Using behavioural science to explore impact and implementation of obstetric anaesthesia training in Tanzania, Nepal and Bangladesh: a qualitative evaluation study with obstetric anaesthesia providers

Abstract

Objective: High quality obstetric anaesthetic care is integral to reducing preventable maternal deaths in Low-and-Middle-Income-Countries (LMICs). We applied behavioural science to evaluate SAFE Obstetrics, a 3-day Continuing Professional Development (CPD) course, on physician and non-physician anaesthetists’ practice behaviours across 3 LMICs.Methods: Seven anaesthetist Fellows from Bangladesh, Nepal and Tanzania were trained in qualitative methods and behavioural science. Structured interviews were undertaken by Fellows and two UK behavioural scientists with course participants. Interviews were based on the Theoretical Domains Framework: a comprehensive framework of influences on behaviour change. Interviews were recorded, transcribed and analysed using content and thematic analysis.Results: 78 physician and non-physician anaesthetists participated (n = 26 Bangladesh, n = 24 Nepal and n = 28 Tanzania). Participants reported positive improvements in patient-centered working, safety, teamwork and confidence. Across countries, we found similar barriers and facilitators: environmental resources, a strong professional identity and positive social influences were key facilitators of change.Conclusion: This multi-country theory-based evaluation highlighted the impact of SAFE Obstetrics on participants’ clinical practice. A supportive work environment was crucial for implementing learning following training; CPD courses in LMICs must furnish participants with skills and equipment to address training implementation challenges. Building local behavioural science capacity can strengthen LMIC health intervention evaluations.

Keywords:

• Obstetrics
• emergency anaesthetic care
• global health
• low middle income countries
• behavioural science

Acknowledgements

We thank participants sincerely for their time and for sharing their expertise and views with us, taking time out of their invaluable work to participate in this study. We are also grateful to Dr Mwenzi Kaino for support for the project and for facilitating the training of the SAFE Fellows in Tanzania. Many thanks also to Amal Paonaskar and WFSA team members for their help with coordination of the data collection and verification of transcripts. We are also grateful for Dr Prince T Murambi’s passion and expertise in the SAFE Fellow training programme and his interest in the study even though interviews could not ultimately proceed in Zimbabwe.

Declaration

All authors declare that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Additional information

Funding

We are grateful to the Laerdal Foundation for funding this study.