Development and testing of a tool to assess health workers' clinical confidence to provide perinatal bereavement care in Sub-Saharan Africa

Background to the research: The death of a baby before, during, or soon after birth, termed stillbirth or neonatal death, is amongst the most traumatic of life events for parents. The overwhelming majority of stillbirths and neonatal deaths happen in low- and middle-income countries, with sub-Saharan Africa and South Asia accounting for around 75% of the world total.

The death of a baby has long-lasting impacts on parents, greatly increasing the risk of poor mental and physical health and family breakdown, which have negative effects on wider society. Across the world, most women give birth in hospitals. We know that when a baby dies, having good care and support from health workers in the hours and days surrounding the death has a positive effect in helping mothers and fathers cope, and adjust to the loss.

However, in many countries, including African countries, parents do not get good enough care or support after their baby dies. Health workers tell us that they find this part of their work difficult and do not always know what they should do to support parents, they need more education and help from facilities to give better care. Having appropriate methods (such as questionnaires) to assess health workers' abilities, identify areas for development, and test the effectiveness of strategies such as training packages, is crucial to demonstrate and maintain improvement.

Tools to assess bereavement care need to reflect the local environment and culture. Currently, there are very few tools designed to assess health workers' knowledge and confidence in providing care after the death of a baby, and none have been developed with African health workers or parents.

Aim: The aim of this research is to develop and test a tool to assess the confidence of health workers to provide bereavement care after stillbirth or neonatal death in sub-Saharan Africa.

Research plan: A team of midwives, psychologists, and statisticians from the UK, Malawi, and Zimbabwe will work with local health workers, managers, policymakers, and parents, with previous experience of the death of a baby. In phase 1, the tool will be developed, using previous research, experiences of local health workers in providing care, and behaviour change theories.

The whole team will be involved in decisions surrounding the choice of topics and questions to be included and methods for response e.g. scales. Once the tool is agreed it will be tested with a small number of health workers in Malawi and Zimbabwe to ensure it is clear, acceptable, and easy to complete. Consistency will be also tested.

Revisions will be made as necessary, based on the results. In phase 2 the tool will be tested with up to 300 health workers

across Malawi, Zimbabwe, Kenya, Tanzania, Uganda, and Zambia, to assess whether it is reliable and measures what is intended.

The tool is likely to be useful in other low- and middle-income countries and for related situations e.g. care following a miscarriage. It could also be used with other professional groups, such as community health workers and counsellors.

Capacity strengthening: During this research, the local researchers will have the opportunity to gain skills in developing and testing tools. Inexperienced researchers will be supported by senior researchers (UK and Africa) to develop leadership and management experience which will contribute to increasing the capacity of local universities, particularly in Malawi and Zimbabwe, to conduct midwifery research and improve the health of mothers and babies. UK researchers will gain additional experience in global health research.