Enhancing Traditional Birth Attendant Training in Guatemala

Abstract

BACKGROUNDThis article describes the follow-up study to Simulation Learning Among Low Literacy Guatemalan Traditional Birth Attendants, published in the International Journal of Childbirth in 2017. This current study had two purposes: (a) to implement and evaluate the use of enhanced training modalities (active-learning strategies and use of technology in a remote area), and (b) to pilot training-of-trainer (ToT) methods. The current study builds upon the previous study in which we conducted and evaluated a simulation-based training among low-literacy Guatemala traditional birth attendants (TBAs).MATERIALS AND METHODSIn the current study, we conducted a focus group with experienced TBAs (n = 8) to elicit concepts and issues important to address in the training. The 60-hour training designed for low-resource settings, was enhanced with active-learning strategies, technology, and ToT modules. We assessed pre–posttest knowledge and attitudes by paper-pencil format, and pre–post skills by demonstration using simulation.RESULTSTraining participants (N = 31) included the eight experienced TBAs from the focus group. Knowledge, skills, and attitudes all improved, with statistical significance achieved in many parameters. Evaluation of the training was positive and enhancement strategies were noted as particularly helpful. Two participants participated in the additional ToT modules and are now collaborating to provide short educational programs to other TBAs in their regions.CONCLUSIONTraining enhancement strategies have the potential to increase safe practice among TBAs where skilled birth attendants are lacking. Adding ToT modules enhances sustainability and exemplifies the importance of locally prepared trainers in a time when global interaction is severely limited.