Training in obstetric and neonatal emergencies in Mexico: effect on knowledge and self-efficacy by gender, age, shift, and profession

Abstract

Background: Continuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship with gender socialization), profession and work conditions might have an influence on the effect of continuing education efforts. Methods: A training in the management of obstetric and neonatal emergencies (PRONTO, Spanish acronym for Neonatal and Obstetric Rescue Program: Optimal and Timely treatment) was implemented in 14 hospitals in six Mexican states between 2013 and 2014, with a before-after evaluation design. A total of 351 health providers including physicians, interns, nurses and midwives completed the training and were included in the analytic sample. Mixed-effects regression models were fitted to model changes in knowledge and self-efficacy scores after the training for each training topic. Interaction terms of training with age, gender, profession, and shift were included to evaluate possible heterogeneities of effect. All models considered the within-hospital clustering of participants. Results: After training, all participants showed a significant knowledge gain by an average of 19 percentage points for hemorrhage, 23 for neonatal resuscitation, 19 for shoulder dystocia, and 15 for preeclampsia/eclampsia (p < 0.001). Participants who worked night shifts showed lower scores for overall knowledge, compared with morning shift workers. Interns perceived the lowest self-efficacy while they scored very high in knowledge. Self-efficacy in managing obstetric and neonatal emergencies increased significantly by 16 percentage points in average. Conclusions: Our results show that PRONTO is generally successful in increasing knowledge and self-efficacy on all topics but knowledge and self efficacy levels vary greatly by factors such as work shift. Training should be particularly aimed at personnel working during weekends and night shifts, as well as interns and nurses.

Barriers to achieving quality birth care under the Sentinel Care model in Mexico

“…Since the 1990s, it has been reported that the main reason why women do not like obstetric attention in public health institutions in Mexico was the perception of poor care, mistreatment and lack of trust in staff. 13 Recently another study 14 documented that health personnel reported a lack of constant training and the fear of possible legal claims by users or adverse legal situations due to complications during obstetrics as the main reason for not attending births.…”

AMBAR: A midwifery‐led training program to improve obstetric and neonatal practices among low‐risk births in Mexico

“…Further investigation is needed The reduction in CB was similar to that found for PRONTO (Programa de Rescate Obstétrico y Neonatal, Tratamiento Óptimo y Oportuno), an obstetric and neonatal emergency management program evaluated in Mexico, with which AMBAR shares similarities. 10,18,19,25,50 It is likely that the decrease is caused by increased provider confidence in handling complications that can arise during low-risk deliveries, without resorting to an unnecessary "emergency" CB, as well as to an emphasis on humanized birth care. 25,50…”

“…We collected information on covariates that were previously found to influence birth practices themselves or knowledge and self-efficacy on birth practices in Mexico. 10,18,19,45 Health provider covariates included profession, gender, and previous training in birth care. Maternal covariates included schooling, speaking an indigenous language, and the number of previous pregnancies.…”

“…To achieve this, simulation-based trainings have been shown to be a useful tool for increasing knowledge and self-efficacy, and changing birth practices in Mexico. 10,18,19 A training program: Evidence-Based Women and Newborn Care (AMBAR for its Spanish acronym: Atención a la Mujer y Recién nacido Basado en evidencia) was developed by experts including a midwife, obstetrician, pediatrician, and researchers based at the National Institute of Public Health of Mexico. The program was implemented to improve the quality of obstetric and neonatal care in a set of hospitals and primary care centers in Mexico.…”

“…Thus, training all health personnel involved in birth care, not only midwives, is essential if the country aims to improve the quality of care in the near to mid‐term. To achieve this, simulation‐based trainings have been shown to be a useful tool for increasing knowledge and self‐efficacy, and changing birth practices in Mexico 10,18,19 …”