“We need that consent to protect ourselves!”: An in-depth analysis of health care provider’s perspectives on informed consent and debriefing for caesarean section in West Cameroon using an interpretivist paradigm.

Women-centredness is a key quality domain for caesarean section (CS) which can be strengthened by adequate informed consent and post-operative debriefing. CS providers are instrumental in delivering these services and in appraising their adequacy, along with facilitating factors and barriers. However, little is known about providers’ perspectives on informed consent and debriefing practice in countries with limited access to and quality of CS, like Cameroon. To explore CS providers perspectives on the routine practice of informed consent and post-operative debriefing in West Cameroon. From March to August 2024, we conducted face-to-face in-depth interviews with 69 CS providers purposively selected to reflect all clinical specialties, gender, levels of seniority and sociolinguistic profiles. Participants worked in the twenty hospitals in the West Region of Cameroon that recorded at least 100 CSs in 2022. Using an interpretivism paradigm, we generated codes inductively from verbatim transcripts and conducted thematic analysis. Three themes emerged: Domination of professional motivation for consent and debriefing by fear of litigations and the need to address unhealthful behaviours at the expenses of genuine women-centredness; Widespread multifaceted structural, processual and staff-related shortcomings in hospitals thwarting professional opportunities to deliver women-centred informed consent and debriefing; The negative impact of socio-cultural reluctance and misinformation on the provision consent and debriefing. Building on the multidimensional shortcomings reported by CS providers, a quality-improvement intervention towards women-centredness of informed consent and debriefing for CS could be designed targeting professional behavioural changes through standardized practice guidelines and supportive oversight among others. • We report care providers’ views on consent and debriefing for c-section in Cameroon • Health provider’s major motivation for consent and debriefing was fear of lawsuits • Health provider’s minor motivation was the need to address unhealthful behaviours • Health providers found hospitals’ context unconducive to consent and debriefing • Social norms and misinformation hamper proper consent and debriefing for c-section