title: Assessing self-efficacy of frontline providers to perform newborn resuscitation in a low-resource setting.
abstract: OBJECTIVE
  Newborn deaths comprise an alarming proportion of under-five mortality globally. In this retrospective cohort study, we investigated the effectiveness of focused newborn resuscitation training and delivery of a positive-pressure device in a rural midwife population in a low-resource setting. The present research attempts to better understand the extent to which knowledge and self-efficacy contribute to resuscitation attempts by birth attendants in practice.
  
  
  METHODS
  A one-year retrospective cohort analysis was undertaken in Aceh, Indonesia of two groups of community-based midwives, one having received formal training and a positive-pressure resuscitative device and the other receiving usual educational resources and management. A path analysis was undertaken to evaluate relative determinants of actual resuscitation attempts.
  
  
  RESULTS
  348 community-based midwives participated in the evaluation and had attended 3116 births during the preceding year. Path analysis indicated that formal training in resuscitation and delivery of a positive-pressure device were significantly related to both increased knowledge (β=0.55, p=0.001) and increased self-efficacy (β=0.52, p=0.001) in performing neonatal resuscitations with a positive-pressure device. However, training impacted actual resuscitation attempts only indirectly through a relationship with self-efficacy and with knowledge. Combined across groups, self-efficacy was significantly associated with positive pressure ventilation attempts (β=0.26, p<0.01) whereas knowledge was not (β=-0.05, p=0.39).
  
  
  CONCLUSIONS
  Although, to date, evaluations of newborn resuscitation programs have primarily focused on training and has reported process indicators, these results indicate that in order to improve intrapartum-related hypoxic events ("birth asphyxia"), increased emphasis should be placed on participant self-efficacy and mastery of newborn resuscitation.
authors.affiliation: Center for Global Health, Massachusetts General Hospital, Boston, MA 02114, United States; Department of Medicine, Clinician Educator Unit, Massachusetts General Hospital, Boston, MA 02114, United States; Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114, United States; Harvard Medical School, Boston, MA 02115, United States. Electronic address: krolson@partners.org.
authors.forename: Kristian R
authors.initials: KR
authors.lastname: Olson
authors.affiliation: Novartis Foundation for Sustainable Development, Basel CH 4002, Switzerland.
authors.forename: Aya
authors.initials: A
authors.lastname: Caldwell
authors.affiliation: Bina Permata Medika School of Health Sciences, Tangerang, Banten, Indonesia.
authors.forename: Melva
authors.initials: M
authors.lastname: Sihombing
authors.affiliation: MGH Institute of Health Professionals, Charlestown, MA 02129, United States.
authors.forename: A J
authors.initials: AJ
authors.lastname: Guarino
authors.affiliation: Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114, United States; Harvard Medical School, Boston, MA 02115, United States.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
authors.affiliation: MGH Institute of Health Professionals, Charlestown, MA 02129, United States.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Petersen
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D006801:Humans; D007214:Indonesia; D007231:Infant, Newborn; D008880:Midwifery / Q000193:education*; D011175:Positive-Pressure Respiration / Q000295:instrumentation; D012151:Resuscitation / Q000193:education*; D012189:Retrospective Studies; D019035:Rural Health Services; D012647:Self-Assessment
keywords: Birth asphyxia; Developing country; Neonatal mortality; Newborn health; Newborn resuscitation; Self-efficacy