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Perceptions of a short-term medical programme in the Dominican Republic: voices of care recipients.

ABSTRACT: Participation in short-term global health programmes for low-income countries is increasing amongst practising clinicians and trainees from high-income countries. However, few studies explicitly examine the perceptions of programme recipients. In July 2012, we conducted semi-structured interviews with a purposive sample of 47 adults receiving care from Medical Ministry International, an international non-governmental organisation providing short-term medical programmes in the Dominican Republic. Thirty interviews met criteria for inclusion. Transcripts were independently coded using a descriptive approach. After thematic saturation, 20 interviews were included in the final analysis. Nine major themes were identified: misidentification, access, identified needs, social determinants, faith, language, student involvement, areas for improvement and respect. Recipients were reluctant to discuss programme improvement directly and frequently misidentified the researcher as a caregiver, suggesting a need to separate clearly programme evaluation from care provision. They viewed student involvement positively in a setting where supervision is emphasised, suggesting a potential to develop measures of supervision's adequacy. Finally, recipients' perceptions of respect as an important but intangible programme element encourage broadening the ethical discourse around short-term programmes beyond only tangible goods and services. Our findings support the usefulness of qualitative methods for short-term programme evaluation and generate important hypotheses for future research.

SUBMITTER: DeCamp M

PROVIDER: S-EPMC4009346 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Perceptions of a short-term medical programme in the Dominican Republic: voices of care recipients.

DeCamp Matthew M Enumah Samuel S O'Neill Daniel D Sugarman Jeremy J

Global public health 20140311 4

Participation in short-term global health programmes for low-income countries is increasing amongst practising clinicians and trainees from high-income countries. However, few studies explicitly examine the perceptions of programme recipients. In July 2012, we conducted semi-structured interviews with a purposive sample of 47 adults receiving care from Medical Ministry International, an international non-governmental organisation providing short-term medical programmes in the Dominican Republic. ...[more]

PMID: 24617943

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Project description:BackgroundNeonatal mortality accounts for 45% of under-5 mortality worldwide, with 98% of newborn deaths occurring in developing countries. The Dominican Republic (DR) demonstrates one of the highest neonatal mortality rates in Latin America despite broad access to care. Strategies to support professional capacity building and strengthen the local health care system are needed to improve neonatal outcomes in the DR.RationaleHelping babies breathe (HBB) and essential care for every baby (ECEB) are evidence-based newborn resuscitation and essential care training programs that have been shown to improve providers' confidence, knowledge, and clinical skills. Lack of professional support and infrequent resuscitation skills practice are commonly cited as barriers to skill retention after HBB training, while establishment of program mentoring and regular skills refreshers are associated with retention of clinical knowledge and skills and improved clinical performance and outcomes. Global partnerships to facilitate implementation of a comprehensive newborn resuscitation and essential care training program with ongoing clinical and program mentorship in the DR should have a lasting impact on workforce capacity, quality of care, and clinical outcomes.MethodsA multidisciplinary, international group of clinicians partnered with the Ministry of Health to design and implement a comprehensive newborn health initiative in the DR. A train-the-trainer model structured the regional rollout of a combined HBB/ECEB program with integrated quality improvement (QI) initiatives and systems for ongoing program monitoring, reinforcement, and mentorship. Cognitive, affective, behavioral, and clinical outcomes are being measured.ResultsSeventeen local champions representing six hospitals participated in the HBB/ECEB master trainer course and design of a QI tool for site-specific clinical performance monitoring. One hundred seventy-eight and 171 providers participated in HBB and ECEB courses, respectively, at pilot sites during the following year. Participants completed prior training need assessment, pre-/post-knowledge assessments and course evaluations. Program mentorship and monitoring of continuing education and clinical performance are ongoing. The Ministry of Health has assumed responsibility for program sustainability and current scale-up, including integration of maternal resuscitation training.ConclusionInternational partnerships facilitated the collaborative implementation of scalable, locally sustainable newborn resuscitation and essential care training in the DR, mobilizing local resources and empowering the workforce to capably pursue improved care of an exceedingly vulnerable community.

Project description:Introduction: In 2017, approximately 295,000 women died during and immediately following pregnancy and childbirth worldwide, with 94% of these deaths occurring in low-resource settings. The Dominican Republic (DR) exhibits one of the highest maternal mortality ratios in the region of Latin America and the Caribbean despite the fact that 99% of registered births in the country are reportedly attended by a skilled birth attendant. This paradox implies that programs to support healthcare worker knowledge and skills improvement are vital to improving maternal health outcomes in the DR. Helping Mothers Survive (HMS) is a provider training program developed by Jhpiego and global partners. The goal of HMS is to combat maternal mortality by contributing to quality improvement efforts that reinforce maternal health skills of local healthcare workers. Methods: An international, multisectoral group of stakeholders collaborated in the implementation of two HMS curricula, Bleeding After Birth (BAB) and pre-eclampsia & eclampsia (PE&E). Demographic information as well as pre- and post-training knowledge scores were recorded for each participant. Knowledge score improvement was assessed in order to support effectiveness of the program on knowledge acquisition of healthcare workers. Results: Three hundred and twenty healthcare workers participated in the HMS training workshops between October 2016-August 2020. Of the 320 participants, 132 were trained as master trainers. The majority of participants identified as attending physicians, followed by residents/interns, nurses, students, and "other." A significant improvement in knowledge scores was observed for both the BAB and PE&E curricula, with a 21.24 and 30.25% change in average score (pre- to post-test), respectively. In response to COVID-19 pandemic restrictions, flexibility of the local team led to a PE&E virtual training pilot workshop in August 2020. Discussion/Conclusions: Simulation-based training improved the knowledge levels of healthcare workers for both HMS curricula. These results suggest that simulation-based workshops have an impact on knowledge acquisition and skills of healthcare workers immediately following training. For the PE&E curriculum, no significant difference in knowledge acquisition was observed between in-person and virtual training sessions. The ongoing pandemic poses challenges to program implementation; however, these preliminary results provide evidence that conducting virtual workshops may be a viable alternative to in-person training.

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Perceptions of a short-term medical programme in the Dominican Republic: voices of care recipients.

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Perceptions of a short-term medical programme in the Dominican Republic: voices of care recipients.

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