{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:39:15Z","timestamp":1790998755445,"version":"4.1.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009647","name":"University Grants Commission- Nepal","doi-asserted-by":"publisher","award":["PhD-79\/80-HS.0I"],"award-info":[{"award-number":["PhD-79\/80-HS.0I"]}],"id":[{"id":"10.13039\/501100009647","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005967","name":"Linn\u00e9universitetet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005967","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ensuring respectful maternity care is crucial to promote positive childbirth experiences among women. Globally, 22\u2013100% women report experiencing at least one form of disrespect and abuse during facility-based birth, with a study in Nepal reporting 100% prevalence. Thus, interventions like Forum Play are needed to promote respectful maternity care but remain scarce. Forum Play is a participatory theatre technique which encourages the participants to create scenes based on their own experiences illustrating a situation of oppression. This study aimed to assess the effectiveness of a pilot Forum Play intervention in promoting respectful maternity care by investigating self-reported perception and behaviour among care providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A quasi-experimental pre\u2013post study with a control group was conducted among doctors and nurses in two tertiary hospitals in Nepal. Participants involved in providing care or interacting with women during labour and delivery were purposively selected for the intervention and control groups. The intervention group comprised 25 care providers (14 nurses and 11 doctors), while the control group included 75 care providers (42 nurses and 33 doctors). Two half-day Forum Play workshops were conducted separately for nurses and doctors in the intervention hospital. Data were collected using a self-administered structured questionnaire at baseline and two months post-intervention in both groups; however, the design was not strictly parallel. In the control hospital, data were collected later at the same intervals to provide contextual comparison. Data were analysed using IBM statistical package for social sciences version 20. Descriptive statistics (frequency, percentage, mean and standard deviation) were used to measure the self-reported perception and behaviour on disrespect and abuse and perceptions of respectful maternity care. Mann Whitney U test was used to compare groups and Wilcoxon Signed Rank test was used to assess within-group changes before and after the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were no differences in background characteristics between intervention and control groups (p=&gt;0.05), nor in the overall disrespect and abuse of women at baseline (p\u2009=\u20090.09 to 0.35) whereas significant differences were observed at follow-up (p=&lt;0.001 to 0.004, r\u2009=\u20090.33 to 0.61). There were no significant differences in perception scores towards respectful maternity care between the groups at baseline while significant differences were found at follow-up (z\u2009=\u2009\u22123.25, p\u2009=\u20090.001 and r\u2009=\u20090.32). The perception score was significantly higher in the intervention group after the intervention (z\u2009=\u2009\u22123.073, p\u2009=\u20090.002 and r\u2009=\u20090.61) while no significant difference was observed in the control group (z\u2009=\u2009\u22120.120, p\u2009=\u20090.90 and r\u2009=\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Forum Play as a method of participatory intervention has the potential to enhance positive perception and behavioral change among care providers towards respectful maternity care. Scaling up the Forum Play intervention and systematically exploring women\u2019s experiences are essential to determine its actual effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349437","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:26:38Z","timestamp":1780507598000},"page":"e0349437","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of Forum Play to promote respectful maternity care: A pilot intervention investigating self-reported perception and behaviour among care providers in urban Nepal"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5785-2712","authenticated-orcid":true,"given":"Narayani","family":"Paudel Ghimire","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7399-9829","authenticated-orcid":true,"given":"Pranab","family":"Dahal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2704-5060","authenticated-orcid":true,"given":"Sunil Kumar","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Swahnberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"pone.0349437.ref001","author":"White Ribbon Alliance for safe motherhood","year":"2022"},{"key":"pone.0349437.ref002","volume-title":"WHO recommendations: Intrapartum care for a positive childbirth experience","year":"2018"},{"key":"pone.0349437.ref003","author":"WHO"},{"key":"pone.0349437.ref004","author":"D Bowser","year":"2010"},{"issue":"6","key":"pone.0349437.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001847","article-title":"The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review","volume":"12","author":"MA Bohren","year":"2015","journal-title":"PLoS Med"},{"key":"pone.0349437.ref006","author":"S Hodin","year":"2017"},{"key":"pone.0349437.ref007","doi-asserted-by":"crossref","first-page":"1465215","DOI":"10.1080\/16549716.2018.1465215","article-title":"Mothers\u2019 experience of disrespect and abuse during maternity care in northern Ethiopia","volume":"11","author":"MW Gebremichael","year":"2018","journal-title":"Glob Health Action"},{"issue":"185","key":"pone.0349437.ref008","article-title":"Prevalence of disrespect and abuse during facility-based childbirth and associated factors, Jimma University Medical Center, Southwest Ethiopia","volume":"19","author":"A Siraj","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"7","key":"pone.0349437.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0200318","article-title":"Disrespect and abuse during childbirth in district Gujrat, Pakistan: a quest for respectful maternity care","volume":"13","author":"Z Azhar","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pone.0349437.ref010","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1186\/s12884-019-2532-z","article-title":"Disrespect and abuse during facility-based childbirth in southern Mozambique: a cross-sectional study","volume":"19","author":"A Galle","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0349437.ref011","doi-asserted-by":"crossref","first-page":"1923327","DOI":"10.1080\/16549716.2021.1923327","article-title":"Disrespect and abuse during facility-based childbirth in central Ethiopia","volume":"14","author":"YM Adinew","year":"2021","journal-title":"Glob Health Action"},{"issue":"18","key":"pone.0349437.ref012","doi-asserted-by":"crossref","first-page":"9612","DOI":"10.3390\/ijerph18189612","article-title":"Women\u2019s experience of disrespect and abuse during institutional delivery in Biratnagar, Nepal","volume":"18","author":"NP Ghimire","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"10210","key":"pone.0349437.ref013","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1016\/S0140-6736(19)32258-5","article-title":"Accountability for respectful maternity care","volume":"394","author":"PA Afulani","year":"2019","journal-title":"Lancet"},{"key":"pone.0349437.ref014","doi-asserted-by":"crossref","first-page":"1048441","DOI":"10.3389\/fgwh.2023.1048441","article-title":"Are respectful maternity care (RMC) interventions effective in reducing intrapartum mistreatment against adolescents? 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