“…These perceptions demonstrate the degree to which accurate information about the profession has been disseminated from key decision makers to the frontline health workers and, ultimately, the public. It is clear that the key decision makers themselves had a unified vision and an accurate understanding of midwifery (Summer et al, ). The midwife [is a] a provider that has … competencies both in obstetrics and neonatal health, and that is going to devote three years of exclusive study to this and is the perfect link between the physician and the medical services.…”
Section: Results: Internal Domainsmentioning
confidence: 99%
“…The original aim for these interviews was to elucidate misperceptions, attitudes, and expectations about the addition of midwifery to the health-care system (Summer, Guendelman, Kestler, & Walker, 2017). Interviewees were not specifically asked about sustainability elements of the midwifery program.…”
Section: Methodsmentioning
confidence: 99%
“…These perceptions demonstrate the degree to which accurate information about the profession has been disseminated from key decision makers to the frontline health workers and, ultimately, the public. It is clear that the key decision makers themselves had a unified vision and an accurate understanding of midwifery (Summer et al, 2017).…”
Guatemala plans to open its first government‐sponsored professional midwifery school since 1960. During the new program's design stages, it is imperative to consider possible impediments to the program's sustainability. Schell's Sustainability Framework assesses internal and external domains to consider a program's capacity for sustainability. We conducted in‐depth interviews with Guatemalan key decision makers and professional midwives (n = 7) and matched pertinent open codes from these interviews with Schell's Sustainability Framework's a priori domains. We analyzed the content of the coded segments, triangulating the findings with policy documents, peer‐reviewed journal articles, and gray literature to identify facilitators and impediments to midwifery's sustainability. Recommendations follow. Our study revealed the following internal facilitators for sustainability: strategic planning, program adaptation, organizational capacity, and funding stability. External facilitators such as political support and funding sustainability were also present. The program's poor internal communications and weak external partnerships pose significant impediments to the program's sustainability. Program evaluation and public health impact were not discussed in the interviews, which merits further consideration. At the launch of this important midwifery program, program designers must heed recommendations informed by identified facilitators and impediments to increase midwifery's likelihood of success in Guatemala.
“…These perceptions demonstrate the degree to which accurate information about the profession has been disseminated from key decision makers to the frontline health workers and, ultimately, the public. It is clear that the key decision makers themselves had a unified vision and an accurate understanding of midwifery (Summer et al, ). The midwife [is a] a provider that has … competencies both in obstetrics and neonatal health, and that is going to devote three years of exclusive study to this and is the perfect link between the physician and the medical services.…”
Section: Results: Internal Domainsmentioning
confidence: 99%
“…The original aim for these interviews was to elucidate misperceptions, attitudes, and expectations about the addition of midwifery to the health-care system (Summer, Guendelman, Kestler, & Walker, 2017). Interviewees were not specifically asked about sustainability elements of the midwifery program.…”
Section: Methodsmentioning
confidence: 99%
“…These perceptions demonstrate the degree to which accurate information about the profession has been disseminated from key decision makers to the frontline health workers and, ultimately, the public. It is clear that the key decision makers themselves had a unified vision and an accurate understanding of midwifery (Summer et al, 2017).…”
Guatemala plans to open its first government‐sponsored professional midwifery school since 1960. During the new program's design stages, it is imperative to consider possible impediments to the program's sustainability. Schell's Sustainability Framework assesses internal and external domains to consider a program's capacity for sustainability. We conducted in‐depth interviews with Guatemalan key decision makers and professional midwives (n = 7) and matched pertinent open codes from these interviews with Schell's Sustainability Framework's a priori domains. We analyzed the content of the coded segments, triangulating the findings with policy documents, peer‐reviewed journal articles, and gray literature to identify facilitators and impediments to midwifery's sustainability. Recommendations follow. Our study revealed the following internal facilitators for sustainability: strategic planning, program adaptation, organizational capacity, and funding stability. External facilitators such as political support and funding sustainability were also present. The program's poor internal communications and weak external partnerships pose significant impediments to the program's sustainability. Program evaluation and public health impact were not discussed in the interviews, which merits further consideration. At the launch of this important midwifery program, program designers must heed recommendations informed by identified facilitators and impediments to increase midwifery's likelihood of success in Guatemala.
“…A 2015 national survey showed that 60.6% of births in Huehuetenango and 43.2% in Alta Verapaz were registered as having occurred at home 2 . For centuries, home births have been delivered by informally trained traditional birth attendants (TBAs), who provide care for women during pregnancy, delivery, and the postpartum period 9 . Qualitative studies in Guatemala suggest that lack of trust in the quality of care is one of the determinants that deter women from giving birth in health centers 10 .…”
Objective
To evaluate the impact of an intervention package on maternal and newborn health indicators.
Methods
A randomized stepped‐wedge non‐blind trial was conducted across six subdistricts within two districts in Guatemala from January 2014 to January 2017. Data on outcomes were collected on all deliveries in all 33 health centers. The intervention package included distribution of promotional materials encouraging health center delivery; education for traditional birth attendants about the importance of health center delivery; and provider capacity building using simulation training. Main outcomes were number of health center deliveries, maternal morbidity, and perinatal morbidity and mortality.
Results
Overall, there were 24 412 deliveries. Health center deliveries per 1000 live births showed an overall increase, although after adjustment for secular trends and clustering, the relative risk for the treatment effect was not statistically significant (aRR, 1.04; 95% confidence interval [CI], 0.97–1.11, P=0.242). Although not statistically significant, maternal morbidity (aRR, 0.78; 95% CI, 0.60–1.02; P=0.068) and perinatal morbidity (aRR, 0.84; 95% CI, 0.68–1.05; P=0.133) showed a tendency toward a decrease.
Conclusion
The present study represents one of the few randomized evaluations of an integrated approach to improve birth outcomes in a low‐income setting.
ClinicalTrials.gov: NCT0315107.
“…Field notes were then sent to the project's lead research team for analysis via open and axial coding (Summer, Guendelman, Kestler, & Walker, 2017). Identified themes were then circulated by the lead research team back to the Veteran Unit Leaders and CARMs for further validation.…”
Although it is widely acknowledged that consumer engagement in healthcare research is a promising pathway to actionable patient-centered findings, there remains some ambiguity regarding effective patient-centered engagement strategies. Therefore, the purpose of this US-based multi-state project was to create a platform from which US veterans could dialogue and articulate (1) their research priorities; (2) perceived barriers to research partnerships and participation; (3) recommendations for engaging other veterans in the research enterprise; and (4) preferences about how they would like to receive research findings. A total of 283 veterans and 101 community stakeholders participated across 54 dialogue sessions or Think Tank Meetings (TTMs) held in six states with the largest veteran populations: California, Texas, Florida, Pennsylvania, New York, and Ohio. Each TTM was led by a local veteran with strong ties to the veteran community. To address veteran concerns about the research process, a local researcher from the project team recorded field notes rather than audiotaping, which were analyzed by the lead research team using open and axial coding. Based on veterans' recommendations, a list of veteran-centered research priorities is presented, as are two checklists designed to guide research teams seeking to engage veterans in research and disseminate findings to the veteran community.
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