Development and testing of a tool to assess health workers' clinical confidence to provide perinatal bereavement care in Sub-Saharan Africa

开发和测试工具来评估卫生工作者在撒哈拉以南非洲地区提供围产期丧亲护理的临床信心

• 批准号: MR/X004082/1
• 负责人: Tracey Mills
• 金额: $ 18.35万
• 依托单位: Liverpool School of Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FX004082%2F1
• 关键词: Development; testing; tool; assess; health

Background to the research: The death of a baby before, during, or soon after birth, termed stillbirth or neonatal death, is amongst the most traumatic of life events for parents. The overwhelming majority of stillbirths and neonatal deaths happen in low- and middle-income countries, with sub-Saharan Africa and South Asia accounting for around 75% of the world total. The death of a baby has long-lasting impacts on parents, greatly increasing the risk of poor mental and physical health and family breakdown, which have negative effects on wider society. Across the world, most women give birth in hospitals. We know that when a baby dies, having good care and support from health workers in the hours and days surrounding the death has a positive effect in helping mothers and fathers cope, and adjust to the loss. However, in many countries, including African countries, parents do not get good enough care or support after their baby dies. Health workers tell us that they find this part of their work difficult and do not always know what they should do to support parents, they need more education and help from facilities to give better care. Having appropriate methods (such as questionnaires) to assess health workers' abilities, identify areas for development, and test the effectiveness of strategies such as training packages, is crucial to demonstrate and maintain improvement. Tools to assess bereavement care need to reflect the local environment and culture. Currently, there are very few tools designed to assess health workers' knowledge and confidence in providing care after the death of a baby, and none have been developed with African health workers or parents.Aim: The aim of this research is to develop and test a tool to assess the confidence of health workers to provide bereavement care after stillbirth or neonatal death in sub-Saharan Africa.Research plan: A team of midwives, psychologists, and statisticians from the UK, Malawi, and Zimbabwe will work with local health workers, managers, policymakers, and parents, with previous experience of the death of a baby. In phase 1, the tool will be developed, using previous research, experiences of local health workers in providing care, and behaviour change theories. The whole team will be involved in decisions surrounding the choice of topics and questions to be included and methods for response e.g. scales. Once the tool is agreed it will be tested with a small number of health workers in Malawi and Zimbabwe to ensure it is clear, acceptable, and easy to complete. Consistency will be also tested. Revisions will be made as necessary, based on the results. In phase 2 the tool will be tested with up to 300 health workersacross Malawi, Zimbabwe, Kenya, Tanzania, Uganda, and Zambia, to assess whether it is reliable and measures what is intended.The tool is likely to be useful in other low- and middle-income countries and for related situations e.g. care following a miscarriage. It could also be used with other professional groups, such as community health workers and counsellors. Capacity strengthening: During this research, the local researchers will have the opportunity to gain skills in developing and testing tools. Inexperienced researchers will be supported by senior researchers (UK and Africa) to develop leadership and management experience which will contribute to increasing the capacity of local universities, particularly in Malawi and Zimbabwe, to conduct midwifery research and improve the health of mothers and babies. UK researchers will gain additional experience in global health research.

研究背景：婴儿在出生前、出生期间或出生后不久死亡，称为死产或新生儿死亡，是对父母来说最痛苦的生活事件之一。绝大多数死产和新生儿死亡发生在低收入和中等收入国家，其中撒哈拉以南非洲和南亚地区约占世界总数的75%。婴儿的死亡会对父母产生长期影响，大大增加身心健康不佳和家庭破裂的风险，从而对更广泛的社会产生负面影响。在世界各地，大多数妇女在医院分娩。我们知道，当婴儿死亡时，在死亡前后的数小时和数天内得到卫生工作者的良好护理和支持对于帮助母亲和父亲应对和适应损失具有积极作用。然而，在许多国家，包括非洲国家，父母在婴儿去世后得不到足够的照顾或支持。卫生工作者告诉我们，他们发现这部分工作很困难，并且并不总是知道应该做什么来支持父母，他们需要更多的教育和设施的帮助，以提供更好的护理。采用适当的方法（例如问卷）来评估卫生工作者的能力、确定需要发展的领域以及测试培训包等策略的有效性，对于展示和保持改进至关重要。评估丧亲护理的工具需要反映当地的环境和文化。目前，用于评估卫生工作者在婴儿死后提供护理方面的知识和信心的工具很少，也没有与非洲卫生工作者或父母一起开发的工具。 目的：本研究的目的是开发和测试一种评估卫生工作者在撒哈拉以南非洲地区死产或新生儿死亡后提供丧亲护理信心的工具。研究计划：来自英国、马拉维和津巴布韦的助产士、心理学家和统计学家组成的团队将与当地有过婴儿死亡经历的卫生工作者、管理人员、政策制定者和家长合作。在第一阶段，将利用先前的研究、当地卫生工作者提供护理的经验以及行为改变理论来开发该工具。整个团队将参与围绕要包含的主题和问题的选择以及响应方法的决策，例如秤。一旦该工具达成一致，将由马拉维和津巴布韦的少数卫生工作者进行测试，以确保其清晰、可接受且易于完成。还将测试一致性。将根据结果进行必要的修改。在第二阶段，该工具将在马拉维、津巴布韦、肯尼亚、坦桑尼亚、乌干达和赞比亚的多达 300 名卫生工作者中进行测试，以评估它是否可靠并测量预期结果。该工具可能在其他低风险国家中有用。和中等收入国家以及相关情况，例如流产后的护理。它还可以与其他专业团体一起使用，例如社区卫生工作者和咨询师。能力强化：在这项研究期间，当地研究人员将有机会获得开发和测试工具的技能。经验不足的研究人员将得到高级研究人员（英国和非洲）的支持，以培养领导力和管理经验，这将有助于提高当地大学（特别是马拉维和津巴布韦）开展助产研究并改善母亲和婴儿健康的能力。英国研究人员将获得全球健康研究的额外经验。