Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based training approaches on day of birth care among maternal and newborn healthcare providers in Ebonyi and Kogi States, Nigeria; a randomized controlled trial

Abstract

BackgroundThere is limited information from low and middle-income countries on learning outcomes, provider satisfaction and cost-effectiveness on the day of birth care among maternal and newborn health workers trained using onsite simulation-based low-dose high frequency (LDHF) plus mentoring approach compared to the commonly employed offsite traditional group-based training (TRAD). The LDHF approach uses in-service learning updates to deliver information based on local needs during short, structured, onsite, interactive learning activities that involve the entire team and are spaced over time to optimize learning. The aim of this study will be to compare the effectiveness and cost of LDHF versus TRAD approaches in improving knowledge and skill in maternal and newborn care and to determine trainees’ satisfaction with the approaches in Ebonyi and Kogi states, Nigeria.MethodsThis will be a prospective cluster randomized control trial. Sixty health facilities will be randomly assigned for day of birth care health providers training through either LDHF plus mobile mentoring (intervention arm) or TRAD (control arm). There will be 150 trainees in each arm. Multiple choices questionnaires (MCQs), objective structured clinical examinations (OSCEs), cost and satisfaction surveys will be administered before and after the trainings. Quantitative data collection will be done at months 0 (baseline), 3 and 12. Qualitative data will also be collected at 12-month from the LDHF arm only. Descriptive and inferential statistics will be used as appropriate. Composite scores will be computed for selected variables to determine areas where service providers have good skills as against areas where their skills are poor and to compare skills and knowledge outcomes between the two groups at 0.05 level of statistical significance.DiscussionThere is some evidence that LDHF, simulation and practice-based training approach plus mobile mentoring results in improved skills and health outcomes and is cost-effective. By comparing intervention and control arms the authors hope to replicate similar results, evaluate the approach in Nigeria and provide evidence to Ministry of Health on how and which training approach, frequency and setting will result in the greatest return on investment.Trial registrationThe trial was retrospectively registered on 24th August, 2017 at ClinicalTrials.Gov: NCT03269240.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3405-2) contains supplementary material, which is available to authorized users.

Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based trainings among health workers in Nigeria; a cluster randomized controlled trial

“…Our findings are consistent with those of previous studies that reported that TRAD offsite training may improve the trainees' competencies, but knowledge and skills may not be transferred to other co-workers at the facility, nor translated into practice or performance [13][14]. On the other hand, methods that involve repetitive, mentor-supported learning and regularly coordinated practice sessions, such as the onsite LDHF/m-mentoring training, resulted in better skills acquisition and retention over time [1,[7][8][11][12][13][14][15][16][17].…”

“…The authors have attempted a brief description of the methodology. The training approaches, eligibility criteria and randomization have been described in the published study protocol [11].…”

“…The LDHF approach uses in-service learning updates to deliver information based on local needs during short, structured, onsite, interactive learning activities that involve the entire team and are spaced over time to optimize learning. It also involves brief, ongoing activities (e.g., skills practice, team drills, games, and quality improvement activities) at the work place to sustain learning and support clinical decision-making [11]. The approach also uses mobile phone mentorship calls and reminder text messages to the trainees to reinforce gains made from training and resolve emerging issues at the workplaces.…”

A mixed-methods evaluation of a cluster randomized controlled trial on simulation-based low-dose, high-frequency plus mobile mentoring training versus traditional group-based training of health workers in Ebonyi and Kogi States, Nigeria

“…Nigeria, with a population of 185.7 million as of 2017 (according to Nigeria Bureau of Statistics), has six geopolitical zones and 36 states plus the Federal Capital Territory (FCT). The study was conducted in two states: Ebonyi state has a population of 2.8 million and is in the South-East zone; Kogi state has a population of 4.3 million and is in the North-Central zone [5]. At the time of the study, the…”

“…There are few studies from low-and middle-income countries (LMICs) on learning outcomes and facilitators and barriers to learning approaches on day-of-birth care among maternal and newborn health workers trained using onsite simulation-based low-dose, high-frequency (LDHF) plus mobile (m)-mentoring training approach compared to those trained by offsite traditional group-based training (TRAD). The LDHF/m-mentoring approach is described in the study protocol manuscript; it differ from the TRAD approach primarily by being onsite, more interactive, and team-oriented thus more suited to meet the needs of the trainees in various contextual situations [5]. The LDHF/m-mentoring approach also uses mobile phone mentorship calls and reminder text messages to the trainees.…”