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

Nimarta Dharni, Lucie M. T. Byrne-Davis, Evans Sanga, Jo Hart, Amir Babu Shrestha, Tara Gurung, Ravi R. Shrestha, Pradip R. Vaidya, Amir Hossain, Maytinee Lilaonitkul, David Snell, Alex Barrett-Chapman, Isabeau Walker, Eleanor R. Bull

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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.
Original languageEnglish
JournalPsychology and Health
Early online date9 Jan 2023
DOIs
Publication statusE-pub ahead of print - 9 Jan 2023

Keywords

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

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