Development of a context specific accreditation assessment tool for affirming quality midwifery education in Bangladesh

Development of a Quality Assurance Assessment Tool to meet accreditation standards for midwifery education: A Delphi study

BACKGROUND

Ensuring the quality of midwifery education is critical for producing a qualified and competent midwifery workforce for sexual, reproductive, maternal, and newborn care services. While global standards advocate for quality enhancement and accreditation systems, challenges persist, particularly in low-income countries like Bangladesh.

AIM

To validate and culturally adapt a Quality Assurance Assessment tool aligned with global midwifery education standards for application in Bangladesh. The goal of the tool is to guide and assess an internal quality education assurance process tailored to meet the national accreditation standards.

METHODS

A modified Delphi technique was conducted with a panel of 55 experts, including educators, principals, and researchers from Bangladesh, India, and Sweden. The study underwent three rounds: tool development, field testing, and consensus building.

RESULTS

The first round was completed by 25 workshop panel members, the second was completed by 30 participants during field testing, and the third was completed by the 25 workshop panel members from the first round. The developed Quality Assurance Assessment Tool demonstrated face and content validity through expert consultation and field testing, aligning with both global education and national accreditation standards. Minor revisions enhanced clarity and feasibility.

CONCLUSION

The Delphi rounds resulted in a validated Quality Assurance Assessment Tool that offers a robust framework for assessing and enhancing midwifery education quality, aiding progress towards meeting national accreditation standards. This study provides a valuable resource for countries seeking to develop similar tools aligned with global and national education priorities.

Midwifery education in Bangladesh: An in-depth analysis through a systematic review

BACKGROUND

While midwifery education in Bangladesh has expanded since its establishment in 2013, there is little information available about the quality of education. The aim of this project was to analyse the literature related to midwifery education in Bangladesh in reference to the Global Standards for Midwifery Education.

METHODS

A systematic review was conducted using PubMed, CINAHL, Web of Science and Scopus databases. A search using keywords was conducted in January 2024. Abstracts were screened against inclusion and exclusion criteria. Data was assessed using the Mixed Methods Appraisal Tool and grouped into the Global Standards for Midwifery Education for analytical purposes.

RESULTS

A total of 14 articles met the inclusion criteria and were included in the study. There was a combination of quantitative (n = 1), qualitative (n = 8) and mixed method studies (n = 5). Key themes included a lack of professional recognition, limited learning and economic resources and sociocultural barriers for students. The implementation of an accreditation tool, upskilling of educators and an improved comprehensive curriculum were found to have positive impacts. This review highlights the progress in midwifery education in Bangladesh in the last decade as there is advancement towards enhancing educator knowledge and programme quality assessment. Some challenges remain such as the limited autonomy and professional acknowledgement, inadequate educational resources, poor financial support, as well as social and cultural barriers.

CONCLUSION

Interventions designed to address these issues are needed to enhance midwifery education in Bangladesh, with a long-term view of contributing to improvements in maternal and neonatal health.

Health System Strengthening Through Professional Midwives in Bangladesh: Best Practices, Challenges, and Successes

In 2008, a cadre of professional midwives was introduced in Bangladesh. Since then, 120 midwifery educational programs have been established. There are 2,556 midwives serving at 667 government health facilities, and there are more midwives working in nongovernmental organizations and the private sector. This case study documents the process of establishing a midwifery profession with distinct midwifery expertise in Bangladesh and aims to guide other low- and middle-income countries in best practices and challenges. We describe the national administrative groundwork for the profession's launch, roll-out of an education program aligned with the International Confederation of Midwives, national deployment, enabling environments in deployment, and the professional association. Bangladesh's professional midwives' roles in humanitarian response and the COVID-19 pandemic are also discussed. The first and final authors were closely involved in supporting the government's establishment of the profession, and their direct experience is drawn upon to contextualize the topics. In addition, the authors conducted a desk review of documents that supported the profession's integration into the health system and documented its results. Both routine program data and existing research studies were reviewed. Outcomes show that midwives are deployed to 95% of government subdistrict hospitals. About 50% of these hospitals are fully staffed with 4 midwives, and within the hospitals, midwives are in charge of 90% of the maternity wards and attend 75%-85% of the births. Since the midwives' deployment, significant quality improvement for most World Health Organization indicators has been found, along with increases in service utilization. The experience of establishing a new midwifery profession in Bangladesh shows that it is possible for a lower middle-income country to introduce a globally standard midwifery profession, distinct from nursing, to improve quality sexual, reproductive, maternal, newborn, and adolescent health services in both humanitarian and development settings.

Understanding competency of nursing students in the course of case-based learning in Cambodia: a convergent mixed method study

BACKGROUND

In the last decade, nursing education has begun to reform to competency-based education worldwide, including in low-and middle-income countries. Case-Based Learning (CBL), an approach to delivering competency-based education, contributes to acquiring critical thinking competency, problem-solving, higher knowledge, professional value and attitude. However, it needs to be taught in a culturally appropriate manner. In Cambodia, CBL was initiated in a classroom and clinical practicum by faculty and preceptors who graduated from the upgrading course. This study examined the factors associated with the competency level of nursing students, explored the practice and perceptions of teaching-learning activities among students, faculty members and preceptors and assessed the coherence of qualitative and quantitative findings.

METHODS

This was a convergent, mixed methods study. Data were collected from eight educational institutions for quantitative and qualitative studies and seven hospitals for qualitative studies. From June to September 2019, a cross-sectional survey of nursing students in the third year of the three-year programme (n = 719), eight focus group discussions (FGDs; n = 55) with 6-8 members and 15 FGDs with faculty (n = 38) and clinical preceptors (n = 37) with 4-7 members were conducted to elicit the teaching-learning experience and perceptions. Multiple linear regression was performed to investigate the factors associated with student competency. Moreover, the study conducted thematic content analysis on the qualitative data. The integrated analysis was presented as side-by-side joint displays.

RESULTS

First, the quantitative and qualitative findings confirmed each other 's CBL learning experiences. Students had higher levels of nursing competencies if they had CBL experiences, both in the classroom and clinical practicum, both in a group manner. Next, the quantitative and qualitative findings complemented students' academic satisfaction with the teaching by faculty members and preceptors. Finally, the quantitative and qualitative findings were expanded to explain students' academic satisfaction with the programme.

CONCLUSIONS

The finding of CBL experiences in a group and students' satisfaction with faculty members' and preceptors' teaching improved nursing students' competency development. Meanwhile, students' satisfaction with the design and delivery of the educational programme provides implications for policy level to narrow the theory and practice gaps in low- and middle-income countries.

Development of accreditation standards for midwifery clinical education in Iran

BACKGROUND

Accreditation is one of the most important methods of quality assurance and improvement in medical education. In Iran, there are no specific midwifery education accreditation standards. This study was designed to develop accreditation standards for midwifery clinical education in Iran.

METHODS

This study was performed in Iran in 2021. It consisted of two phases. In the first phase, accreditation standards for midwifery education in the United Kingdom, the United States, Australia and the International Confederation of Midwives were thoroughly examined through a narrative review. The domains obtained from this phase were used as a framework for coding in the second phase. In the second phase, a qualitative study was conducted with a directed content analysis approach to determine standards and criteria for clinical midwifery education accreditation in Iran. Participants were policymakers and senior managers of midwifery education, faculty members of midwifery departments with clinical teaching experience, and final year undergraduate midwifery students. The participants were selected by purposive sampling method, and data collection continued until data saturation.

RESULTS

The standards and accreditation criteria of midwifery education from the review study were formed 6 domains: Mission and goals; Curricula; Clinical instructors; Students, Clinical setting; and Assessment. In the second phase, data analysis led to the extraction of 131 codes, which were divided into 35 sub-subcategories, 15 sub-categories, and 6 main categories.

CONCLUSION

Implementing the specific and localized standards of clinical midwifery education in Iran can lead to improved quality of clinical education programs.

Concepts and issues related to adolescent health in nursing education

OBJECTIVE

analyze the structure of teaching programs and contents of the adolescent health and its development in nursing education.

METHOD

descriptive observational study conducted in Colombia, Ecuador and Peru. Data was collected by the Instrument for (self-)evaluation of the adolescent health and development component in undergraduate nursing programs, and investigated using descriptive statistics.

RESULTS

A total of 95 nursing schools participated in the study (84.1% of the total). Of the faculty responsible for teaching contents relating to adolescent health, 31.6% had no specific training on the topic and 18.9% had no educational/pedagogical training. Behavior, gender identity and sexual orientation, bullying and cyberbullying, use of digital technologies, partner violence, parenting, and pubertal delay were the main topics which could be incorporated into nursing education.

CONCLUSION

the faculty of the schools analyzed have limited education in pedagogical/educational topics and specific adolescent health issues. Curricula should be updated, including knowledge of laws and policies, thus expanding nurses' ability to generate, analyze and use data for decision making.

(1) 31.6% of faculty have no specific education in adolescent health. (2) 18.9% of faculty have no educational/pedagogical training. (3) Progress is needed in the use of active methodologies and interactive multimedia. (4) Knowledge of laws and policies for the adolescent population must be expanded. (5) Current and relevant adolescent health issues need to be addressed in nursing education.

The interplay of structural and external factors for strengthening midwifery education in Indonesia

OBJECTIVES

This study aimed to identify the barriers to and enablers of the strengthening of midwifery education in Indonesia. Indonesia has a long history of midwifery education. In 1996, midwifery education in Indonesia had a three-year direct-entry pathway leading to a higher education level to meet international standards. The quality of midwifery education is deemed essential for preparing competent midwives.

METHODS

A qualitative design was undertaken in 12 midwifery schools in eight cities in six provinces involving 37 participants. Data were gathered using in-depth interviews. Data were analysed using thematic analysis.

RESULTS

Several intertwined factors were found to play a vital role in midwifery education. This article focuses on results on "structural and external factors", a theme which contained three sub-themes: "the structures of midwifery programmes", "midwifery accreditation impacts on midwifery education", and "the Midwifery Act".

CONCLUSION

The structure of midwifery programmes, the accreditation of midwifery programmes, and establishment of the Midwifery Act contribute to the strengthening of midwifery education in Indonesia. This study highlights the challenges faced and the scheme required to strengthen midwifery education in producing competent newly graduated midwives who improve the midwifery workforce in Indonesia.

Conceptos y temas relacionados a la salud de los adolescentes en la formación en enfermería

Resumen Objetivo: analizar la estructura de los programas de enseñanza y los contenidos del componente de salud y desarrollo del adolescente en la formación de los estudiantes de enfermería. Método: estudio observacional descriptivo, realizado en Colombia, Ecuador y Perú. Se aplicó el Instrumento para (auto)evaluar el componente de salud y desarrollo del adolescente en la formación de pregrado de los proveedores de salud. Se utilizaron estadísticas descriptivas. Resultados: participaron 95 escuelas (84,1% del total). De los docentes encargados de la enseñanza de la salud de los adolescentes, el 31,6% no tenía formación específica en la materia y el 18,9% no tenía formación en el ámbito de la educación/pedagogía. Los principales temas que podrían incorporarse a la formación son: comportamiento, identidad de género y orientación sexual, bullying y cyberbullying, uso de las tecnologías digitales, violencia en el noviazgo, paternidad y retraso puberal. Conclusión: el profesorado tiene una formación limitada en temas pedagógicos/educativos y en temas específicos de la salud del adolescente. El plan de estudios debe actualizarse con contenidos del desarrollo y salud del adolescente, incluir conocimientos sobre las leyes y políticas, y ampliar la capacidad de las enfermeras para generar, analizar y utilizar datos para la toma de decisiones.

Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments

INTRODUCTION

Women and children bear a substantial burden of the impact of conflict and instability. The number of people living in humanitarian and fragile settings (HFS) has increased significantly over the last decade. The provision of essential maternal and newborn healthcare by midwives is crucial everywhere, especially in HFS. There is limited knowledge about the interventions, support systems and enabling environments that enhance midwifery care in these settings. The aim of this paper is to identify the factors affecting an enabling environment for midwives in HFS and to explore the availability and effectiveness of support systems for midwives.

METHODS

A structured systematic review was undertaken to identify peer-reviewed primary research articles published between 1995 and 2020.

RESULTS

In total, 24 papers were included from Afghanistan, Bangladesh, Nigeria, Democratic Republic of Congo, South Sudan and Sudan, Ethiopia, Pakistan, Uganda and Liberia. There were two broad themes: (1) the facilitators of, and barriers to, an enabling environment, and (2) the importance of effective support systems for midwives. Facilitators were: community involvement and engagement and an adequate salary, incentives or benefits. Barriers included: security and safety concerns, culture and gender norms and a lack of infrastructure and supplies. Support systems were: education, professional development, supportive supervision, mentorship and workforce planning.

CONCLUSION

More efforts are needed to develop and implement quality midwifery services in HFS. There is an urgent need for more action and financing to ensure better outcomes and experiences for all women, girls and families living in these settings.

PROSPERO REGISTRATION NUMBER

CRD42021226323.

Implementation of a context-specific accreditation assessment tool for affirming quality midwifery education in Bangladesh: a qualitative research study

Background: Only recently did midwifery become a profession in Bangladesh. As such, sufficient quality education, both theory and practice, remains a challenge. In 2018, a context-specific accreditation assessment tool for affirming quality midwifery education was therefore developed and implemented.Objectives: To describe both the positive and negative aspects of the implementation of an accreditation process at midwifery education institutions in Bangladesh and to sketch out areas for possible improvement.Method: Forty focus group discussions were conducted with 276 policymakers, regulatory authorities and educators involved in midwifery education and services in Bangladesh. The Consolidated Framework for Implementation Research (CFIR) was used in a directed content analysis approach.Results: The accreditation assessment tool was developed using a participatory and consensus-building approach, building on existing policies, which resulted in the national ownership of its implementation. Staff from clinical sites were not included in the accreditation process; unless this changes, this will make it difficult for Bangladesh to achieve the set accreditation standards. The accreditation process has improved communication between the midwifery teaching institutions, policymakers and regulatory authorities. Educators started to visit the clinical sites more frequently. The planning process was complex and time-consuming, and emphasis was put on the importance of developing a plan of action for measuring improvements.Conclusion: In the move from the initial assessment of an accreditation process to its implementation, it is essential to make public the results found at all educational institutions. This encourages acceptance, while soliciting feedback and suggestions for future action. Only then can an accreditation process have an impact on the provision of high-quality midwifery education and services. This paper aims to encourage and guide other countries in their development, planning and implementation of a national accreditation process for midwifery education.

Experiences of a new cadre of midwives in Bangladesh: findings from a mixed method study

BACKGROUND

Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. The objective of the findings presented in this paper, which is part of a larger study, was to better understand the experience of the midwives of their education programme and first posting as a qualified midwife and to assess their midwifery knowledge and skills.

METHODS

We applied a mixed method approach, which included interviewing 329 midwives and conducting 6 focus group discussions with 43 midwives and midwifery students. Sampling weights were used to generate representative statistics for the entire cohort of the midwives deployed in the public sector health facilities.

RESULTS

Most of the midwives were satisfied with different dimensions of their education programme, with the exception of the level of exposure they had to the rural communities during their programme. Out of 329 midwives, 50% received tuition fee waivers, while 46% received funding for educational materials and 40% received free accommodation. The satisfaction with the various aspects of the current posting was high and nearly all midwives reported that a desire to work in the public sector in the long run. However, a significant proportion of the midwives expressed concerns with equipment, accommodation, transport and prospect of transfers. The scores on the knowledge test and self-reported skill levels were varied but reasonably high.

CONCLUSION

While the midwives are highly motivated, satisfied with many aspects of their current jobs and have adequate knowledge and skills, there are some bottlenecks and concerns that, if unaddressed, may derail the success of this programme. To capture the career progress of these midwives, additional research, including a follow-up study with the same cohort of midwives, would be beneficial to this programme.

The professional role of skilled birth attendants' in Nepal - A phenomenographic study

OBJECTIVE

The aim of this study was to describe the Nepali Skilled Birth Attendants' (SBAs) perceptions of their professional role.

METHODS

Fifteen Nepalese SBAs were interviewed using a semi-structured interview guide. A phenomenographic approach was chosen to describe their qualitatively different and unreflective conceptions of the professional role. Data was analysed in a seven-step process and three description categories and six conceptions emerged.

RESULTS

The SBAs described the role as provider, the role as counsellor and the role as educator. As provider, the SBA maintained midwifery nursing and prevented maternal deaths. As counsellor, the SBA advocated and empowered women and facilitated family planning. As educator, the SBA promoted health of families and health in the society. She also tutored students and colleagues about skills and human rights.

CONCLUSION

The SBAs' vulnerability emerged especially in rural areas while preventing complications and newborn and maternal death in rural areas where she often worked alone with lack of proper equipment and access to other medical professionals. The SBAs perceived that their professional roles required knowledge and experiences, were safety was closely linked to health education. Ethical dilemma could arose when they had to relate to the families' cultural decisions. Education was a key factor connected to close life-saving procedures and to retain good quality and safety in newborn and maternal healthcare. The SBAs switched between their three roles, always striving to be aware of compliance with the Sustainable Development Goals policy.