Training of maternity service providers on supportive and dignified maternity care: pre-post training assessment

Poor psychosocial support and lack of respectful care for women during
childbirth are commonplace in health facilities in low- and middle-income
countries. While WHO recommends providing supportive care to pregnant
women, there is a scarcity of material for building the capacity of
maternity staff to provide systematic and inclusive psychosocial support
to women in the intrapartum phase and prevent work stress and burnout in
maternity teams. To address this need we adapted WHO’s mhGAP and its
training manual for maternity care staff to provide psychosocial support
in labour room settings. Mental Health Gap Action Programme
(mhGAP)  is an evidence-based intervention which focuses on
providing psychosocial support to people with mental, neurological and
substance-use disorders  (MNS). The objective of this paper is to
describe the adaptation of mhGAP to develop psychosocial
support-capacity-building materials for maternity staff to provide support
to maternity patients, and also to staff, in the labour room. Adaptation
was conducted within the Human-Centered Design framework in three phases:
inspiration, ideation, and implementation feasibility. In the inspiration
phase, a review of national-level maternity service-delivery documents and
formative study via in-depth interviews of maternity staff were conducted.
Ideation involved a multidisciplinary team to develop capacity-building
materials by adapting mhGAP. This phase was iterative and included cycles
of pretesting with staff, deliberations among the core team, and revision
of materials. In the implementation feasibility phase, materials were
tested via the training of 98 maternity staff and exploring system
feasibility via post-training visits to health facilities. The inspiration
phase identified gaps in policy directives and implementation. A formative
study found that staff lacked the understanding and skills to assess
patients’ psychosocial needs and provide appropriate support. Allied with
this, it became evident that maternity staff themselves needed
psychosocial support. In ideation, the team developed capacity-building
materials comprising two modules: one dedicated to conceptual
understanding, and the other to implementing psychosocial support in
collaboration with maternity staff. In the implementation feasibility
phase, Staff found the materials relevant, acceptable and feasible for the
labour room setting. Finally, users and experts reviewed and endorsed the
relevance and usefulness of the materials.  Our work in
developing psychosocial-support training materials for maternity staff
extends the utility of mhGAP by building the capacity of maternity staff
to identify specific, hitherto-neglected needs of patients and staff, and
by supporting, respectively, pregnant women to have positive birthing
experiences, and maternity staff to manage workplace stress and avoid
burnout. These materials can be used in a similar maternity setting after
cultural adaptation.

中低收入国家的医疗卫生机构中，产妇分娩期间社会心理支持不足、缺乏尊重性照护的情况十分普遍。尽管世界卫生组织（World Health Organization, WHO）已推荐为孕产妇提供支持性照护，但目前仍缺乏相关资料，用以提升产科医护人员的能力，使其能够为产时阶段的女性提供系统性、包容性的社会心理支持，并预防产科团队出现工作压力与职业倦怠。为填补这一需求空白，我们对世界卫生组织的精神卫生差距行动规划（Mental Health Gap Action Programme, mhGAP）及其培训手册进行了适配改造，以应用于产房场景下的社会心理支持服务。精神卫生差距行动规划（mhGAP）是一项基于证据的干预方案，旨在为精神、神经与物质使用障碍（Mental, Neurological and Substance-use Disorders, MNS）患者提供社会心理支持。本文旨在阐述针对mhGAP的适配改造过程，以开发面向产科医护人员的社会心理支持能力建设资料，既用于为产科患者提供支持，也兼顾产科医护人员自身的支持需求。本次适配改造以人为中心的设计（Human-Centered Design）框架为指导，分为三个阶段：启发阶段、构思阶段与实施可行性阶段。在启发阶段，我们对国家级产科服务交付文件开展了文献综述，并通过对产科医护人员的深度访谈完成了形成性研究。构思阶段由多学科团队主导，通过适配mhGAP开发能力建设资料；该阶段为迭代式流程，包含医护人员预测试、核心团队研讨以及资料修订的多轮循环。在实施可行性阶段，我们通过对98名产科医护人员开展培训对资料进行了测试，并通过培训后对医疗机构的走访评估了系统可行性。启发阶段的研究发现了政策指令与实际执行中的缺口。形成性研究显示，医护人员缺乏评估患者社会心理需求并提供恰当支持的认知与技能。与此同时，研究也明确了产科医护人员自身也亟需社会心理支持。在构思阶段，团队开发了包含两个模块的能力建设资料：其一专注于概念性认知，其二则聚焦于与产科医护人员协作开展社会心理支持的实操落地。在实施可行性阶段，医护人员认为该资料贴合产房场景、可接受度高且具备实操可行性。最终，使用者与专家对资料的相关性与实用性进行了评审并予以认可。本次我们为产科医护人员开发的社会心理支持培训资料，拓展了mhGAP的应用边界：通过提升产科医护人员识别患者与医护人员此前被忽视的特定需求的能力，分别助力孕产妇获得积极的分娩体验，以及帮助产科医护人员管理工作压力、规避职业倦怠。该资料经文化适配后，可在类似的产科场景中推广使用。