An education package to improve health worker communication with women and families after still birth or neonatal death
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Date
2020-10-08
Authors
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Publisher
Kamuzu University of Health Sciences
Abstract
Study type
This study will be an action research that will follow the cycles of problem identification,
planning change and action to implement the change. The approach will be complemented
with use of the Behaviour Change Wheel which is a structured approach to designing
behaviour change educational interventions.
The problem
Stillbirth or neonatal death is acknowledged as among the most traumatic and distressing life
experiences with profound and long-lasting impacts for parents. Good communication is
identified as being essential. This includes appropriate empathic and compassionate verbal and
non-verbal communication and respect for privacy. However, negative experiences feature
prominently in the global literature surrounding parents’ views and perceptions surrounding
care after stillbirth and neonatal death. Our recent qualitative work across rural and urban
facilities in East Africa has confirmed parents in these settings received inadequate information
surrounding their care. In the proposed study, we will use our exploratory data to produce, test
and refine a stillbirth communication package. We will also assess the acceptability of the
package and determine the feasibility of a full-scale trial to assess effectiveness and the
possibility of a scale up of the intervention.
Broad objective:
The broad objective of the study is to investigate the effectiveness of an educational
package on health worker communication with women and families after stillbirth or early
neonatal death (neonatal deaths that occur before the mother is discharged from the
hospital after delivery) in Malawi, Uganda, Zambia and Zimbabwe.
The specific objectives of the study are to:
• assess knowledge, skills, attitude and confidence of healthcare workers in
communication of stillbirth;
• develop an education intervention to use in health worker communication of still
birth;
• assess the impact of an education package on health worker communication of on still
birth and early neonatal death;
• determine the acceptability of the package with healthcare workers, managers and
undergraduate midwifery students;
• establish the feasibility of implementing the intervention as a full trial protocol.
Methodology : Study design: This study will use mixed methods; a quasi-experimental design,
and qualitative methods. The study will take place in four countries: Malawi, Uganda,
Zambia and Zimbabwe. In Malawi the study will take place at Queen Elizabeth Hospital. The
sample will comprise 120 (30 per 4 countries) healthcare workers; 60 Student midwives
(from Malawi and Uganda) and up to 15 clinical trainers (depending on saturation of data)
and service managers per country. The Intervention will be a one-day educational workshop
focused on ‘Good communication after a stillbirth or neonatal death co-produced with input
from stakeholders and Community Engagement and Involvement (CEI) in-country. A pre and post-test questionnaire will be used to collect quantitative data. Qualitative data will be
guided by an interview guide. Data analysis of quantitative data will be done using SPSS.
Qualitative data will be transcribed verbatim and analysed using framework analysis. This
approach allows for analysis of a prior and emergent concepts and themes.
Expected findings: We expect that participants will improve on how they communicate to a
woman/mother and significant others about a stillbirth or neonatal death.
Dissemination: Study findings will be disseminated at COMREC and other research
dissemination conferences, to CEI groups, stakeholders and health care workers and nursing
/midwifery colleges through facility events. The findings will also be published in
appropriate journals
Description
Keywords
Still birth, Neonatal death