Volume 86, July 2025, 104439Author links open overlay panel, , , , , , AbstractAim

To identify the mechanisms having an impact on the implementation of two profiles in a midwifery education programme in the Democratic Republic of Congo (DRC): i) a person-centred care model and ii) strengthened simulation-based learning - both on campus and in clinical practice.

Background

Midwives play a crucial role in advancing maternal and neonatal health. Therefore, it is important for midwifery education programmes to be of high quality.

Design

A qualitative process evaluation with an exploratory design was conducted. Interviews were conducted with 29 midwifery students across four focus groups.

Methods

Data analysis employed deductive and inductive content analysis, guided by an evaluation framework focusing on mechanisms having an impact on the intervention. Registered as ISRCTN10049855.

Results

The implementation of the two profiles created synergistic reinforcement, as simulation-based learning, on campus and in clinical practice, enhanced the implementation of person-centred care through practical case scenarios. Implementing person-centred care was facilitated by increased awareness of women involvement, enhanced communication and skilled faculty, but faced challenges due to cultural norms. Simulation-based learning was supported by adequate material, continuous capacity building and ensuring team safety, though hierarchical barriers in clinical settings limited implementation.

Conclusion

This study identifies the mechanisms impacting the implementation of person-centred care and the strengthened use of simulation-based learning in midwifery education. It highlights that using both profiles in campus-based education and in clinical practice creates synergy and contributes to an enhanced quality of care. The results may offer insights that could be helpful when designing and implementing a midwifery education programme in similar contexts.

Introduction

Quality of care affects maternal and newborn health and midwives play a pivotal role in its improvement (Nove et al., 2021). However, a global shortage of adequately skilled midwives remains a challenge. Educating midwives based on international education standards (International Confederation of Midwives, 2021) is crucial to achieving the Sustainable Development Goals, which include improving maternal and newborn health outcomes (Lee et al., 2016, Luyben et al., 2017, Tunçalp et al., 2015). Hence there is a need for interventions to accelerate improvements in the quality of midwifery education (Homer et al., 2022).

Section snippetsBackground

Person-centred care, defined as a healthcare model based on mutual respect and collaboration, ensuring that patients actively participate in their own care rather than being passive recipients (Rosengren et al., 2021, Byrne et al., 2020) is a model that aims to enhance the quality of care and it has been shown to increase satisfaction with care among patients and healthcare professionals (Kullberg et al., 2019). The implementation of person-centred maternity care has demonstrated improvements

Study design

To identify the mechanisms having an impact on the implementation of person-centred care and strengthened simulation-based learning in a midwifery education programme, both on campus and in clinical practice in the DRC, we adopted a qualitative design guided by the principles of an evaluation framework (Moore et al., 2015). The study is part of a multidisciplinary collaborative research project involving researchers from Sweden and the DRC. It is part of a larger programme designed to support

Enhanced communication skillsThe students mentioned that having theoretical knowledge of person-centred care was useful when caring for the women during labour and birth. This included enhanced communication skills, enabling midwives to establish a respectful relationship with the women, to continuously inform them and to make mutual decisions:

Before, we did a lot without asking for permission or making agreements, but now, with this new approach to care, it has enabled us to treat our patients differently. This

Skilled facultyThe midwifery students expressed that having skilled faculty in person-centred care both on campus and at clinical practice sites was a mediator to enhance the adaptation of person-centred care. They considered it important to integrate person-centred not only into midwifery education but also into medical education more generally, ensuring that all healthcare providers have the same understanding of its importance:

[It is important] that the teachers in the program have expertise in this. You

Fosters collaboration

Adapting a person-centred care model in clinical practice fostered collaboration. Initially, the midwifery students encountered hesitation from their preceptors in adopting the model. However, as supervisors observed the improved communication and collaboration between the students and the women they were caring for, they started to practise person-centred care themselves. Colleagues actively involved the women in their own care; they refrained from imposing interventions and instead ensured

Bridges theory and practice

Midwifery students recognised that strengthened simulation-based learning on campus played a crucial role in bridging theoretical knowledge with practical application, both when it came to person-centred care and midwifery competence. By using realistic childbirth care scenarios and hands-on experiences, they effectively applied concepts to real-world situations, such as managing postpartum haemorrhage or performing vacuum extraction, while having a person-centred approach considering the women

Safety in the team

Simulation-based learning fostered an environment, both on campus and in clinical practice, where midwifery students felt safe and supported. They felt comfortable in the team and were encouraged to take on various roles without pre-existing hierarchies. Clearly defined roles in childbirth-related case scenarios enhanced learning and deepened the students’ understanding of team dynamics. The supportive atmosphere encouraged students to practise their skills freely, without fear of negative

Hierarchical challengesIn some instances, students possessed greater knowledge about simulation-based learning than their preceptors in clinical practice. This, coupled with hierarchical structures and a reluctance among some preceptors to learn and develop new skills, hindered the implementation of the programme. Midwifery students also noted that a lack of understanding of how to integrate simulation materials into clinical practice negatively affected implementation:

Another barrier is that, even if there are

Discussion

This study demonstrates that the implementation of person-centred care and simulation-based learning benefited from their synergistic reinforcement. The operationalisation of person-centred care into clinical practice was supported by simulation-based learning activities, which resulted in enhanced communication, women involvement and collaboration. Key mechanisms influencing a successful implementation of simulation-based learning included bridging theory and practice, fostering professional

Conclusion

This study highlights the key mechanisms influencing the implementation of a model for person-centred care and the strengthened use of simulation-based learning in midwifery education. The synergy between these two profiles showcases their complementary roles in both campus-based learning and clinical practice. These mechanisms of impact may offer insights that could be helpful when designing and implementing a midwifery education programme in similar contexts.

Author agreement

This article is the author(s) original work. The article has not received prior publication and is not under consideration for publication elsewhere. All authors have seen and approved the manuscript being submitted.

CRediT authorship contribution statement

Aline Mulunda: Writing – review & editing, Writing – original draft, Conceptualization. Urban Berg: Writing – review & editing, Writing – original draft, Methodology, Investigation. Olivier Nyakio: Writing – review & editing, Writing – original draft, Conceptualization. Ewa Carlsson Lalloo: Writing – review & editing, Writing – original draft, Validation, Supervision, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Marie Berg: Writing – review & editing, Writing –

Ethical statement

Ethical clearances were obtained from: the National Ethical Committee in Sweden Dnr: 2023–07343–01 and the National Ethical Committee of Public Health in the South Kivu Province Register number: CNES 001/DPSK/219PP/2024 and CNES 035/DPSK/219PP/2022. Procedures to obtain informed consent from all study participants, were carried out according to relevant regulations as well as the Helsinki Declaration, 1975. The consent for publication is clearly stated in the consent form and was obtained by

Funding

This study was funded by the University of Gothenburg Centre for Person-centred Care and the United Nations Population Fund, in the Democratic Republic of Congo. The funders have no role in the design of the study and collection, analysis and interpretation of data. One of the co-authors are from UNFPA and supported therefore the writing of the manuscript.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper. Any opinions stated within this document reflect those of the authors and not necessarily of the “United Nations Population Fund”.

Acknowledgements

The authors would like to thank all midwifery students participating in this study and giving their valuable time to actively participate in focus group discussions. We would also like to thank the Universite Evangelical de Africa (UEA) to allow us to undertake this implementation research and to support the work.

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