Implementation of a novel ultrasound training programme for midwives in Malawi: A mixed methods evaluation using the RE-AIM framework.
Implementation of a novel ultrasound training programme for midwives in Malawi: A mixed methods evaluation using the RE-AIM framework.
复制标题
DOI：
10.3389/frhs.2022.953677
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Chipeta, Effie
中科院分区：
文献类型：
--
作者：
Viner, Alexandra C;Malata, Monica P;Mtende, Medrina;Membe-Gadama, Gladys;Masamba, Martha;Makwakwa, Enita;Bamuya, Catherine;Lissauer, David;Stock, Sarah J;Norman, Jane E;Reynolds, Rebecca M;Magowan, Brian;Freyne, Bridget;Gadama, Luis;Cunningham-Burley, Sarah;Nyondo-Mipando, Linda;Chipeta, Effie
尽管建议所有妇女在怀孕24周之前接受超声波检查，但在缺乏训练有素的医生的低收入国家，许多妇女仍然无法获得这项服务。虽然许多方案已显示出效力，但很少有方案能够实现长期的可持续性，因为缺乏关于如何最好地执行这些方案的资料。这项混合方法研究旨在评估马拉维一项新的教育计划的实施情况，该计划旨在向没有接触过超声波的助产士教授基础产科超声，并评估其在覆盖、有效性、采用、实施和维护（RE-AIM）框架下的影响。该研究于2020年10月至2021年6月在马拉维的六个地点进行，分为三个阶段；实施前、实施中和实施后。29名助产士接受了定制的一揽子教育，课程前后进行了匹配的调查，评估了他们的知识、态度和信心，并对实际技能进行了“动手”评估。培训评估表格和深度访谈考察了他们对培训包的满意度，通过重复评估和远程图像回顾评估技能的维持。28/29助产士完成了培训，知识、信心和实践技能都有了显著提高。对整套教育方案的遵守情况各不相同，但对拟议方法的许多修改是适当的，似乎有助于方案的效力。不幸的是，尽管报告对培训本身表示赞同，但对监督和跟进的满意度却参差不齐，这反映了在提供持续的面对面和远程支持方面遇到的困难。该方案成功地提高了受训者在进行基本产科超声检查方面的知识、信心和技能，这在很大程度上是由于采用了适应性的执行方法。持续支持的维持是具有挑战性的，这反映在受训人员的不满上。通过评估这一教育方案的实施效果，而不仅仅是其效果，我们对可持续高档的障碍，特别是维护方面的障碍有了新的认识。
Despite recommendation that all women receive an ultrasound in pregnancy prior to 24 weeks', this remains unavailable to many women in low-income countries where trained practitioners are scarce. Although many programmes have demonstrated efficacy, few have achieved longterm sustainability, with a lack of information about how best to implement such programmes. This mixed-methods study aimed to evaluate the implementation of a novel education package to teach ultrasound-naive midwives in Malawi basic obstetric ultrasound, assessing its impact in the context of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. The study ran across six sites in Malawi between October 2020 and June 2021, encompassing three phases; pre-implementation, implementation and post-implementation. Twenty nine midwives underwent a bespoke education package with matched pre and post course surveys assessed their knowledge, attitudes and confidence and “hands on” assessments evaluating practical skills. Training evaluation forms and in-depth interviews explored their satisfaction with the package, with repeat assessment and remote image review evaluating maintenance of skills. 28/29 midwives completed the training, with significant increases in knowledge, confidence and practical skills. Adherence to the education package varied, however many changes to the proposed methodology were adaptive and appeared to facilitate the efficacy of the programme. Unfortunately, despite reporting approval regarding the training itself, satisfaction regarding supervision and follow up was mixed, reflecting the difficulties encountered with providing ongoing in-person and remote support. This programme was successful in improving trainees' knowledge, confidence and skill in performing basic obstetric ultrasound, largely on account of an adaptive approach to implementation. The maintenance of ongoing support was challenging, reflected by trainee dissatisfaction. By evaluating the success of this education package based on its implementation and not just its efficacy, we have generated new insights into the barriers to sustainable upscale, specifically those surrounding maintenance.