Raposo Nicholas M, Yang Olivia, Konyani Alice, Owoko Chrisencia, Debrah Adelaide, Viera Jennina Rose, Sonnie Mustapha, Mann Julie, van de Water Brittney J
Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.
Seed Global Health, Freetown, Sierra Leone.
BMC Glob Public Health. 2025 Sep 9;3(1):81. doi: 10.1186/s44263-025-00202-5.
Sierra Leone has the world's third highest incidence of maternal mortality, with 443 deaths per 100,000 live births. Strengthening the country's midwifery workforce is essential to providing adequate maternal healthcare and reducing preventable perinatal mortality. In support of this goal, we developed and implemented a midwifery preceptor program (MPP) to train experienced midwives to effectively mentor new and student midwives. The aim of this study was to qualitatively evaluate barriers and facilitators to the implementation of the MPP using the Consolidated Framework for Implementation Research (CFIR).
At the end of the first year of MPP implementation, all preceptors, facilitators, and stakeholders from both implementation sites in Sierra Leone were invited for virtual, individual interviews; 26 participated. Using deductive content analysis, interview transcripts were coded according to the five CFIR domains - innovation, outer setting, inner setting, individuals, and process - and an added sixth domain: future directions. Barriers and facilitators to MPP implementation were assessed per domain.
Participants identified barriers and facilitators to MPP implementation across all six domains. Facilitators included a well-designed program that comprehensively integrated theory and practice, the support of program facilitators, and effective stakeholder collaborations. Barriers included limited resources and time constraints, which occasionally made it difficult to balance professional responsibilities with program activities. Nonetheless, participants advocated for formalizing the MPP to sustain the program's impact.
The findings indicate that the MPP is a valuable innovation for enhancing midwifery education in Sierra Leone, which in turn can help to improve perinatal health outcomes. By identifying key barriers and facilitators to implementation, this study provides actionable insights to inform the adaptation, scaling, and sustainability of the MPP not only in Sierra Leone but also in other resource-limited settings facing similar workforce challenges.
塞拉利昂的孕产妇死亡率位居世界第三，每10万例活产中有443例死亡。加强该国的助产士队伍对于提供充足的孕产妇保健服务和降低可预防的围产期死亡率至关重要。为支持这一目标，我们制定并实施了一项助产士导师计划（MPP），以培训经验丰富的助产士，使其能够有效地指导新入职和实习助产士。本研究的目的是使用实施研究综合框架（CFIR）对MPP实施过程中的障碍和促进因素进行定性评估。
在MPP实施的第一年结束时，邀请了来自塞拉利昂两个实施地点的所有导师、协调员和利益相关者进行虚拟的个人访谈；26人参与。采用演绎性内容分析法，根据CFIR的五个领域——创新、外部环境、内部环境、个人和过程——以及新增的第六个领域：未来方向，对访谈记录进行编码。每个领域都评估了MPP实施的障碍和促进因素。
参与者在所有六个领域中都识别出了MPP实施的障碍和促进因素。促进因素包括精心设计的计划，该计划全面整合了理论与实践、计划协调员的支持以及有效的利益相关者合作。障碍包括资源有限和时间限制，这偶尔使得难以在工作职责与计划活动之间取得平衡。尽管如此，参与者主张将MPP正规化，以维持该计划的影响。
研究结果表明，MPP是塞拉利昂加强助产士教育的一项有价值的创新举措，这反过来有助于改善围产期健康结果。通过识别实施过程中的关键障碍和促进因素，本研究提供了可操作的见解，不仅可为塞拉利昂，也可为其他面临类似劳动力挑战的资源有限环境中MPP的调整、推广和可持续性提供参考。
