Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India
Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India
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DOI：
10.9745/ghsp-d-16-00410
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发表时间：
2017-06-27
影响因子：
4
通讯作者：
Firestone, Rebecca
中科院分区：
文献类型：
--
作者：
Delaney, Megan Marx;Maji, Pinki;Firestone, Rebecca
背景：坚持循证的基本分娩实践对于改善母亲和新生儿的健康结果至关重要。世卫组织安全分娩清单（SCC）包含了这些做法，这些做法发生在4个关键的暂停点：入院时，推前（或剖宫产），出生后不久和出院前。同伴指导策略，以支持一致使用SCC可能是一种有效的方法，以提高助产士的坚持这些做法。方法：我们评估了来自印度北方邦60家公共卫生机构的数据，这些机构在2014年12月至2016年9月期间接受了为期8个月的交错辅导干预，作为BetterBirth试验的一部分，该机构正在研究以SCC为中心的干预措施对孕产妇和新生儿伤害的有效性。护士教练记录了助产士对39种基本分娩做法的遵守情况。计算每个干预月的实践依从性。经过2个月的辅导，15个设施的子样本被选为独立观察时，教练不在场。我们比较了教练和独立观察员记录的18种做法的依从性。结果：教练在5,971次分娩中观察了助产士的行为。到干预的最后一个月，39种基本分娩实践中有35种在教练在场的情况下达到了90%以上的依从性，而在第一个月，39种实践中只有7种。改善最大的关键行为包括解释危险信号、测量体温、评估胎儿心音、开始皮肤接触和母乳喂养。没有教练在场，助产士的平均遵守的做法和清单的使用是24个百分点，低于教练在场时（范围：-1%至62%）。设施工作人员之间的协调和沟通，以及具有直接，切实利益的行为，表现出最大的改善。难以执行的行为和那些延迟或理论上的好处是不太可能持续没有教练在场。辅导可能是实施安全分娩检查表的重要组成部分。注：在本文发表时，对BetterBirth干预措施影响的评估结果正在另一份期刊上发表。在影响结果公布后，我们将参考影响结果更新这篇关于干预措施对生育做法的影响的文章。
Background: Adherence to evidence-based essential birth practices is critical for improving health outcomes for mothers and newborns. The WHO Safe Childbirth Checklist (SCC) incorporates these practices, which occur during 4 critical pause points: on admission, before pushing (or cesarean delivery), soon after birth, and before discharge. A peer-coaching strategy to support consistent use of the SCC may be an effective approach to increase birth attendants' adherence to these practices.Methods: We assessed data from 60 public health facilities in Uttar Pradesh, India, that received an 8-month staggered coaching intervention from December 2014 to September 2016 as part of the BetterBirth Trial, which is studying effectiveness of an SCC-centered intervention on maternal and neonatal harm. Nurse coaches recorded birth attendants' adherence to 39 essential birth practices. Practice adherence was calculated for each intervention month. After 2 months of coaching, a subsample of 15 facilities was selected for independent observation when the coach was not present. We compared adherence to the 18 practices recorded by both coaches and independent observers.Results: Coaches observed birth attendants' behavior during 5,971 deliveries. By the final month of the intervention, 35 of 39 essential birth practices had achieved >90% adherence in the presence of a coach, compared with only 7 of 39 practices during the first month. Key behaviors with the greatest improvement included explanation of danger signs, temperature measurement, assessment of fetal heart sounds, initiation of skin-to-skin contact, and breastfeeding. Without a coach present, birth attendants' average adherence to practices and checklist use was 24 percentage points lower than when a coachwaspresent (range: -1% to 62%).Conclusion: Implementation of the WHO Safe Childbirth Checklist with coaching improved uptake of and adherence to essential birth practices. Coordination and communication among facility staff, as well as behaviors with an immediate, tangible benefit, showed the greatest improvement. Difficult-to-perform behaviors and those with delayed or theoretical benefits were less likely to be sustained without a coach present. Coaching may be an important component in implementing the Safe Childbirth Checklist at scale.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth intervention were pending publication in another journal. After the impact findings have been published, we will update this article on the effect of the intervention on birth practices with a reference to the impact findings.