Enablers and barriers of domiciliary midwifery practice using the socio-ecological model: a qualitative study exploring the perspectives of students and lecturers in Uganda

Early postnatal discharge is increasingly common worldwide, yet the World Health Organization’s recommended 3-3-6 schedule for postnatal visits and assessments is often not adhered to by mothers and healthcare workers. The early neonatal period is critical for both mother and baby, accounting for a significant proportion of maternal and neonatal deaths, especially in developing countries. According to the recently released Midwifery Accelerator, achieving universal coverage of care provided by midwives can avert two-thirds of maternal and newborn deaths, including stillbirths. Domiciliary midwifery practice, where mothers and newborns are followed up at home after discharge, represents a promising model of midwifery continuity of care that can assist in reducing maternal and neonatal mortality. This study therefore, aims to explore the perceived factors influencing domiciliary midwifery practice among midwifery students. A qualitative descriptive cross-sectional study was conducted using semi-structured interview and focus group discussion guides. Seven key informant interviews and three focus group discussions were conducted among purposively selected lecturers and 20 Bachelor of Midwifery Science students in Lira District, Uganda. Data was collected between May and July 2024, and analyzed using the socio-ecological model, thematic analysis, while NVivo software was used to organize the data. Two major themes of barriers and facilitators, with 14 subthemes were identified. Multiple intertwined factors at various levels were found to influence student’s domiciliary midwifery practice. Most of these factors operated at the individual and institutional levels. Individual-level factors included poverty, cultural beliefs, and trust. At the institutional level, factors included the availability of resources, supervision, time constraints, and the working environment. Significant figure influence, attitudes, relationships, and feedback were identified at the interpersonal level. Many of the individual and institutional factors that hinder effective domiciliary midwifery practice by students are preventable. Therefore, stakeholder engagement is crucial to address these barriers at all levels, with the ultimate goal of reducing maternal neonatal mortality during the early postnatal period.