Nurses’ and clients’ experiences of co-designing solutions to improve provider-client relationships in maternal and child healthcare: A human-centred design study in rural Tanzania

Background: There has been a persistent increase in clients’ dissatisfaction with providers’ competencies in maternal and child healthcare (MCH). Existing interventions have failed to address the complexity of provider-client relationships. Therefore, targeted, contextualized innovative solutions that place providers and clients at the forefront as agents of change in optimizing intervention design and implementation are needed. The study team adopted a co-design approach where MCH nurses, clients, and stakeholders partnered to design an intervention package to improve provider-client relationships in rural Tanzania. Objective This paper explored nurses’, clients’, and MCH stakeholders’ experiences of participation in a co-design process to generate interventions to strengthen nurse-client relationships in Shinyanga. Methods A qualitative descriptive design was used. Thirty semi-structured key informant interviews were conducted in the Swahili language with purposefully selected nurses, clients, and MCH stakeholders. The inclusion criterion was participation in synthesis, ideation, and creative workshops as part of the co-design of an intervention package to strengthen nurse-client relationships. Data were transcribed and translated simultaneously, managed using NVivo, and analyzed thematically. Results Three main themes emerged from the analysis. 1) Key learnings from participation in the co-design process, which included knowledge that: both nurses and clients contributed to tensions within their relationships; the benefits of good nurse-client relationship extended beyond nurses and clients to the health sector; and improvement of nurse-client relationships requires interventions targeting nurses, clients, and the health sector. 2) Co-design offered a promising strategy for addressing many challenges facing the health sector beyond interpersonal relationships because it is innovative and brings together parties and end-users impacted by the problem and generates acceptable interventions that contribute to enhanced satisfaction. 3) Co-design promoted co-learning of new skills and knowledge among participants, which influenced changes in their behaviours and practices, even before the implementation of the generated solutions. Conclusion End-users’ experiences of co-design suggest it provides a novel entry point for strengthening provider-client relationships and addressing other health sector challenges. In co-design, clients are invited to partner with providers and stakeholders in designing highly acceptable and feasible interventions. Researchers and interventionists should consider embracing a co-design approach to address health service delivery challenges.