Assessing behavioural influences and behavioural changes following Safer Anaesthesia from Education Obstetrics training in Africa and Asia

Background
There is a need for continuing professional development in obstetric anaesthesia in low- and middle-income countries to reduce maternal and newborn mortality and morbidity. The Safer Anaesthesia From Education (SAFE) Obstetrics Course was developed to meet this need and has been delivered to over 3355 healthcare providers in 40 countries. The impact the training course has on behavioural influences and behaviour change is not known. The study aimed to evaluate the impact on behaviour and behavioural influences following the SAFE Obstetric training course in four new locations, countries across Africa and Asia (Tanzania, Zimbabwe, Nepal and Bangladesh).

Methods and results
Participants knowledge, skills and behavioural influences (perceptions of capability, opportunity and motivation) were explored via a questionnaire and skills assessments at three different time points; baseline, post-training and at follow-up (3-9 months). A sub-sample of participants were observed in their own workplace at follow-up using a structured checklist to assess any changes in behaviour.
Three-hundred and sixty-one participants completed the behavioural influences assessments, knowledge and skills both improved after the course and improvements were maintained at follow-up. Other behavioural influences did not show change over time. Completion of behaviours in a sub-sample of 78 participants to SAFE standards varied widely, ranging from 10% for performing inflation breaths to 96% for measuring blood pressure before administering spinal anaesthetic.

Conclusions
There is evidence of efficacy of the course to increase capabilities. However, for conclusions to be drawn about behavioural influences and behaviour change, more resources need to be made available for robust data collection.