and validation of the framework was done through consensus agreement with four experts.

The growing number of minority populations living in the United States makes it mandatory that all health care organizations seek to be culturally sensitive. There is no consensus on the definition of the term cultural sensitivity. The goal of this thesis is to define what cultural sensitivity means in a rural health center, from the perspective of the staff as well as the Hispanic patient. Anthropological methods, such as participant observation, semi-structured interviews, and archival data analysis, show that the qualities that Hispanic patients value in a clinic are 1) attention, 2) availability of Spanish language, 3) financial assistance, 4) solution to their health problems, 5) presence of Hispanics around the clinic, and 6) clinic services. Furthermore, 90% of staff responses indicate acceptance and respect of patients health beliefs and practices. Results demonstrate that while the clinic is culturally sensitive, there are a few recommendations that would improve the quality of care that Hispanics receive. Based on the results of the data collection, a practical model for other rural health centers to build upon a culturally sensitive health care system is developed.

The exponential growth of culturally diverse populations in the United States has led to a multicultural patient population while the nursing workforce remains predominantly White. At the project site, managers identified that staff nurses struggled to deliver culturally competent care. The purpose of this project was to improve the cultural competence of registered nurses (RNs) through a transcultural nursing education program. Leininger's transcultural nursing theory guided the project. Sources of evidence used to develop a face-to-face educational program included peer-reviewed journals, credible websites, and the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-R tool. Aggregate pretest and posttest scores were used to determine RNs' competency levels. The Statistical Package for the Social Sciences software was used for data analysis, and a paired t test was used to determine the impact of the program. Of the 22 participants, 4 (18%) scored within the culturally competent range on the pretest, compared to 17 (77%) on the posttest. These findings were statistically significant (p < 0.000) and demonstrated a positive outcome from the educational project. Key recommendations are to continue this education for other RNs in the facility and at other facilities in the network. The implications of this project for positive social change include raising the cultural competency of nurses, which has the potential to improve patient outcomes.