Exploring the CASCADA Model in nurses and physicians on traditional midwifery: A qualitative study

Abstract

Introduction. In hard-to-reach indigenous communities in the state of Guerrero, Mexico, traditional birth attendants are the only trained personnel available for prenatal care and childbirth. The importance of linking nurses and physicians with traditional birth attendants arises from the inability of health systems to provide maternal care, especially in rural areas. Objective. Explore the Model of Knowledge, Attitudes, Subjective Norms, Intention to Change, Agency, Discussion and Action –CASCADA- in nurses and physicians regarding traditional midwifery in Xochistlahuaca, Guerrero. Methodology. Qualitative and descriptive study. Twenty-one in-depth interviews were conducted: 11 with physicians and 10 with nurses from the Basic Community Hospital and Health Centers of Xochistlahuaca, following the CASCADA model. The selection criterion involved medical personnel having contact with traditional birth attendants in the last twelve months. The work observed ethical guidelines and principles related to studies involving human participation. For the assessment, a priori codes and categories were identified. Results. Health personnel, aware of the loss of traditional midwifery, expressed positive and negative attitudes toward traditional birth attendants; health workers reported that traditional midwifery is worth developing, showed intention to change behavior, and presented the capacity to implement it. Conclusions. Health workers recognized that the decline in traditional midwifery would lead to more complications in pregnant women and even more maternal deaths, so they were willing to undertake behavior change actions to develop traditional midwifery.