Determinants of healthcare providers’ confidence in their clinical skills to deliver quality obstetric and newborn care in Uganda and Zambia

Abstract

Background Poor quality obstetric and newborn care persists in sub-Saharan Africa and weak provider competence is an important contributor. To be competent, providers need to be both knowledgeable and confident in their ability to perform necessary clinical actions. Confidence or self-efficacy has not been extensively studied but may be related to individuals’ knowledge, ability to practice their skills, and other modifiable factors. In this study, we investigated how knowledge and scope of practice are associated with provider confidence in delivering obstetric and newborn health services in Uganda and Zambia. Methods This study was a secondary analysis of data from an obstetric and newborn care program implementation evaluation. Provider knowledge, scope of practice (completion of a series of obstetric tasks in the past 3 months) and confidence in delivering obstetric and newborn care were measured post intervention in intervention and comparison districts in Uganda and Zambia. We used multiple linear regression models to investigate the extent to which exposure to a wider range of clinical tasks associated with confidence, adjusting for facility and provider characteristics. Results Of the 574 providers included in the study, 69% were female, 24% were nurses, and 6% were doctors. The mean confidence score was 71%. Providers’ mean knowledge score was 56% and they reported performing 57% of basic obstetric tasks in the past 3 months. In the adjusted model, providers who completed more than 69% of the obstetric tasks reported a 13-percentage point (95% CI 0.08, 0.17) higher confidence than providers who performed less than 50% of the tasks. Female providers and nurses were considerably less confident than males and doctors. Provider knowledge was moderately associated with provider confidence. Conclusions Our study showed that scope of practice (the range of clinical tasks routinely performed by providers) is an important determinant of confidence. Ensuring that providers are exposed to a variety of services is crucial to support improvement in provider confidence and competence. Policies to improve provider confidence and pre-service training should also address differences by gender and by cadres.

Predictors of job satisfaction and intention to stay in the job among health-care providers in Uganda and Zambia

“…Information on providers’ demographics and characteristics of facilities were also collected. Results from the two other instruments—knowledge test and confidence assessment—have been published elsewhere [ 20 ].…”

Training needs assessment for practicing pediatric critical care nurses in Malawi to inform the development of a specialized master’s education pathway: a cohort study

“…For example, nearly all nurses felt confident or somewhat confident in assessment and management of skills across all ABCDE domains. A study in Uganda and Zambia showed that healthcare providers’ confidence increased with exposure to a variety of skills, which will be important to consider when designing the content of a PCC master’s program [ 23 ].…”

“…This was not a surprising finding as the only ventilators are located at PICU at MJC and in the main ICU at QECH, therefore very few nurses provide care for ventilated patients. Additionally, intubation is not a skill that nurses are permitted to perform or gain competency in and so less familiarity with the procedure may impact confidence in managing related equipment such as endotracheal tubes and ventilators [ 23 ].…”

Training Needs Assessment for Practicing Paediatric Critical Care Nurses in Malawi To Inform The Development of A Specialized Master’s Education Pathway: A Cohort Study

“…Additionally, intubation is not a skill that nurses are permitted to perform or gain competency in and so less familiarity with the procedure may impact con dence in managing related equipment such as endotracheal tubes and ventilators. [21] Infrequent exposure may have also impacted nurses' low con dence in ECG interpretation despite nearly 90% con dence with cardiac assessments, as there is no dedicated paediatric cardiac unit and continuous ECG monitoring is not available on most of the paediatric units. Children with cardiac problems receive the same monitoring that other children receive: oxygen saturation, pulse rate, and temperature.…”

“…A study in Uganda and Zambia showed that healthcare providers' con dence increased with exposure to a variety of skills, which will be important to consider when designing the content of a PCC master's program. [21] Nurses rated high con dence particularly in task-oriented or scale-dependent skills, including the Glasgow or Blantyre Coma Scale, blood glucose monitoring, nasogastric tube management, pain assessment, temperature monitoring, skin assessment, and infection prevention. Further investigation may be revealing as to whether nurses know how to interpret the data they collect, what intervention is indicated based on the ndings, and when to reassess the patient, which would better demonstrate critical thinking skills and a higher level of nursing competency.…”