Enhancing obstetric care in Uganda

Background- what is this work about?

Health partnerships are collaborations between high-income countries and low- and middle-income countries with the aim of strengthening health systems. The aim of the health partnership between the Royal College of Obstetricians and Gynaecologists (RCOG) and Kitovu Hospital, Uganda, is to improve obstetric care (including pregnancy, childbirth, and up to around 6 weeks after birth), and reduce the incidence of obstetric fistula (a condition where a hole develops in the birth canal, which can result in incontinence). The partnership co-ordinated and delivered a three-day course (‘Excellence in: Obstetric Skills’), which included a mixture of lectures, workshops and skills clinics. To make sure this training would be long-lasting, this included ‘train-the-trainer’ training, which means that those attending could then train others within their own districts.

Aim- what did we hope to achieve?

The Change Exchange (a collective of volunteer behavioural scientists) worked with the health partnership, with the aim of using the theories, techniques and assessments of behavioural science to strengthen the training.

Design- what did we do?

Behaviour change techniques (BCTs) are the smallest parts of an intervention, for example goal setting. Interventions are usually made up of bundles of these. Pairs of behavioural consultants watched the training, and coded the behaviour change techniques that were used. The behavioural consultants also spoke with those attending the course, and visited health centres to watch trainees at work. The behavioural consultants then made suggestions to improve the content of the training, and how it was delivered, based on what they saw, and what behaviour change theory says should be included. In particular, they used the COM-B model, which focuses on the importance of three things for behaviour change: Capability (are they able to perform the behaviour?), Opportunity (do they have the opportunity to perform the behaviour?) and Motivation (do they want to perform the behaviour?).

Results- what did we find?

The behavioural consultants found that the training used a lot of BCTs which focused on the trainees’ capability, some that focused on their motivation, but only a few that focused on improving their opportunity. Based on this, suggestions were made to tweak the training by:

  • incorporating more examples of the benefits of changing their practice (i.e., presenting a locally relevant, meaningful rationale for change), including personalised goals, and developing posters to be displayed in health centres acting as reminders (all targeting motivation)
  • using easily accessible social media platforms such as Facebook and WhatsApp groups (targeting opportunity)

The behavioural consultants also recommended that BCTs should be key in education training, and clearly included in the materials for UK course facilitators and Ugandan trainers. To do this, the behavioural consultants were invited by the Royal College of Obstetrics and Gynaecology to contribute behavioural science training to the train-the-trainer programme for both the UK and Ugandan professionals. Through the same set of activities of the training course (lectures, workshops and skills practice), training was provided on motivational support. This included how motivational techniques could be used to motivate co-workers to change their practice, and used to encourage greater use of health centres by local women rather than receiving care from a local birthing attendant. Ugandan trainers were provided with instruction and mentoring on how to guide and motivate new trainees.

Overall, the inclusion of behavioural science led to improvements in the interventions within the education and training and also the inclusion of behavioural theories and techniques within the masters training project.

Dissemination- where has this study been shared?

This has been published alongside two other case studies in the journal Globalization and Health and is free to access here: https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-0254-4

Credits- Who was involved in this work?

Behavioural scientists: Nisha Sharma, Fiona Gillison, Amy Burton, Jo Hart, Lucie Byrne-Davies

Partnership staff:

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