Using ‘Appreciative Inquiry’ in India to improve infection control practices in maternity care: a qualitative study

Bharati Sharma, K V Ramani, Dileep Mavalankar, Lovney Kanguru, Julia Hussein

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7 Citations (Scopus)
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Background: Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection.

Objective: To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units.

Design: An organisational change process called ‘appreciative inquiry’ (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained from three hospitals which implemented AI and another three not involved in the intervention.

Results: Challenges which emerged included management processes (e.g. decision-making and problem-solving modalities), human resource shortages, and physical infrastructure (e.g. space, water, and electricity supplies). AI was perceived as having a positive influence on infection control practices. Respondents also said that management processes improved although some hospitals had already undergone an accreditation process which could have influenced the changes described. Participants reported that team relationships had been strengthened due to AI.

Conclusion: Technical knowledge is often emphasised in health care settings and less attention is paid to factors such as team relationships, leadership, and problem solving. AI can contribute to improving infection control by catalysing and creating forums for team building, shared decision making and problem solving in an enabling environment.
Original languageEnglish
Article number26693
Number of pages11
JournalGlobal Health Action
Issue number1
Early online date25 Jun 2015
Publication statusPublished - 2015

Bibliographical note

The inputs and facilitation of field work from the Gujarat state government officials are acknowledged. We express our gratitude to the doctors, nurses and other health facility staff for actively participating in the study. Our special thanks to Dr. Pritam Pal for capacity building of the research team for appreciative inquiry and Mr. Sanjay Joshi for follow-up of the AI process. We appreciate the help of Dr. Purvi Shah in data collection and preparing transcripts for the study. The study was funded by the John D. and Catherine T. MacArthur Foundation.


  • India
  • Infection Control
  • sepsis
  • maternal health
  • maternity services
  • appreciative inquiry


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