A process evaluation of PRONTO simulation training for obstetric and neonatal emergency response teams in Guatemala

Dilys M Walker, Francesca Holme, Sarah T Zelek, Marisela Olvera-García, Airaín Montoya-Rodríguez, Jimena Fritz, Jenifer Fahey, Héctor Lamadrid-Figueroa, Susanna Cohen, Edgar Kestler, Dilys M Walker, Francesca Holme, Sarah T Zelek, Marisela Olvera-García, Airaín Montoya-Rodríguez, Jimena Fritz, Jenifer Fahey, Héctor Lamadrid-Figueroa, Susanna Cohen, Edgar Kestler

Abstract

Background: Despite expanding access to institutional birth in Guatemala, maternal mortality remains largely unchanged over the last ten years. Enhancing the quality of emergency obstetric and neonatal care is one important strategy to decrease mortality. An innovative, low-tech, simulation-based team training program (PRONTO) aims to optimize care provided during obstetric and neonatal emergencies in low-resource settings.

Methods: We conducted PRONTO simulation training between July 2012 and December 2012 in 15 clinics in Alta Verapaz, Huehuetenango, San Marcos, and Quiche, Guatemala. These clinics received PRONTO as part of a larger pair-matched cluster randomized trial of a comprehensive intervention package. Training participants were obstetric and neonatal care providers that completed pre- and post- training assessments for the two PRONTO training modules, which evaluated knowledge of evidence-based practice and self-efficacy in obstetric and neonatal topics. Part of the training included a session for trained teams to establish strategic goals to improve clinical practice. We utilized a pre/post-test design to evaluate the impact of the course on both knowledge and self-efficacy with longitudinal fixed effects linear regression with robust standard errors. Pearson correlation coefficients were used to assess the correlation between knowledge and self-efficacy. Poisson regression was used to assess the association between the number of goals achieved and knowledge, self-efficacy, and identified facility-level factors.

Results: Knowledge and self-efficacy scores improved significantly in all areas of teaching. Scores were correlated for all topics overall at training completion. More than 60 % of goals set to improve clinic functioning and emergency care were achieved. No predictors of goal achievement were identified.

Conclusions: PRONTO training is effective at improving provider knowledge and self-efficacy in training areas. Further research is needed to evaluate the impact of the training on provider use of evidence-based practices and on maternal and neonatal health outcomes.

Trial registration: NCT01653626.

Figures

Fig. 1
Fig. 1
Timeline and components of PRONTO training intervention in Guatemala

References

    1. Stanton C, Blanc AK, Croft T, Choi Y. Skilled care at birth in the developing world: progress to date and strategies for expanding coverage. J Biosoc Sci. 2007;39:109–120. doi: 10.1017/S0021932006001271.
    1. Garcés A, McClure EM, Hambidge M, Krebs NF, Mazariegos M, Wright LL, et al. Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality. Acta Obs Gyn Scan. 2012;91:593–597. doi: 10.1111/j.1600-0412.2012.01374.x.
    1. Department of Reproductive Health Research. Making Pregnancy Safer: The Critical Role of the Skilled Attendant: A Joint Statement by WHO, ICM and FIGO. Geneva, Switzerland; 2004:24.
    1. Victora CG, Rubens CE, GAPPS Review Group Global report on preterm birth and stillbirth (4 of 7): delivery of interventions. BMC Pregnancy Childbirth. 2010;10(Suppl 1):S4. doi: 10.1186/1471-2393-10-S1-S4.
    1. Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet. 2006;368:1189–1200. doi: 10.1016/S0140-6736(06)69380-X.
    1. Bhutta ZA, Cabral S, Chan C-W, Keenan WJ. Reducing maternal, newborn, and infant mortality globally: an integrated action agenda. Int J Gynaecol Obs. 2012;119(119 Suppl):S13–S17. doi: 10.1016/j.ijgo.2012.04.001.
    1. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF A. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066–1074. doi: 10.1016/S0140-6736(06)68397-9.
    1. Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381:1747–1755. doi: 10.1016/S0140-6736(13)60686-8.
    1. Campbell OMR, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368:1284–1299. doi: 10.1016/S0140-6736(06)69381-1.
    1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379:2151–2161. doi: 10.1016/S0140-6736(12)60560-1.
    1. Thaddeus S, Maine D. Too far to walk: Maternal mortality in context. Soc Sci Med. 1994;38:1091–1110. doi: 10.1016/0277-9536(94)90226-7.
    1. At a glance: Guatemala []
    1. MSPAS . National Study of Maternal Mortality. 2011. p. 122.
    1. Guatemala Maternal and Infant Health and Nutrition PO77756 []
    1. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375:1609–1623. doi: 10.1016/S0140-6736(10)60518-1.
    1. Daniels K, Arafeh J, Clark A, Waller S, Druzin M, Chueh J. Prospective randomized trial of simulation versus didactic teaching for obstetrical emergencies. Simul Heal. 2010;5:40–45. doi: 10.1097/SIH.0b013e3181b65f22.
    1. Robertson B, Schumacher L, Gosman G, Kanfer R, Kelley M, DeVita M. Simulation-based crisis team training for multidisciplinary obstetric providers. Simul Heal. 2009;4:77–83. doi: 10.1097/SIH.0b013e31819171cd.
    1. Robertson B, Kaplan B, Atallah H, Higgins M, Lewitt MJ, Ander DS. The use of simulation and a modified TeamSTEPPS curriculum for medical and nursing student team training. Simul Heal. 2010;5:332–337. doi: 10.1097/SIH.0b013e3181f008ad.
    1. Phipps MG, Lindquist DG, McConaughey E, O’Brien JA, Raker CA, Paglia MJ. Outcomes from a labor and delivery team training program with simulation component. Am J Obs Gynecol. 2012;206:3–9. doi: 10.1016/j.ajog.2011.06.046.
    1. Hofmeyr GJ, Haws RA, Bergström S, Lee ACC, Okong P, Darmstadt GL, et al. Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obs. 2009;107(Suppl):S21–S44. doi: 10.1016/j.ijgo.2009.07.017.
    1. Kawaguchi A, Mori R. The In-Service Training for Health Professionals to Improve Care of the Seriously Ill Newborn or Child in Low- and Middle-Income Countries. Geneva: Switzerland; 2010.
    1. Walker DM, Cohen SR, Estrada F, Monterroso ME, Jenny A, Fritz J, et al. PRONTO training for obstetric and neonatal emergencies in Mexico. Int J Gynaecol Obs. 2012;116:128–133. doi: 10.1016/j.ijgo.2011.09.021.
    1. Kestler E, Walker D, Bonvecchio A, de Tejada SS, Donner A. A matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol. BMC Pregnancy Childbirth. 2013;13:73. doi: 10.1186/1471-2393-13-73.
    1. Cohen SR, Cragin L, Rizk M, Hanberg A, Walker DM. PartoPantsTM: The High-Fidelity, Low-Tech Birth Simulator. Clin Simul Nurs. 2011;7:e11–e18. doi: 10.1016/j.ecns.2009.11.012.
    1. King HB, Battles J, Baker DP, Alonso A, Salas E, Webster J, et al. TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety. 2008, 3:5–20.
    1. Powell SM. TeamSTEPPS TM - Strategies and Tools to Enhance Performance and Patient Safety : A Collaborative Initiative for Improving Communication and Teamwork in Healthcare. 2006.
    1. WHO . Standards for Maternal and Neonatal Care. 2006.
    1. Fahey JO, Cohen SR, Holme F, Buttrick ES, Dettinger JC, Kestler E, et al. Promoting cultural humility during labor and birth: putting theory into action during PRONTO obstetric and neonatal emergency training. J Perinat Neonat Nurs. 2013;27:36–42. doi: 10.1097/JPN.0b013e31827e478d.
    1. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;2:191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Bandura A. Guide for Constructing Self-Efficacy Scales. In Self-Efficacy Beliefs of Adolescents. Information Age Publishing; 2006:307–337.
    1. Allison P. Fixed Effects Regression Models. Newbury Park, CA: Sage; 2009.
    1. Rogers WH. Stata Technical Bulletin 13: Regression Standard Errors in Clustered Samples. 1993. pp. 19–23.
    1. StataCorp . STATA Statistical Software: Release12.0. 2011.
    1. Walker D, Cohen S, Fritz J, Olvera M, Lamadrid-Figueroa H, Cowan J, et al. Team training in obstetric and neonatal emergencies using highly realistic simulation in Mexico: impact on process indicators. BMC Pregnancy Childbirth. 2014;14:367. doi: 10.1186/s12884-014-0367-1.
    1. Crofts JF, Ellis D, Draycott TJ, Winter C, Hunt LP, Akande VA. Change in knowledge of midwives and obstetricians following obstetric emergency training: a randomised controlled trial of local hospital, simulation centre and teamwork training. BJOG. 2007;114:1534–1541. doi: 10.1111/j.1471-0528.2007.01493.x.
    1. Reynolds A, Ayres-de-Campos D, Lobo M. Self-perceived impact of simulation-based training on the management of real-life obstetrical emergencies. Eur J Obs Gyn R B. 2011;159:72–76. doi: 10.1016/j.ejogrb.2011.07.022.
    1. Crofts JF, Fox R, Draycott TJ, Winter C, Hunt LP, Akande VA. Retention of factual knowledge after practical training for intrapartum emergencies. Int J Gynaecol Obs. 2013;123:81–85. doi: 10.1016/j.ijgo.2013.04.015.
    1. Guise J-M, Segel S. Teamwork in obstetric critical care. Clin Obs Gynecol. 2008;22:937–951.
    1. Deering S, Johnston LC, Colacchio K. Multidisciplinary teamwork and communication training. Semin Perinatol. 2011;35:89–96. doi: 10.1053/j.semperi.2011.01.009.
    1. Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, et al. Does training in obstetric emergencies improve neonatal outcome? BJOG. 2006;113:177–182. doi: 10.1111/j.1471-0528.2006.00800.x.
    1. Siassakos D, Crofts JF, Winter C, Weiner CP, Draycott TJ. The active components of effective training in obstetric emergencies. BJOG. 2009;116:1028–1032. doi: 10.1111/j.1471-0528.2009.02178.x.

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