Perceived self-efficacy and willingness to teach family planning among nursing and midwifery faculty in higher learning institutions in Rwanda
Authors: Nkurunziza Aimable , Mukeshimana Madeleine , Endale Tamrat , Habtu Michael , Uwera Yvonne Delphine Nsaba , Rutayisire Reverien , Bagirisano Justine , Hitayezu Jean Bosco Henri , Ishimwe Marie Laetitia Bazakare , Uwimana Jean De Dieu 
Published: August 2023

Background Promoting family planning is a key strategy for health, economic and population growth, and to achieve sustainable development goals (SDGs). However, there is a lack of research on the capacity of nurses and midwives to deliver FP at higher learning institutions (HLIs) in Rwanda. Specific Aim To explore and describe the perceived self-efficacy and willingness of the nursing and midwifery faculty to teach family planning to HLIs students. Research design/Methodology We conducted a mixed methods study using a sequential explanatory design among almost all the HLIs (n = 6, 1 institution declined) in Rwanda that train nurses and midwives. One hundred thirty-six nursing and midwifery teaching faculty who were actively teaching family planning either in class, simulation lab, or clinical practice were invited to participate in a self-administered questionnaire and four qualitative focused group discussions. Participants answered questions ranking their self-efficacy in four domains from 0 - not confident to 3 - completely confident. Scores were calculated for each domain. A semi-structured interview guide was developed based on the quantitative survey findings to gain a deep understanding of the ability and willingness to teach family planning. Data were analyzed using thematic analysis. Ethical approval was obtained from the University of Rwanda, College of Medicine and Health Sciences Institutional Review Board. Results A total number of 89 nursing and midwifery faculty participated in the study and only 85 completed the questionnaires fully yielding a response rate of 95.5%. The mean age was 40.39 and there were more females (62.4%) compared to their male counterparts (37.6%). Respondents scored highest for perceived self-efficacy for course preparation (mean = 2.37), evaluation and examination (mean = 2.12) and instructor behavior and delivery (mean = 2.35). However, the score was low for clinical practices (mean = 1.79). There was a significant correlation among the four items of self-efficacy (p < 0.05). Being a female, a midwife, and having more years of experience in nursing education were each significantly associated with the perceived self-efficacy to teach FP (p < 0.05). In the qualitative phase, 32 study participants participated in four focus group discussions. Four themes were identified: a) Educational background as determinant of confidence to teach FP; b) willingness to teach FP; c) enabling factors of teaching FP; and d) structural challenges. Conclusion Nursing and midwifery teaching faculty reported moderate self-efficacy in teaching family planning. They also reported inadequate self-confidence in teaching family planning in clinical practice, especially for long-acting, reversible contraceptives (LARC). There is a need for HLIs and different stakeholders to invest in training the nursing and midwifery teaching faculty on family planning practical skills to have a nursing and midwifery workforce providing up to date clinical FP service that will help Rwanda reach the SDGs.