An evaluation of obstetric ultrasound education program in Nepal using the RE-AIM framework

Abstract

Background Nepal has a high prevalence of congenital anomaly contributing to high infant mortality. Ultrasound, an important tool to detect congenital anomalies and manage maternity-related risk factors, is not properly used in Nepal because Nepali doctors have limited opportunities for learning ultrasound techniques. Hence, we developed and implemented an ultrasound education program from 2016 to 2018. The objective of this study is to evaluate the education program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods We conducted a mixed-method study to evaluate each component of RE-AIM. The team collected quantitative data from administrative records, tests, surveys, and an online follow-up survey. Qualitative data were collected from individual in-depth interviews at least a year after the program. The proportions, means, and t-tests were used for quantitative data, and thematic coding for qualitative data. Results A total of 228 healthcare workers representing 27.3% of the districts of Nepal were reached from 2016 to 2018. The program improved participants’ knowledge (29.3, 8.7, and 23.8 increases out of 100, each year, p< 0.001, n=85) and self-confidence (0.6, 0.3, 1.3 increases out of 4.0, p< 0.01, n=111). The participants were highly satisfied with the program (4.2, 4.1, and 4.0 out of 5.0, n=162). Among the respondents of the online follow-up survey (n=28), 60.7% had used ultrasound in their daily practice after the education program, and a medical institution established an ultrasound training center. The absence of clear accreditation and practical guidelines in ultrasound use were presented as barriers for adoption and maintenance. Conclusion The program was successful in improving participant’s knowledge and self-confidence in ultrasound techniques and showed great potential for the adoption and maintenance of the techniques in their practice. Continuous implementation of the program and institutional policy changes to facilitate ultrasound use may increase the ultrasound use and improve ultrasound service quality in Nepal.

Training in Ultrasound to Determine Gestational Age in Low- and Middle- Income Countries: A Systematic Review

“…In total, 25/1,262 studies were included (Figure 1) (27)(28)(29)(30)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52) all of which were programme evaluations. The majority were undertaken in Africa (n = 18, 72%) (25-28, 30, 33, 35, 36, 38, 40-42, 45-48, 50), with three in South East Asia (12%) (31,40,45), one in South America (4%) (51), and several across multiple sites in Africa, Asia, and South America (n = 3, 12%) (35,44,53). Most were descriptive studies (n = 23, 92%) (27,29,30,(34)(35)(36)(37)(38)(39)(40)(41)(43)(44)(45)(46)(47)(48)…”

“…The majority were undertaken in Africa (n = 18, 72%) (25-28, 30, 33, 35, 36, 38, 40-42, 45-48, 50), with three in South East Asia (12%) (31,40,45), one in South America (4%) (51), and several across multiple sites in Africa, Asia, and South America (n = 3, 12%) (35,44,53). Most were descriptive studies (n = 23, 92%) (27,29,30,(34)(35)(36)(37)(38)(39)(40)(41)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54) of which 3 (12%) (40,43,46) employed mixed methods. The remaining 2 (8%) (28,42) were case reports.…”

“…Four (16%) studies presented data on the barriers and facilitators to the provision of ultrasound training, having formally reported this in the context of implementation outcomes (40,43,46,53). Supplementary Table 2 provides an overview of the main characteristics of each study.…”

“…Instead, over half (n = 14, 56%) focused on training those who had not used ultrasound before (28,30,31,36,38,41,42,(44)(45)(46)(47)(48)(49)51). Six (24%) of the studies did not comment on trainees' prior experience (34,37,39,40,50,52). Of the 10 (40%) studies where training had been developed by local teams (29-31, 36, 39, 40, 42, 44, 52, 53), nearly all (8, 80%) were in collaboration with overseas institutions (30,31,36,39,40,42,44,53).…”

“…Six (24%) of the studies did not comment on trainees' prior experience (34,37,39,40,50,52). Of the 10 (40%) studies where training had been developed by local teams (29-31, 36, 39, 40, 42, 44, 52, 53), nearly all (8, 80%) were in collaboration with overseas institutions (30,31,36,39,40,42,44,53). Local practitioners delivered the training in 14 (56%) of the programs (29-31, 36, 39, 40, 42-47, 52, 53).…”