Nurses' and auxiliary nurse midwives' adherence to essential birth practices with peer coaching in Uttar Pradesh, India: a secondary analysis of the BetterBirth trial

Rose L Molina, Brandon J Neal, Lauren Bobanski, Vinay Pratap Singh, Bridget A Neville, Megan Marx Delaney, Stuart Lipsitz, Ami Karlage, Mrunal Shetye, Katherine E A Semrau, Rose L Molina, Brandon J Neal, Lauren Bobanski, Vinay Pratap Singh, Bridget A Neville, Megan Marx Delaney, Stuart Lipsitz, Ami Karlage, Mrunal Shetye, Katherine E A Semrau

Abstract

Background: The BetterBirth trial tested the effect of a peer coaching program around the WHO Safe Childbirth Checklist for birth attendants in primary-level facilities in Uttar Pradesh, India on a composite measure of perinatal and maternal mortality and maternal morbidity. This study aimed to examine the adherence to essential birth practices between two different cadres of birth attendants-nurses and auxiliary nurse midwives (ANMs)-during and after a peer coaching intervention for the WHO Safe Childbirth Checklist.

Methods: This is a secondary analysis of birth attendant characteristics, coaching visits, and behavior uptake during the BetterBirth trial through birth attendant surveys, coach observations, and independent observations. Descriptive statistics were calculated overall, and by staffing cadre (staff nurses and ANMs) for demographic characteristics. Logistic regression using the Pearson overdispersion correction (to account for clustering by site) was used to assess differences between staff nurses and ANMs in the intervention group during regular coaching (2-month time point) and 4 months after the coaching program ended (12-month time point).

Results: Of the 570 birth attendants who responded to the survey in intervention and control arms, 474 were staff nurses (83.2%) and 96 were ANMs (16.8%). In the intervention arm, more staff nurses (240/260, 92.3%) received coaching at all pause points compared to ANMs (40/53, 75.5%). At baseline, adherence to practices was similar between ANMs and staff nurses (~ 30%). Overall percent adherence to essential birth practices among ANMs and nurses was highest at 2 months after intervention initiation, when frequent coaching visits occurred (68.1% and 64.1%, respectively, p = 0.76). Practice adherence tapered to 49.2% among ANMs and 56.1% among staff nurses at 12 months, which was 4 months after coaching had ended (p = 0.68).

Conclusions: Overall, ANMs and nurses responded similarly to the coaching intervention with the greatest increase in percent adherence to essential birth practices after 2 months of coaching and subsequent decrease in adherence 4 months after coaching ended. While coaching is an effective strategy to support some aspects of birth attendant competency, the structure, content, and frequency of coaching may need to be customized according to the birth attendant training and competency.

Trial registration: ClinicalTrials.gov: NCT2148952; Universal Trial Number: U1111-1131-5647.

Trial registration: ClinicalTrials.gov NCT02148952.

Keywords: Birth attendant; Childbirth; Coaching; Competency; Uttar Pradesh.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Birth attendant observation points
Fig. 2
Fig. 2
Average adherence to essential birth practices by time point and staffing cadre in 30 facilities in the BetterBirth trial
Fig. 3
Fig. 3
Select behaviors and checklist use during observation point (OP) by birth attendant cadre in the BetterBirth trial
Fig. 4
Fig. 4
Complication management of elevated blood pressure in 30 facilities in the BetterBirth trial at the 12-month observation point

References

    1. The United Nations. Millennium development goals and beyond 2015: goal 5: improve maternal health. Available from: . Accesssed 14 Nov 2019.
    1. The United Nations. The millennium development goals report 2015. 2015; Available from: . Cited 2019 Aug 20
    1. Munabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle- income countries: a qualitative evidence synthesis (Review) Cochrane Database Syst Rev. 2017;11:CD011558.
    1. Koblinsky M, Moyer CA, Calvert C, et al. Quality maternity care for every woman, everywhere: a call to action. Lancet. 2016;388(10057):2307–2320. doi: 10.1016/S0140-6736(16)31333-2.
    1. World Health Organization . Definition of skilled health personnel providing care during childbirth: the 2018 joint statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA. 2018. pp. 1–4.
    1. Indian Nursing Council. Types of nursing programs. Available from: . Cited 2019 Aug 20
    1. Lovell B. What do we know about coaching in medical education? A literature review. Med Educ. 2018;52(4):376–390. doi: 10.1111/medu.13482.
    1. Kara N, Firestone R, Kalita T, et al. The BetterBirth program: pursuing effective adoption and sustained use of the WHO safe childbirth checklist through coaching-based implementation in Uttar Pradesh, India. Glob Health Sci Pract. 2017;5(2):232–243. doi: 10.9745/GHSP-D-16-00411.
    1. Marx Delaney M, Maji P, Kalita T, et al. 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. Glob Health Sci Pract. 2017;5(2):217–231. doi: 10.9745/GHSP-D-16-00410.
    1. Hirschhorn LR, Krasne M, Maisonneuve J, et al. Integration of the opportunity-ability-motivation behavior change framework into a coaching-based WHO safe childbirth checklist program in India. Int J Gynaecol Obstet. 2018;142(3):321–328. doi: 10.1002/ijgo.12542.
    1. Semrau KEA, Hirschhorn LR, Marx Delaney M, et al. Outcomes of a coaching-based WHO safe childbirth checklist program in India. N Engl J Med. 2017;377(24):2313–24. doi: 10.1056/NEJMoa1701075.
    1. Marx Delaney M, Miller KA, Bobanski L, et al. Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO safe childbirth checklist in Uttar Pradesh, India (BetterBirth) Lancet Glob Health. 2019;7(8):e1088–e1096. doi: 10.1016/S2214-109X(19)30261-X.
    1. Semrau KEA, Hirschhorn LR, Kodkany B, et al. Effectiveness of the WHO safe childbirth checklist program in reducing severe maternal, fetal, and newborn harm in Uttar Pradesh, India: study protocol for a matched-pair, cluster-randomized controlled trial. Trials. 2016;17(1):576. doi: 10.1186/s13063-016-1673-x.
    1. The World Health Organization . WHO safe childbirth checklist implementation guide. 2015.
    1. Fullerton JT, Thompson JB, Johnson P. Competency-based education: the essential basis of pre-service education for the professional midwifery workforce. Midwifery. 2013;29(10):1129–1136. doi: 10.1016/j.midw.2013.07.006.
    1. Sharma B, Hildingsson I, Johansson E, Prakasamma M, Ramani KV, Christensson K. Do the pre-service education programmes for midwives in India prepare confident “registered midwives”? A survey from India. Glob Health Action. 2015;8(1):29553. doi: 10.3402/gha.v8.29553.
    1. Garces A, McClure EM, Chomba E, et al. Home birth attendants in low income countries: who are they and what do they do? BMC Pregnancy Childbirth. 2012;12:34.
    1. Brewster AL, Curry LA, Cherlin EJ, Talbert-Slagle K, Horwitz LI, Bradley EH. Integrating new practices: a qualitative study of how hospital innovations become routine. Implement Sci. 2015;10:168. doi: 10.1186/s13012-015-0357-3.
    1. Bali S, Reddy VB. Evaluation of competency and skills of skilled birth attendants in Madhya Pradesh, Central India. Indian J Public Health. 2018;62(1):61–64.
    1. Jaffari A, Troxel SAB. Maternal health in India: a survey of birth attendant competency through completeness of prescribed care during perinatal visits, in 12 randomly chosen districts of Uttar Pradesh, India. Health Care Women Int. 2018;39(11):1193–1208. doi: 10.1080/07399332.2018.1443105.
    1. Jhpiego . Improving quality of maternal and newborn health in India. 2017.
    1. Rowe AK, Rowe SY, Peters DH, Holloway KA, Chalker J, Ross-Degnan D. Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review. Lancet Glob Health. 2018;6(11):e1163–e1175. doi: 10.1016/S2214-109X(18)30398-X.
    1. Evans CL, Johnson P, Bazant E, Bhatnagar N, Zgambo J, Khamis AR. Competency-based training “helping mothers survive: bleeding after birth” for providers from central and remote facilities in three countries. Int J Gynaecol Obstet. 2014;126(3):286–290. doi: 10.1016/j.ijgo.2014.02.021.
    1. Fritz J, Walker DM, 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(3):e0172623. doi: 10.1371/journal.pone.0172623.
    1. Raney JH, Morgan MC, Christmas A, et al. Simulation-enhanced nurse mentoring to improve preeclampsia and eclampsia care: an education intervention study in Bihar, India. BMC Pregnancy Childbirth. 2019;19(1):41. doi: 10.1186/s12884-019-2186-x.
    1. Vail B, Morgan MC, Spindler H, Christmas A, Cohen SR, Walker DM. The power of practice: simulation training improving the quality of neonatal resuscitation skills in Bihar, India. BMC Pediatr. 2018;18(1):291. doi: 10.1186/s12887-018-1254-0.
    1. Leonard K, Masatu MC. Outpatient process quality evaluation and the Hawthorne effect. Soc Sci Med. 2006;63(9):2330–2340. doi: 10.1016/j.socscimed.2006.06.003.

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