Knowledge Transfer of Continuous Professional Development to Clinical Practice in Rwanda: Midwives' Perspective

Babenko-Mould, Yolanda B.

Purpose: The purpose of this study was to gain an in-depth understanding of midwives’ experiences of applying the new knowledge and skills gained from participating in the ALSO^® education course into their practice settings.

Methods:

Research Questions

What are midwives’ experiences of transferring into practice new knowledge and skills gained from completing the ALSO^® education course?
What facilitators and barriers impact midwives’ ability to implement new knowledge and skills in their practice settings?

Ethics Approvals

This study met ethics requirements in that it was approved by the Western University Health Sciences Research Ethics Board and the Rwanda National Ethics Committee. Midwives who voluntarily accepted to participate in this study signed a consent form.

Methodology and Sampling

A descriptive qualitative design was used with a purposeful sample of nine midwives who were able to speak English or Kinyarwanda, were currently working in a maternity service in the Eastern Province of Rwanda, and had completed an ALSO^®course within the last 2 years.

Data Collection and Analysis

To collect data, face-to-face individual interviews were conducted using a semi-structured interview guide. All participants chose to have their interviews in Kinyarwanda, and with permission of each participant, all interviews were audio-recoded. Individual interviews lasted approximately 60 to 90 minutes. The audio-recorded interviews were then transcribed verbatim in Kinyarwanda, and then translated to English by the researcher. Inductive content analysis was used to analyse the data.

Trustworthiness

To ensure the quality of this study, trustworthiness, namely credibility, conformability, dependability and transferability were used.

Results:

Five interrelated themes emerged from the data analysis: Improved Midwifery Practice, Availability of Resources, Inter-professional Collaboration, Job (Dis) satisfaction, and Autonomy for Midwifery Practice.

Discussion

Opportunities: The findings from this study revealed that midwives who participated in an ALSO^® course increased their knowledge, skills, and confidence in the management of obstetric emergencies. The study findings also suggest that team spirit and knowledge sharing among health professionals who work in maternity services improved due to involvement in the ALSO^® education program. Midwives reported improved communication and relationships between midwives and their clients after participating in the ALSO^® course. The findings revealed that midwives perceived a reduction in maternal and neonatal morbidity and mortality, which had previously been attributed to health professionals’ insufficient knowledge and skills regarding obstetric emergency management prior to participation in the ALSO^®course.

Challenges: The findings highlighted that a shortage of midwives and other health professionals, insufficient resources, and non-conducive working environments were identified as key issues encumbering midwives’ abilities to fully apply their new knowledge and skills gained from the ALSO^®course into practice to improve the provision of quality care. Limited inter-professional collaboration, especially between physicians and midwives, heavy workloads, and limited autonomy for midwifery practice were found in this study as the main factors associated with non-conducive work environments, and some midwives’ experiences of job dissatisfaction.

Conclusion: The findings showed that after participating in an ALSO^® course, midwives applied the newly acquired knowledge and skills into practice, and perceived themselves to have increased confidence for managing obstetric emergencies. The midwives felt empowered to change practice, but often faced challenges such as non-conducive work environments, shortage of health care providers, and insufficient equipment and materials.