Improving the Quality of Maternity Care through the Introduction of Professional Midwives and Mentoring in Selected Sub-District Hospitals in Bangladesh: A Mixed Method Study Protocol
Abstract
:1. Introduction
1.1. Background
1.2. Rational
1.3. Research Questions
- Is there an association between newly introduced professional midwives, with and without mentoring, and improved availability and quality of maternal and newborn health care in sub-district hospitals in Bangladesh?
- What are the experiences of the midwives, the maternity staff, and health managers (e.g., facility manager, residential medical officer, consultants), in establishing midwifery care?
1.4. Hypothesis
1.5. Objectives
- (1)
- To determine if a national deployment of midwives in a low-resource setting improves evidence-based maternal and newborn care practices with and without facility mentorship.
- (2)
- To explore the experiences of midwives providing care, as well as non-midwife maternity staff and health managers, to understand the underlying motivators that facilitated and challenged the introduction of midwives.
2. Experimental Design
2.1. Study Design and Setting
2.2. Theoretical Framework
2.3. Interventions
2.3.1. The Midwifery-Led Continuum of Care
2.3.2. Health Facility Mentoring
2.4. Eligibility Criteria of the Hospital
2.5. Team of the Data Collectors
2.6. Ethical Approval
3. Materials and Equipment
3.1. Data Collection Tools
3.2. Field Testing of the Data Collection Tools
3.3. Operational Definition
3.3.1. Professional Midwives
3.3.2. Health Facility Mentoring
3.4. Sample Size
3.4.1. Quantitative Component
3.4.2. Qualitative Component
3.5. Data Storage and Management
3.6. Data Analysis Plan
3.6.1. Quantitative Analysis
3.6.2. Qualitative Analysis
4. Detailed Procedure
4.1. Procedure to Recruit Participants
4.2. Data Sources/Measurements
5. Expected Results
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Miller, S.; Abalos, E.; Chamillard, M.; Ciapponi, A.; Colaci, D.; Comandé, D.; Diaz, V.; Geller, S.; Hanson, C.; Langer, A.; et al. Beyond too little, too late and too much, too soon: A pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016, 388, 2176–2192. [Google Scholar] [CrossRef]
- Adam, T.; de Savigny, D. Systems thinking for strengthening health systems in LMICs: Need for a paradigm shift. Health Policy Plan. 2012, 27, iv1–iv3. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- National Institute of Population Research and Training, Mitra and Associates, ICF International. Bangladesh Demographic and Health Survey 2017–2018; NIPORT: Dhaka, Bangladesh; ICF: Rockville, MD, USA, 2018. [Google Scholar]
- National Institute of Population Research and Training, Mitra and Associates, ICF International. Bangladesh Demographic and Health Survey 2014; NIPORT Mitra and Associates, and ICF International: Rockville, MD, USA; Dhaka, Bangladesh, 2016. [Google Scholar]
- DR, B. More health workers needed for universal health coverage. Bull. World Health Organ. 2018, 96, 734–735. [Google Scholar]
- World Health Organization. Health SDG Profile: Bangladesh 2019. Available online: https://apps.who.int/iris/bitstream/handle/10665/327747/Ban-profile-eng.pdf?sequence=1 (accessed on 27 August 2022).
- Rahman, M.S.; Rahman, M.M.; Gilmour, S.; Swe, K.T.; Abe, S.K.; Shibuya, P.K. Trends in, and projections of, indicators of universal health coverage in Bangladesh, 1995–2030: A Bayesian analysis of population-based household data. Lancet Glob. Health 2018, 6, e84–e94. [Google Scholar] [CrossRef] [Green Version]
- Chowdhury, M.E.; Nisha, M.K.; Roy, L.; Biswas, T.; Rahman, M.; Akhter, S. Human Resource Situation for Emergency Obstetric and Newborn Care (EmONC) Services in Public Facilities in MNHI Districts of Bangladesh; International Centre for Diarrhoeal Disease Research: Dhaka, Bangladesh, 2014. [Google Scholar]
- World Health Organization. Standards for Improving Quality of Maternal and Newborn Care in Health Facilities. 2016. Available online: https://apps.who.int/iris/bitstream/handle/10665/249155/9789241511216-eng.pdf?sequence=1%0Ahttp://www.who.int/iris/handle/10665/249155 (accessed on 14 October 2022).
- Bogren, M.; Begum, F.; Erlandsson, K. The Historical Development of the Midwifery Profession in Bangladesh. J. Asian Midwives 2017, 4, 65–74. [Google Scholar]
- World Health Organization. Global Standards for the Initial Education of Professional Nurses and Midwives. 2009. Available online: https://apps.who.int/iris/bitstream/handle/10665/44100/WHO_HRH_HPN_08.6_eng.pdf (accessed on 14 October 2022).
- Fullerton, J.; Severino, R.; Brogan, K.; Thompson, J. The International Confederation of Midwives’ study of essential competencies of midwifery practice. Midwifery 2003, 19, 174–190. [Google Scholar] [CrossRef]
- Zaman, R.U.; Khaled, A.; Sabur, M.A.; Islam, S.; Ahmed, S.; Varghese, J.; Sherratt, D.; Witter, S. Experiences of a new cadre of midwives in Bangladesh: Findings from a mixed method study. Hum. Resour. Health 2020, 18, 73. [Google Scholar] [CrossRef]
- Tiruneh, G.T.; Karim, A.M.; Avan, B.I.; Zemichael, N.F.; Wereta, T.G.; Wickremasinghe, D.; Keweti, Z.N.; Kebede, Z.; Betemariam, W.A. The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia. BMC Pregnancy Childbirth 2018, 18, 123. [Google Scholar] [CrossRef]
- Rajbhandari, S. Quality improvement in maternal and newborn health through on-site mentoring in Nepal. Int. J. Gynecol. Obstet. 2018, 143 (Suppl. S3), 701. [Google Scholar]
- Potty, R.S.; Lakkappa, M.H.; Kar, A.; Bidappa, M.; Manjappa, R.B.; Jayanna, K. Influence of integrated community- and facility-based interventions on select maternal and neonatal outcomes in Northern Karnataka, India: Lessons for implementation and measurement. Indian J. Public Health 2017, 61, 19–25. [Google Scholar] [CrossRef]
- Deussom, R.; Mwarey, D.; Bayu, M.; Abdullah, S.S.; Marcus, R. Systematic review of performance-enhancing health worker supervision approaches in low-and middle-income countries. Hum. Resour. Health 2022, 20, 2. [Google Scholar] [CrossRef] [PubMed]
- Bradley, J.; Jayanna, K.; Shaw, S.; Cunningham, T.; Fischer, E.; Mony, P.; Ramesh, B.M.; Moses, S.; Avery, L.; Crockett, M.; et al. Improving the knowledge of labour and delivery nurses in India: A randomized controlled trial of mentoring and case sheets in primary care centres. BMC Health Serv. Res. 2017, 17, 14. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fischer, E.A.; Jayana, K.; Cunningham, T.; Washington, M.; Mony, P.; Bradley, J.; Moses, S. Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Lessons from a Pilot Program in Northern Karnataka, India. Glob. Health Sci. Pract. 2015, 3, 660–675. [Google Scholar] [CrossRef] [PubMed]
- Jayanna, K.; Bradley, J.; Mony, P.; Cunningham, T.; Washington, M.; Bhat, S.; Rao, S.; Thomas, A.; S, R.; Kar, A.; et al. Effectiveness of Onsite Nurse Mentoring in Improving Quality of Institutional Births in the Primary Health Centres of High Priority Districts of Karnataka, South India: A Cluster Randomized Trial. PLoS ONE 2016, 11, e0161957. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kim, D.H. Introduction to Systems Thinking; Pegasus Communications: Waltham, MA, USA, 1999. [Google Scholar]
- Willig, C. Introducing Qualitative Research in Psychology; McGraw-Hill Education: Berkshire, England, 2013. [Google Scholar]
- Heale, R.; Forbes, D. Understanding triangulation in research. Evid. Based Nurs. 2013, 16, 98. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization. Systems Thinking for Health Systems Strengthening: Alliance for Health Policy and Systems Research. 2009. Available online: https://ahpsr.who.int/publications/i/item/2009-11-13-systems-thinking-for-health-systems-strengthening (accessed on 14 October 2022).
- Namazzi, G.; Waiswa, P.; Nakakeeto, M.; Nakibuuka, V.K.; Namutamba, S.; Najjemba, M.; Namusaabi, R.; Tagoola, A.; Nakate, M.G.; Ajeani, J.; et al. Strengthening health facilities for maternal and newborn care: Experiences from rural eastern Uganda. Glob. Health Action 2015, 8, 24271. [Google Scholar] [CrossRef] [Green Version]
- Paina, L.; Peters, D.H. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan. 2012, 27, 365–373. [Google Scholar] [CrossRef] [Green Version]
- De Savigny, D.; Adam, T. Systems Thinking for Health Systems Strengthening; World Health Organization: Geneva, Switzerland, 2009. [Google Scholar]
- Willis, C.D.; Mitton, C.; Gordon, J.; Best, A. System tools for system change. BMJ Qual. Saf. 2012, 21, 250–262. [Google Scholar] [CrossRef]
- Mingers, J. Systems Thinking, Critical Realism and Philosophy, A Confluence of Ideas; Routledge: London, UK, 2014. [Google Scholar]
- Shrivastava, S.R.; Shrivastava, P.S.; Ramasamy, J. Medical Education: Entrusting Faith in Bedside Teaching. Res. Dev. Med. Edu. 2014, 3, 1–2. [Google Scholar]
- Anatole, M.; Magge, H.; Redditt, V.; Karamaga, A.; Niyonzima, S.; Drobac, P.; Mukherjee, J.S.; Ntaganira, J.; Nyirazinyoye, L.; Hirschhorn, L. Nurse mentorship to improve the quality of health care delivery in rural Rwanda. Nurs. Outlook 2013, 61, 137–144. [Google Scholar] [CrossRef]
- Wallen, G.R.; Mitchell, S.A.; Melnyk, B.; Fineout-Overholt, E.; Miller-Davis, C.; Yates, J.; Hastings, C. Implementing evidence-based practice: Effectiveness of a structured multifaceted mentorship programme. J. Adv. Nurs. 2010, 66, 2761–2771. [Google Scholar] [CrossRef] [PubMed]
- National Institute of Population Research and Training. Bangladesh Health Facility Survey. 2017. Available online: https://dhsprogram.com/pubs/pdf/SPA28/SPA28.pdf (accessed on 14 October 2022).
- International Confederation of Midwives. International Definition of the Midwife; ICM: The Hague, The Netherlands, 2005. [Google Scholar]
- Sandall, J.; Soltani, H.; Gates, S.; Shennan, A.; Devane, D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst. Rev. 2016, 2016, CD004667. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Butler, M.M.; Fullerton, J.T.; Aman, C. Competence for basic midwifery practice: Updating the ICM essential competencies. Midwifery 2018, 66, 168–175. [Google Scholar] [CrossRef] [PubMed]
- Fritz, J.; Walker, D.M.; Cohen, S.; Angeles, G.; Lamadrid-Figueroa, H. Can a simulation-based training program impact the use of evidence based routine practices at birth? Results of a hospital-based cluster randomized trial in Mexico. PLoS ONE 2017, 12, e0172623. [Google Scholar]
- Charan, J.; Biswas, T. How to Calculate Sample Size for Different Study Designs in Medical Research? Indian J. Psychol. Med. 2013, 35, 121–126. [Google Scholar] [CrossRef]
- Dyble, G.; Tickle, A.; Collinson, C. From end user to provider: Making sense of becoming a peer support worker using interpretative phenomenological analysis. J. Public Ment. Health 2014, 13, 83–92. [Google Scholar] [CrossRef]
- Lester, S. (Ed.) An Introduction to Phenomenological Research; Indiana University Press: Bloomington, IN, USA, 1999; Available online: http://devmts.org.uk/resmethy.pdf (accessed on 20 October 2022).
- Bazeley, P. Qualitative Data Analysis: Practical Strategies; Sage Publications: London, UK, 2013. [Google Scholar]
- Embree, L. Disciplinarity in Phenomenoligical Perspective. Indo Pac. J. Phenomenol. 2010, 10, 1–5. [Google Scholar]
- Hycner, R.H. Some guidelines for the phenomenological analysis of interview data. Hum. Stud. 1985, 8, 279–303. [Google Scholar] [CrossRef]
- Teddlie, C.; Tashakkori, A. Foundations of Mixed Methods Research: Integrating Quantitative and Qualitative Approaches in the Social and Behavioral Sciences; Sage Publications: London, UK, 2009. [Google Scholar]
- Manyazewal, T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Arch. Public Health Arch. Belg. Sante Publique 2017, 75, 50. [Google Scholar] [CrossRef] [Green Version]
- Alaei, M.; Pourshams, A.; Altaha, N.; Goglani, G.; Jafari, E. Obtaining informed consent in an illiterate population. Middle East J. Dig. Dis. 2013, 5, 37. [Google Scholar]
- Kurtz, S.L. Measuring and accounting for the Hawthorne effect during a direct overt observational study of intensive care unit nurses. Am. J. Infect. Control 2017, 45, 995–1000. [Google Scholar] [CrossRef] [PubMed]
- Leonard, K.L.; Masatu, M.C. Professionalism and the know-do gap: Exploring intrinsic motivation among health workers in Tanzania. Health Econ. 2010, 19, 1461–1477. [Google Scholar] [CrossRef] [PubMed]
- Scales, D.C.; Dainty, K.; Hales, B.; Pinto, R.; Fowler, R.A.; Adhikari, N.K.J.; Zwarenstein, M. A multifaceted intervention for quality improvement in a network of intensive care units: A cluster randomized trial. JAMA 2011, 305, 363–372. [Google Scholar] [CrossRef] [PubMed]
Contexts Evaluation |
---|
What facilitates/impedes the intervention? Motivations to provide quality care versus personal gain, enabling environments, supportive co-workers and managers, autonomy/agency of midwives |
What other co-interventions are relevant? Supportive policies and guidelines, relevant training |
What else is changing in the system? Momentum around health system improvement and reducing maternal mortality Increasing inequitable access to health care Resources shifting to urban health systems |
Hospital Readiness Form | |
Hospital readiness | Purpose: Assess the readiness of hospitals to provide basic maternity care, including emergency response Data sources: Observation checklist and hospital register books Variables (will be defined as per WHO/standard criteria’s): Oxytocin in emergency & delivery rooms * Magnesium sulfate in emergency & delivery rooms* Newborn resuscitation area with Ambu bag in the delivery room* Separate ANC corner Diploma midwife staffing ANC corner Midwives staffing maternity area Register book with midwife identification used for births Register book for PPH and eclampsia* Number of births performed by midwives in the last 6 months Number of PPH cases in last 6 months Number of eclampsia cases in last 6 months * Indicates emergency preparedness variable Analysis: Descriptive statistics will be generated using frequencies and proportions |
Direct Observation Form | |
Clinical observations | Purpose: Direct observation of clinical practice Data sources: Observation Checklist Variables (will be defined as per WHO/standard criteria’s): Individual patient ANC cards used Skin-to-skin contact for 1 h Companionship in labor & delivery Partograph used during labor Upright position for labor & delivery Delayed cord clamping Active management of the third stage of labor Analysis: A series of analyses will be performed to determine statistical significance. |
Survey Form | |
Evidence-based practice survey | Purpose: Assess provider comfort with and use of evidence-based interventions Data sources: Provider self-reports, shared verbally in response to question prompts Variables (will be defined as per WHO/standard criteria’s): Importance of ANC Yes/No questions on whether the provider felt capable of and carried out these interventions: Partograph use Skin-to-skin contact for 1 h Initial care for PPH Initial care for eclampsia Likert scale questions asking for respondents’ opinions about the importance and or value of these interventions: Companion in labor and delivery Non-supine positioning for labor and delivery Diploma midwives providing maternity care True/False checkboxes: Whether the facility had recently changed in terms of performing ten critical evidence-based interventions If True, whether the introduction of mentors and separately midwives precipitated the change Analysis: Descriptive statistics will be generated using frequencies and proportions. |
Number | Concept |
---|---|
1 | Respect for human dignity and women as persons with full human rights |
2 | Advocacy for women so that their voices are heard and their healthcare choices are respected |
3 | Cultural sensitivity, including working with women and healthcare providers to overcome those cultural practices that harm women and babies |
4 | A focus on health promotion and disease prevention that views pregnancy as a normal life event |
5 | Advocacy for normal physiologic labor and birth to enhance the best outcomes for mothers and infants |
6 | Autonomous when caring for healthy women, able to be the first responder in obstetric and newborn emergencies, and work in interdisciplinary teams when complications arise. |
Methods | Number of Respondents |
---|---|
Interviews (estimated number) | 10 Nursing supervisors Five hospital head managers Three obstetrician-gynaecologist doctors Four medical doctors |
Focus group discussions (FGD) | Approximately 6–8 respondents will participate in an FGD. We will conduct the following number of FGDs: One at hospitals with no midwives Two at hospitals with midwives but no mentoring Three at hospitals with midwives and mentoring |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Anderson, R.; Zaman, S.B. Improving the Quality of Maternity Care through the Introduction of Professional Midwives and Mentoring in Selected Sub-District Hospitals in Bangladesh: A Mixed Method Study Protocol. Methods Protoc. 2022, 5, 84. https://doi.org/10.3390/mps5050084
Anderson R, Zaman SB. Improving the Quality of Maternity Care through the Introduction of Professional Midwives and Mentoring in Selected Sub-District Hospitals in Bangladesh: A Mixed Method Study Protocol. Methods and Protocols. 2022; 5(5):84. https://doi.org/10.3390/mps5050084
Chicago/Turabian StyleAnderson, Rondi, and Sojib Bin Zaman. 2022. "Improving the Quality of Maternity Care through the Introduction of Professional Midwives and Mentoring in Selected Sub-District Hospitals in Bangladesh: A Mixed Method Study Protocol" Methods and Protocols 5, no. 5: 84. https://doi.org/10.3390/mps5050084