title: A process evaluation of PRONTO simulation training for obstetric and neonatal emergency response teams in Guatemala.
abstract: BACKGROUND
  Despite expanding access to institutional birth in Guatemala, maternal mortality remains largely unchanged over the last ten years. Enhancing the quality of emergency obstetric and neonatal care is one important strategy to decrease mortality. An innovative, low-tech, simulation-based team training program (PRONTO) aims to optimize care provided during obstetric and neonatal emergencies in low-resource settings.
  
  
  METHODS
  We conducted PRONTO simulation training between July 2012 and December 2012 in 15 clinics in Alta Verapaz, Huehuetenango, San Marcos, and Quiche, Guatemala. These clinics received PRONTO as part of a larger pair-matched cluster randomized trial of a comprehensive intervention package. Training participants were obstetric and neonatal care providers that completed pre- and post- training assessments for the two PRONTO training modules, which evaluated knowledge of evidence-based practice and self-efficacy in obstetric and neonatal topics. Part of the training included a session for trained teams to establish strategic goals to improve clinical practice. We utilized a pre/post-test design to evaluate the impact of the course on both knowledge and self-efficacy with longitudinal fixed effects linear regression with robust standard errors. Pearson correlation coefficients were used to assess the correlation between knowledge and self-efficacy. Poisson regression was used to assess the association between the number of goals achieved and knowledge, self-efficacy, and identified facility-level factors.
  
  
  RESULTS
  Knowledge and self-efficacy scores improved significantly in all areas of teaching. Scores were correlated for all topics overall at training completion. More than 60 % of goals set to improve clinic functioning and emergency care were achieved. No predictors of goal achievement were identified.
  
  
  CONCLUSIONS
  PRONTO training is effective at improving provider knowledge and self-efficacy in training areas. Further research is needed to evaluate the impact of the training on provider use of evidence-based practices and on maternal and neonatal health outcomes.
  
  
  BACKGROUND
  NCT01653626.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, 98104, USA. dilys@uw.edu.|Department of Global Health, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA. dilys@uw.edu.
authors.forename: Dilys M
authors.initials: DM
authors.lastname: Walker
authors.affiliation: Department of Global Health, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA. holemf@uw.edu.
authors.forename: Francesca
authors.initials: F
authors.lastname: Holme
authors.affiliation: Department of Global Health, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA. stz2@uw.edu.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Zelek
authors.affiliation: Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655, Col Santa Maria Ahuacatitlan, CP 62100, Cuernavaca, Morelos, Mexico. marisela.olvera@insp.mx.
authors.forename: Marisela
authors.initials: M
authors.lastname: Olvera-García
authors.affiliation: Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655, Col Santa Maria Ahuacatitlan, CP 62100, Cuernavaca, Morelos, Mexico. alejandra.montoya@insp.mx.
authors.forename: Airaín
authors.initials: A
authors.lastname: Montoya-Rodríguez
authors.affiliation: Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655, Col Santa Maria Ahuacatitlan, CP 62100, Cuernavaca, Morelos, Mexico. jimena.fritz@insp.mx.
authors.forename: Jimena
authors.initials: J
authors.lastname: Fritz
authors.affiliation: Department of Obstetrics and Gynecology, University of Maryland School of Medicine, 22 S Green St, Baltimore, MD, 12201, USA. jfahey@fpi.umaryland.edu.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Fahey
authors.affiliation: College of Nursing, University of Utah, 10 South 2000 East Salt, Lake City, UT, 84112, USA. hlamadrid@insp.mx.
authors.forename: Héctor
authors.initials: H
authors.lastname: Lamadrid-Figueroa
authors.affiliation: Division of Reproductive Health, Research Center for Population Health, National Institute of Public Health, Universidad No 655, Col Santa Maria Ahuacatitlan, CP 62100, Cuernavaca, Morelos, Mexico. susanna.cohen@nurs.utah.edu.
authors.forename: Susanna
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Epidemiological Research Center in Sexual and Reproductive Health (CIESAR), Guatemala City, Guatemala. ekestler@ciesar.org.gt.
authors.forename: Edgar
authors.initials: E
authors.lastname: Kestler
mesh_terms: D000328:Adult; D000368:Aged; D003906:Developing Countries; D004630:Emergencies; D005260:Female; D006166:Guatemala; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000193:education*; D009359:Neonatology / Q000193:education*; D009774:Obstetrics / Q000193:education*; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D011247:Pregnancy; D015397:Program Evaluation; D020377:Self Efficacy; D000066908:Simulation Training / Q000379:methods / Q000592:standards; D055815:Young Adult