Development and testing of a distance learning package used to improve the knowledge of trained Auxiliary Nurse/Midwives (ANM) in normal midwifery practice in Central India

Abstract

Background: This study is set in the Indian State of Madhya Pradesh (MP) where maternal health is poor and women’s social status is low. In the majority of cases women’s autonomy and decision making within the family is limited and their ability to seek medical treatment is through their husband or father-in-law. The State government identified a need to strengthen midwifery care given by Auxiliary Nurse/Midwives (ANMs) in the hope of improving maternal and neonatal health. This study formed part of one Non-Governmental Organisation’s response to this need.
Design: This cross-cultural, two phase study was designed in partnership with an Indian Non-Government Organisation, utilising Elliot’s Action Research model within the paradigm of critical theory. The first phase investigated the then current situation and established a potential solution to strengthening midwifery practice within MP. This solution comprised an educational approach using a specifically designed self-directed distance learning programme (DLP) focussing on normal pregnancy and childbirth. The DLP consisted of a hard copy workbook supported by a multimedia resource. The second phase was the use and evaluation of the DLP with a sample of 28 ANMs in MP. Their knowledge was tested using a pre- and post-test multiple-choice question paper. Data were analysed using Wilcoxon signed rank. Participants then negotiated a three day workshop to cover aspects they had not been able to address. A further 19 participants joined these three days.
Outcomes: The MCQ test results indicated that the first group had poor knowledge of the normal process of pregnancy and childbirth. This group did not improve their personal performance scores significantly after the three day workshop. However, the second group demonstrated a significant change which suggests that coupling self-directed guided study material with an enabling, face-to-face environment can be successful.
Conclusion: Distance learning may be more effective if coupled with face-to-face workshops. Partnership working was a crucial component of this cross cultural Action Research study which required attention to detail in all stages for a successful conclusion. Both of these points have relevance for others undertaking similar studies.
Recommendations: Improved interface between global organisations and the Indian Government to improve midwifery education and status.

More information

Identifiers

Catalogue record

Export record