Health workers’ and administrators’ experiences of duty handover on maternity wards in public health facilities in Hoima District, Uganda: a qualitative phenomenological study
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Background
Duty handover is a high-risk point in the continuity of maternity care, and breakdowns in handover communication have been linked to delayed care and avoidable harm. Qualitative evidence from maternity wards in low-resource Sub-Saharan African settings is limited, and to our knowledge no study has examined handover experiences on maternity wards in Hoima District, Uganda. This study explored the experiences and challenges of health workers and administrators regarding duty handover on maternity wards in public health facilities in Hoima District, Uganda.
Methods
We conducted a qualitative phenomenological study. Fifteen in-depth interviews with maternity ward health workers and five key informant interviews with administrators were carried out across six public health facilities. Interviews were audio-recorded, transcribed verbatim and analysed using a modified Colaizzi seven-step method. Reflexivity and bracketing were addressed through a pre-fieldwork assumptions statement and bracketing interview, a reflexive journal kept throughout data collection, and independent double-coding of a subset of transcripts.
Results
Two themes were identified: duty handover practices on maternity wards, and challenges experienced by health workers during handover. Handover was inconsistent in structure, duration and adherence to protocol, and relied heavily on informal telephone communication rather than structured face-to-face reporting. Standardised tools were used in some facilities only. Participants identified time constraints and workload, inadequate training, limited resources and supervision, negative staff attitudes, and difficulty accessing patient information as key challenges, and linked communication breakdowns to delays and errors in care. Patients and families were largely not involved in handover.
Conclusions
Duty handover on the maternity wards studied was inconsistent and constrained by capability-, opportunity- and motivation-related barriers operating together. Standardised and locally adapted handover tools, targeted training, stronger supervision and facility- and national-level guidance appear necessary to protect continuity of care in comparable low-resource maternity settings.
