Data collection process
MAY, MINOR
Implementation of the Rwanda group ANC model took place from July of 2017 to May of 2019. A total of 7 Master Trainers, comprised of one nurse, five midwives, and one physician, were trained in group care facilitation, and collaborated in the development of monitoring tools and processes. Master Trainers trained 72 nurses and midwives and 216 CHWs for three days per training cohort on group care facilitation [A concurrent mixed methods design was used. At each visit, the Master Trainer completed two monitoring tools, a quantitative assessment tool called a Model Fidelity Assessment, and a more qualitative report called the Activity Report. Findings from both tools were triangulated with the objective of achieving a more in depth understanding of the relationship between time, observer assessment and support, and implementation fidelity. This methodology is aligned with Creswell’s approach to concurrent mixed methods, in which both qualitative and quantitative data are collected during the same stage and are triangulated to more accurately define relationships among variables being studied [The Model Fidelity Assessment was developed prior to initiation of monitoring visits, but the Activity Report was a tool developed by the Master Trainers as monitoring began because they felt a need to give a more holistic assessment. Occasionally separate MFAs were completed on the same day, evaluating different group ANC meetings.The assessment tool (the MFA) was developed by the Technical Working Group, UCSF’s group ANC technical advisor and Rwandan Master Trainers. Items were based on elements from the CenteringPregnancy model that were found to be essential in providing a structure for effective group ANC. The MFA included 15 items: Items one through three recorded the date, observation site and provider code and were not included in the statistical analysis (Each item was ranked using a 5-point Likert scale from 0 to 4. An overall score, ranging from 0 to 4, was calculated by averaging the score of all MFA items. Higher scores assumed the group session was implemented with greater fidelity. The breakdown of scores was: were not able to perform this skill even though the opportunity was present (0), made attempts but need significant help and to be retrained (1), have beginning skills but require more modelling, role-playing, and instruction (2), require a few minor suggestions from the Master Trainer (3), were fully competent (4).Qualitative data from the Activity Report included responses to open-ended questions on the group care process, lessons learned, best practices, challenges and recommendations. Upon completion of each session, Master Trainers provided group ANC facilitators with mentoring and support based on monitoring results. Monitoring consisted of observing preparation and execution of the session, after which Master Trainers answered questions and provided feedback focused on bridging gaps. When gaps were observed, Master Trainers conducted repeat visits earlier to observe if the gap had been corrected.