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The Heshima project developed several study instruments to measure disrespect and abuse throughout the study’s formative, baseline, and endline stages. The quasi-experimental implementation research design applied a mixed methods approach to understanding the meaning and factors that drive disrespect and abuse in maternity settings in Kenya. These tools allowed the project to measure the prevalence of disrespect and abuse in this setting, as well as the changes affected by the project.

The Heshima project involved a complex set of multi-level interventions that sought to curb disrespectful and abusive practices during childbirth and promote dignified and respectful maternity care. The evidence collected using the surveys, assessments, interview, and discussion guides were informed through participatory research mechanisms, which also enabled the design of an intervention package rooted in local values and reality of the health system.

This toolkit is intended to support researchers, evaluators, monitoring systems, and other practitioners interested in measuring and conducting implementation research around respectful maternity care. Data collection tools and measures should be adapted to socio-cultural context through rigorous qualitative research.

We request that those using any of these tools please let us know ( and reference the Population Council in their work.


Please see the additional files at the end of this page to download individual tools.

  • The 2011 qualitative tools (files 1–5) informed the quantitative survey design, the intervention package, and baseline tools.
  • The quantitative tools (files 6–9) were used at baseline and endline to evaluate the changes following implementation.
  • The 2014 qualitative tools (files 10–12) were used at endline as explanatory measures.






Heshima: Promoting Dignified and Respectful Care During Childbirth

Heshima_IDI-for-women-who-experienced-DA_2011.pdf (203 kB)
In-depth Interview Guide for Women Who Experienced Disrespect and Abuse (2011)

Heshima_IDI-for-women-who-have-never-experienced-DA_2011.pdf (176 kB)
In-depth Interview Guide for Women Who Have Never Experienced Disrespect and Abuse (2011)

Heshima_IDI-with-policy-makers_2011.pdf (298 kB)
In-depth Interview Guide: Policy Makers (2011)

Heshima_IDI-with-service-provider_2011.pdf (292 kB)
In-depth Interview Guide: Service Providers (2011)

Heshima_FGD-for-community-members_2011.pdf (267 kB)
Focus Group Discussion Guide for Community Members (2011)

Heshima_CPI_Final.pdf (1266 kB)
Client Provider Interaction

Heshima_CEI_Final.pdf (979 kB)
Client Exit Survey

Heshima_Facility-Inventory_Final.pdf (393 kB)
Facility Assessment Tool

Heshima_Provider-Survey-Tool_Final.pdf (881 kB)
Service Provider Interview

Heshima_FGD-Guide_2014.pdf (289 kB)
Focus Group Discussion Guide for Community Members (2014)

Heshima_IDI_Case_Narrative_Women_who_gave_birth_2014.pdf (216 kB)
Case Narrative Guide (2014)

Heshima_KII-Guide_2014.pdf (282 kB)
Key Informant Interview (2014)