DOI: 10.5061/dryad.h44j0zpq5
title: Training of maternity service providers on supportive and dignified maternity care: pre-post training assessment

description: 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.
description: The data were collected before and after a 3-day training on
 Supportive and Dignified Maternity Care. The participants were (clinical
 and non-clinical) maternity care staff. The participants were given a
 structured self-administered questionnaire.