Facilitators and Barriers to Discharge Education for Puerperal Sepsis Prevention After Caesarean Section: A Qualitative Study at a Tertiary Health Facility in Southwestern Uganda

Abstract

Introduction: Maternal mortality remains a major global health concern, disproportionately affecting low- and middle-income countries. Puerperal sepsis remains an important contributor to maternal morbidity and mortality, with caesarean delivery increasing women’s risk of infection. As caesarean deliveries increase, strengthening strategies to prevent puerperal sepsis throughout the continuum of care is increasingly important. Although prevention efforts have focused largely on antenatal and intrapartum care, post- discharge self-care and education remain insufficiently emphasized. Evidence from Mbarara Regional Referral Hospital indicates gaps in women’s knowledge and practices regarding post-caesarean self-care, highlighting the need for effective discharge education to support prevention, early recognition, and timely care-seeking for puerperal sepsis. However, the effectiveness of discharge education depends not only on the information provided but also on healthcare providers’ ability and willingness to deliver it within the available health-system environment. The COM-B framework provides a useful lens for understanding these influences by examining providers’ capability, opportunities within the health system, and motivation to deliver discharge education. Understanding these factors is therefore important for identifying barriers and facilitators that can be addressed to strengthen puerperal sepsis prevention after discharge. The study aimed to explore the facilitators and barriers to the provision of discharge education for puerperal sepsis prevention following caesarean delivery. Methods: This study employed an exploratory qualitative design at Mbarara Regional Referral Hospital. A total of 12 healthcare providers, comprising six senior house officers and six midwives, were purposively selected, provided informed consent, and participated in in-depth interviews. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted by systematically coding statements from the transcripts, organizing similar codes into subthemes, and subsequently synthesizing the subthemes into overarching themes. Results: Twelve healthcare providers (six midwives and six senior house officers) participated in the study. Under Capability, knowledge, clinical experience, and awareness of puerperal sepsis and its prevention facilitated discharge education. Opportunity was facilitated by the availability of discharge forms and opportunities to provide education, but barriers included limited post- caesarean-specific information, inconsistent timing and content of instructions, language barriers, inadequate staffing and time, fatigue, limited space and privacy, and gaps in coordination and teamwork. Under Motivation, professional commitment, passion for patient care, and awareness of the consequences of inadequate education facilitated discharge teaching, whereas patient disengagement, heavy workload, and other demotivating factors hindered it. Conclusion: Discharge education for puerperal sepsis prevention following caesarean section was influenced by interacting provider and health-system factors. While providers’ knowledge, experience, commitment, and available resources supported education, workload, staffing constraints, limited privacy and space, language and literacy barriers, inadequate post-caesarean materials, inconsistent timing, and gaps in teamwork constrained its consistent delivery. Strengthening discharge education therefore requires a multi-level approach that addresses both providers’ capability and motivation and the health-system opportunities needed to deliver effective education.