Shtanko Yulia, Litenski Melissa N, Clarke Rachel, Hernandez Sasha, Oliveira Jessica B
Medical Education, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Psychiatry and Behavioral Health, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Cureus. 2024 Sep 22;16(9):e69940. doi: 10.7759/cureus.69940. eCollection 2024 Sep.
While there has been notable global advancement in reducing maternal mortality rates (MMRs) in Latin America, the rates among indigenous women remain alarmingly high. This disparity persists in Guatemala, where indigenous women face a two-fold higher MMR compared to their non-indigenous counterparts. Most of the obstetrical care is performed by traditional Mayan birth attendants (TBAs), also known as comadronas, who have minimal formalized clinical training in obstetrical care. Considering there was no national comprehensive training program for TBAs, a unique training program was established in 2014. This program, the School of PowHER (Providing Outreach in Women's Health and Educational Resources), aims to ensure sustainable education led by TBAs for TBAs in rural Guatemala with the ultimate goal of helping TBAs provide basic antenatal care and learn how to identify and refer high-risk pregnancies. The aim of this proposed study is to examine the cultural appropriateness and sensitivity of the training program through a mixed-methods approach.
We utilized a mixed-methods strategy, combining quantitative and qualitative methodologies. The quantitative aspect involved a 14-item written survey using a three-point Likert scale for responses, while the qualitative part utilized a semi-structured interview guide to conduct a focus group discussion.
The survey (n=33) showed that 32 comadronas found the curriculum applicable (97%) and comprehensible (97%). However, only 26 comadronas (79%) were comfortable with anatomy terminology. Opinions on teaching tools varied: 13 comadronas (39%) felt they were always representative, 13 comadronas (39%) sometimes, and seven comadronas (21%) never. Group discussions echoed this lack of representation. In the learning environment, 32 comadronas felt welcomed (97%) and 31 felt understood (94%), but five comadronas (15%) were not comfortable asking questions. Thirty-one comadronas (94%) believed training made pregnant women trust comadronas more. Group interviews highlighted increased confidence, better care, and perceived lower maternal mortality.
This study found the program to be culturally sensitive and effective. Group interviews highlighted increased confidence, improved patient care, and perceived reductions in maternal mortality. Feedback emphasized the need for more culturally relevant materials, resources, and collaboration with the Ministry of Health. This program's community-centered approach could serve as a model for similar initiatives in low- and middle-income countries addressing high maternal mortality rates, despite language and access challenges.
尽管拉丁美洲在降低孕产妇死亡率（MMR）方面取得了显著的全球进展，但土著妇女的死亡率仍然高得惊人。危地马拉也存在这种差异，当地土著妇女的孕产妇死亡率是非土著妇女的两倍。大多数产科护理由传统的玛雅助产士（TBA）进行，她们也被称为科马德罗纳，在产科护理方面接受的正规临床培训极少。由于没有针对玛雅助产士的全国性综合培训计划，2014年设立了一个独特的培训计划。这个名为“PowHER学校”（提供妇女健康外展和教育资源）的计划旨在确保由玛雅助产士主导，为危地马拉农村地区的玛雅助产士提供可持续教育，最终目标是帮助玛雅助产士提供基本的产前护理，并学习如何识别和转诊高危妊娠。本拟议研究的目的是通过混合方法来检验该培训计划的文化适宜性和敏感性。
我们采用了混合方法策略，将定量和定性方法相结合。定量方面涉及一项14项的书面调查，采用三点李克特量表进行回答，而定性部分则使用半结构化访谈指南进行焦点小组讨论。
调查（n = 33）显示，32名科马德罗纳认为课程适用（97%）且易于理解（97%）。然而，只有26名科马德罗纳（79%）对解剖学术语感到满意。对教学工具的看法各不相同：13名科马德罗纳（39%）认为它们总是具有代表性，13名科马德罗纳（39%）有时这样认为，7名科马德罗纳（21%）则从不这样认为。小组讨论也反映了这种缺乏代表性的情况。在学习环境方面，32名科马德罗纳感到受到欢迎（97%），31名感到被理解（94%），但有5名科马德罗纳（15%）在提问时感到不自在。31名科马德罗纳（94%）认为培训使孕妇更加信任科马德罗纳。小组访谈强调了信心增强、护理改善以及孕产妇死亡率降低的看法。
本研究发现该计划具有文化敏感性且有效。小组访谈强调了信心增强、患者护理改善以及孕产妇死亡率降低的看法。反馈强调需要更多与文化相关的材料、资源以及与卫生部的合作。尽管存在语言和获取方面的挑战，但该计划以社区为中心的方法可为中低收入国家应对高孕产妇死亡率的类似举措提供范例。
