Development and testing of a tool to assess health workers' clinical confidence to provide perinatal bereavement care in Sub-Saharan Africa

研究背景：婴儿在出生前、出生中或出生后不久死亡，称为死产或新生儿死亡，是父母生活中最痛苦的事件之一。绝大多数死产和新生儿死亡发生在低收入和中等收入国家，撒哈拉以南非洲和南亚约占世界总数的75%。婴儿死亡会对父母产生长期影响，大大增加身心健康状况不佳和家庭破裂的风险，对更广泛的社会产生负面影响。在世界各地，大多数妇女在医院分娩。我们知道，当婴儿死亡时，在死亡前后得到卫生工作者的良好照顾和支持，对帮助母亲和父亲应对和适应损失具有积极作用。然而，在许多国家，包括非洲国家，父母在婴儿死亡后没有得到足够好的照顾或支持。卫生工作者告诉我们，他们发现这部分工作很困难，并不总是知道他们应该做些什么来支持父母，他们需要更多的教育和机构的帮助，以提供更好的护理。采用适当的方法（如调查表）来评估卫生工作者的能力，确定有待发展的领域，并检验一揽子培训等战略的有效性，对于展示和保持改进至关重要。评估丧亲关怀的工具需要反映当地的环境和文化。目前，用于评估卫生工作者在婴儿死亡后提供护理方面的知识和信心的工具非常少，而且也没有与非洲卫生工作者或父母一起开发的工具。目的：本研究的目的是开发和测试一种工具，以评估卫生工作者在撒哈拉以南非洲地区死胎或新生儿死亡后提供丧亲护理的信心。研究计划：由来自英国、马拉维和津巴布韦的助产士、心理学家和统计学家组成的团队将与当地卫生工作者、管理人员、政策制定者和以前有过婴儿死亡经验的父母合作。在第一阶段，将利用以前的研究、当地卫生工作者在提供护理方面的经验以及行为改变理论来开发该工具。整个团队将参与围绕主题和问题的选择以及回答方法（如量表）的决策。一旦该工具获得同意，将在马拉维和津巴布韦的少数卫生工作者中进行测试，以确保它清晰、可接受且易于完成。一致性也将受到考验。根据结果，必要时将进行修订。在第二阶段，该工具将在马拉维、津巴布韦、肯尼亚、坦桑尼亚、乌干达和赞比亚的多达300名卫生工作者中进行测试，以评估其是否可靠并衡量其目的。该工具可能对其他低收入和中等收入国家以及流产后护理等相关情况有用。它也可以与其他专业团体一起使用，例如社区卫生工作者和顾问。能力提升：在这项研究中，本地研究人员将有机会获得开发和测试工具的技能。经验不足的研究人员将得到资深研究人员（联合王国和非洲）的支持，以发展领导能力和管理经验，这将有助于提高当地大学，特别是马拉维和津巴布韦的地方大学开展助产研究和改善母婴健康的能力。英国研究人员将在全球卫生研究方面获得更多经验。

Background to the research: The death of a baby before, during, or soon after birth, termed stillbirth or neonatal death, is amongst the most traumatic of life events for parents. The overwhelming majority of stillbirths and neonatal deaths happen in low- and middle-income countries, with sub-Saharan Africa and South Asia accounting for around 75% of the world total. The death of a baby has long-lasting impacts on parents, greatly increasing the risk of poor mental and physical health and family breakdown, which have negative effects on wider society. Across the world, most women give birth in hospitals. We know that when a baby dies, having good care and support from health workers in the hours and days surrounding the death has a positive effect in helping mothers and fathers cope, and adjust to the loss. However, in many countries, including African countries, parents do not get good enough care or support after their baby dies. Health workers tell us that they find this part of their work difficult and do not always know what they should do to support parents, they need more education and help from facilities to give better care. Having appropriate methods (such as questionnaires) to assess health workers' abilities, identify areas for development, and test the effectiveness of strategies such as training packages, is crucial to demonstrate and maintain improvement. Tools to assess bereavement care need to reflect the local environment and culture. Currently, there are very few tools designed to assess health workers' knowledge and confidence in providing care after the death of a baby, and none have been developed with African health workers or parents.Aim: The aim of this research is to develop and test a tool to assess the confidence of health workers to provide bereavement care after stillbirth or neonatal death in sub-Saharan Africa.Research plan: A team of midwives, psychologists, and statisticians from the UK, Malawi, and Zimbabwe will work with local health workers, managers, policymakers, and parents, with previous experience of the death of a baby. In phase 1, the tool will be developed, using previous research, experiences of local health workers in providing care, and behaviour change theories. The whole team will be involved in decisions surrounding the choice of topics and questions to be included and methods for response e.g. scales. Once the tool is agreed it will be tested with a small number of health workers in Malawi and Zimbabwe to ensure it is clear, acceptable, and easy to complete. Consistency will be also tested. Revisions will be made as necessary, based on the results. In phase 2 the tool will be tested with up to 300 health workersacross Malawi, Zimbabwe, Kenya, Tanzania, Uganda, and Zambia, to assess whether it is reliable and measures what is intended.The tool is likely to be useful in other low- and middle-income countries and for related situations e.g. care following a miscarriage. It could also be used with other professional groups, such as community health workers and counsellors. Capacity strengthening: During this research, the local researchers will have the opportunity to gain skills in developing and testing tools. Inexperienced researchers will be supported by senior researchers (UK and Africa) to develop leadership and management experience which will contribute to increasing the capacity of local universities, particularly in Malawi and Zimbabwe, to conduct midwifery research and improve the health of mothers and babies. UK researchers will gain additional experience in global health research.