Table 1. Normative and evidential building blocks: the link between definitions of disrespect and abuse, and the list of actions and behaviours used in measurement.
| Normative Building block | Definition | Category of D&A a | Evidentiary Building Block: Examples of actions or behaviors that are reported | Questions asked |
|---|---|---|---|---|
| Human rights law | Right to health, freedom from abusive behavior and entitlement to facility conditions that are, accessible, affordable, acceptable and of good quality (AAAQ). | Physical abuse | Pinching/slapping/pushing/beating/ poking Rape/ sexual harassment. |
At any point during your stay for this delivery were you physically abused by any of the healthcare workers? For example physical abuse might include being hit or slapped. |
| Detention | Detained when a woman is unable to pay for services. | At any point during your stay for this delivery were you or your baby prevented from leaving this facility because you could not pay? | ||
| Non confidential | HIV status shown to others; health information discussed with non-health staff; uncovered during delivery or examination; no screens blocking view during delivery or examination; discussed her issues when other clients were listening | At any point during your stay for this delivery were you treated in a way that violated your privacy? At any point during your stay for this delivery were you treated in a way that violated your confidentiality? | ||
| Domestic law | Malpractice or criminal wrongs such as assault. | Corruption | Request for a bribe for services. | At any point during this delivery in this facility did you feel/ perceive or were you asked by anyone for money other than the official cost of service to access services or any favors. |
| Ethical codes | Standards of conduct for members of medical /nursing professions and national standards of care developed by the MOH. | Non consented care | No permission obtained before examination for medical procedures such as tubal ligation, hysterectomy. | At any point during your stay for this delivery was any treatment done to you without your permission? |
| Abandonment /neglect | Ignored when sought help for pain relief or left unattended by heath workers when they needed help. | At any point during your stay for this delivery were you left un attended by health providers when you needed care? | ||
| Local consensus | Specific set of behaviors or conditions that patients, families, providers, agree constitute inexcusable D&A. | Non dignified care | Use of non-dignified language such as shouting and scolding; Threats of withholding services /threatened with going to theatre, called insulting names, laughed or scorned at | At any point during your stay for this delivery did any healthcare provider talk to you or use a tone or facial expression that made you feel uncomfortable? |
Note: Normative building blocks comprise codes of behavior or infrastructural standards, and departure from these standards could be considered violations constituting D&A. The normative block has four key dimensions: human rights law, domestic law, ethical codes and local consensus on behaviors The evidentiary building block, meanwhile, refers to events or conditions considered as D&A, regardless of patient experience or provider intention, classified into three dimensions: 1) subjective experiences whereby women experience D&A even if it does not result from actions observed; 2) objective events or conditions that are observable actions experienced or intended as such;; and 3) intentionality, whereby a woman does not interpret an action as D&A, but the provider actually intends it as disrespectful or abusive.