The feasibility and acceptability of collaborative learning in improving health worker performance on adolescent health: findings from implementation research in Moldova

Abstract

Background Collaborative learning has been shown to be effective in improving health worker performance, but relatively little is known about the feasibility or acceptability of collaborative learning in youth-friendly health services (YFHS). This paper describes the characteristics, feasibility and acceptability of a collaborative learning approach implemented in YFHS in Moldova as part of a national scaling up process. Methods We gathered and analysed data on the number, location, themes, and participants of sessions, as well as benefits and challenges of collaborative learning, using two information sources: 1) formal reports on collaborative learning sessions, and 2) two questionnaires conducted with participants and moderators. Results Collaborative learning sessions have been implemented in 30 out of 35 YFHS in Moldova. In 2016, 464 collaborative learning sessions were conducted. Sessions were conducted one to three times per month, had a mean of 15 participants and an average duration of two - three hours. 74.3% of participants ( n = 6942) were from rural areas and 55.1% were health professionals. The most common topics in 2016 were adolescent health and YFHS (159 of 464 sessions), sexual and reproductive health (103 sessions), and violence (76 sessions). Reported benefits for participants of collaborative learning fell into three categories: 1) improved knowledge on adolescent health / development and use of evidence-based resources; 2) strengthened teamwork and cooperation; and 3) empowerment to provide high quality, youth-friendly care. Moderators identified benefits for the quality, youth-friendliness, and positioning of YFHS as centres of excellence on adolescent health. Challenges included the time and resources required to start and maintain the program, developing a constructive multi-disciplinary learning culture, and ensuring the involvement of stakeholders from outside YFHS. Conclusion This study confirms that collaborative learning within YFHS is feasible and acceptable, and offers benefits to both participants and YFHS. Collaborative learning may be a valuable strategy to improve the quality and youth-friendliness of services. It may also be relevant to key challenges in scaling up YFHS such as increasing utilisation and achieving long-term sustainability. Further research is required to confirm our results in other settings and to examine the effects of collaborative learning at the outcome and impact level.

A collaborative learning approach to improving health worker performance in adolescent sexual and reproductive health service provision: a descriptive feasibility study in six health zones in the Democratic Republic of the Congo

“…This points to the importance of enabling health service providers to learn from and support each other through discussion and reflection, as well as the need for comprehensive, multi-sectoral approaches to address the wider social determinants of adolescents’ health. As noted by Lesco et al, the inclusion of sensitive themes like violence and abortion in collaborative learning sessions could contribute to changing the values and attitudes of health service providers on key issues [ 14 ].…”

“…Group problem solving and collaborative learning have been shown to be effective in improving the attitudes and performance of health service providers in low- and middle-income countries [ 11–13 ]. However, few studies have assessed the feasibility and acceptability of collaborative learning in the context of adolescent health; further, the most comprehensive of these studies was conducted in a European setting [ 14 ].…”

“…In March 2018, a four-day meeting was held with the Ministry of Health, specifically PNLS and PNSA, implementing partners, members of the steering committee responsible for the project implementation and key stakeholders to the collaborative learning approach. This meeting was used to validate and finalise the ‘Collaborative Learning Guide for Improving the Performance of Health Service Providers,’ which was developed by the WHO in collaboration with the Ministry of Health and implementing partners specifically for use in the DRC, based on experience from a separate collaborative learning approach implemented in Moldova [ 14 , 26 ].…”

Improving access to and use of contraception by adolescents: What progress has been made, what lessons have been learnt, and what are the implications for action?

“…To overcome service provider bias in contraceptive provision in general, Solo and Festin recommend not blaming service providers, promoting sharing and learning from positive deviants, being explicit about what not being discriminative means in practice and using comprehensive approach to change behaviour [ 24 ]. This is illustrated in a study from Moldova which showed that fostering peer-sharing and learning in a safe environment can stimulate bottom-up problem definition and problem-solving and foster the development of norms and practices that are respectful and equitable in a group setting (even when they are not in the wider community in the group operates) [ 25 ]. Another study in India showed that health workers can be motivated, and their performance improved by supporting them to work as teams to achieve collective goals and rewarding them with public recognition and non-financial incentives [ 26 ].…”

Acceptability of peer learning and education approach on malaria prevention (PLEA-malaria) through primary schools communities in rural Ethiopia: peer educators’ perspectives

“…Successful school-based programmes are often characterized by improved acceptability and feasibility of the intervention which is ultimately is used to sustain it [ 38 , 39 ]. The collaborative learning nature of such a programme might have been contributed to the improved feasibility [ 40 ]. The observed higher perceptions of intervention’s acceptability reported in the current study may be due to many reasons: first, the multi-sectors engagement approach contained within the SBCC framework (i.e.…”