Developing and validating a self-assessment tool for assessing confidence of nurse-midwives against competency domains of the International Confederation of Midwives, in India

Abstract

While midwives are recognized as primary care-providers for maternal and new-born care in many parts of the world, India is transitioning to professional midwifery. The pathway to midwifery in India has been through integrated nursing and midwifery education. Since 2018, India has introduced an 18-month post nursing midwifery education programme. To establish a baseline for midwives’ competence and measure progress, there is a need for a quick, easy-to-administer and low-cost tool that can be used at scale to guide programme efforts. This paper describes the process of validation and testing of a tool to assess the confidence of practicing nurse-midwives as a proxy indicator for competence against the seven competency domains of the International Confederation of Midwives (2013). A total of 2198 nurse-midwives, providing maternal and new-born services at the time of the study, from 442 public and private hospitals across six states in India, responded to a self-administered questionnaire. The tool is psychometrically sound and can potentially be used in low-middle-income countries to measure confidence of midwives and nurse-midwives against international competence standards. It is suitable for quick large-scale programmatic assessments within a short time period, providing evidence to inform midwifery strengthening initiatives. The tool can be contextualized to suit specific country contexts. Since it was tested in India, where a distinct cadre of midwives is not yet established and nurse-midwives provide maternity care, the tool can be easily adapted for use in other countries in the South East Asia Region with similar contexts. © 2024 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

Author Keywords

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Index Keywords

Author Affiliations

Indian Institute of Public Health Gandhinagar, Gandhinagar, GJ, India

Göteborgs Universitet, Gothenburg, Vastra Gotaland, Sweden

Health Institute of Mother and Child, Mamta, New Delhi, India

Organisation Mondiale de la Santé, Geneva, Switzerland

Bill & Melinda Gates Foundation, Seattle, WA, United States

Foundation for Research in Health Systems, Bengaluru, KA, India

Funding & Acknowledgements

Ministry of Health and Family Welfare, MOHFW

This research was funded by the WHO country office in New Delhi, India (Grant Ref. No. 2018/862808-0) who were supported by the Bill and Melinda Gates Foundation (BMGF). The funding covered full or part salaries of all coauthors except SG, AP, RC, FEM, and MG. The authors RC, FEM from WHO and MG from BMGF contributed to the initial tool development, and provided comments on the draft manuscript. We would like to express our deepest gratitude to Dr. Pandey, who passed away before the submission of the final version of this manuscript, for his invaluable contributions to the study. Our sincere thanks go to the study respondents for their enthusiastic participation, and to the local clinical sites for assisting in mobilizing respondents. We are grateful to the Ministry of Health and Family Welfare (MoHFW), Government of India, and the State Health Departments of the six states for their valuable suggestions towards the study design and for facilitating the study with necessary approvals and communication with educational and clinical facilities. We also extend our thanks to the panel of experts, including representatives from the Society of Midwives of India, the State Nursing Councils, the Indian Nursing Council, and the Nursing Division at MoHFW, for their role in the content validation of the tool. We acknowledge the dedication of the research team members who adhered to the study protocol and ensured data quality, despite the challenges of the COVID-19 pandemic.

Bill and Melinda Gates Foundation, BMGF

This research was funded by the WHO country office in New Delhi, India (Grant Ref. No. 2018/862808-0) who were supported by the Bill and Melinda Gates Foundation (BMGF). The funding covered full or part salaries of all coauthors except SG, AP, RC, FEM, and MG. The authors RC, FEM from WHO and MG from BMGF contributed to the initial tool development, and provided comments on the draft manuscript. We would like to express our deepest gratitude to Dr. Pandey, who passed away before the submission of the final version of this manuscript, for his invaluable contributions to the study. Our sincere thanks go to the study respondents for their enthusiastic participation, and to the local clinical sites for assisting in mobilizing respondents. We are grateful to the Ministry of Health and Family Welfare (MoHFW), Government of India, and the State Health Departments of the six states for their valuable suggestions towards the study design and for facilitating the study with necessary approvals and communication with educational and clinical facilities. We also extend our thanks to the panel of experts, including representatives from the Society of Midwives of India, the State Nursing Councils, the Indian Nursing Council, and the Nursing Division at MoHFW, for their role in the content validation of the tool. We acknowledge the dedication of the research team members who adhered to the study protocol and ensured data quality, despite the challenges of the COVID-19 pandemic.

World Health Organization, WHO

This research was funded by the WHO country office in New Delhi, India (Grant Ref. No. 2018/862808-0) who were supported by the Bill and Melinda Gates Foundation (BMGF). The funding covered full or part salaries of all coauthors except SG, AP, RC, FEM, and MG. The authors RC, FEM from WHO and MG from BMGF contributed to the initial tool development, and provided comments on the draft manuscript. We would like to express our deepest gratitude to Dr. Pandey, who passed away before the submission of the final version of this manuscript, for his invaluable contributions to the study. Our sincere thanks go to the study respondents for their enthusiastic participation, and to the local clinical sites for assisting in mobilizing respondents. We are grateful to the Ministry of Health and Family Welfare (MoHFW), Government of India, and the State Health Departments of the six states for their valuable suggestions towards the study design and for facilitating the study with necessary approvals and communication with educational and clinical facilities. We also extend our thanks to the panel of experts, including representatives from the Society of Midwives of India, the State Nursing Councils, the Indian Nursing Council, and the Nursing Division at MoHFW, for their role in the content validation of the tool. We acknowledge the dedication of the research team members who adhered to the study protocol and ensured data quality, despite the challenges of the COVID-19 pandemic.

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Developing and validating a self-assessment tool for assessing confidence of nurse-midwives against competency domains of the International Confederation of Midwives, in India

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