title: Evaluation of an international educational programme for health care professionals on best practice in the management of a perinatal death: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE).
abstract: Stillbirths and neonatal deaths are devastating events for both parents and clinicians and are global public health concerns. Careful clinical management after these deaths is required, including appropriate investigation and assessment to determine cause (s) to prevent future losses, and to improve bereavement care for families. An educational programme for health care professionals working in maternal and child health has been designed to address these needs according to the Perinatal Society of Australia and New Zealand Guideline for Perinatal Mortality: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE). The programme has a major focus on stillbirth and is delivered as six interactive skills-based stations. We aimed to determine participants' pre- and post-programme knowledge of and confidence in the management of perinatal deaths, along with satisfaction with the programme. We also aimed to determine suitability for international use.
  
  
  
  The IMPROVE programme was delivered to health professionals in maternity hospitals in all seven Australian states and territories and modified for use internationally with piloting in Vietnam, Fiji, and the Netherlands (with the assistance of the International Stillbirth Alliance, ISA). Modifications were made to programme materials in consultation with local teams and included translation for the Vietnam programme. Participants completed pre- and post-programme evaluation questionnaires on knowledge and confidence on six key components of perinatal death management as well as a satisfaction questionnaire.
  
  
  
  Over the period May 2012 to May 2015, 30 IMPROVE workshops were conducted, including 26 with 758 participants in Australia and four with 136 participants internationally. Evaluations showed a significant improvement between pre- and post-programme knowledge and confidence in all six stations and overall, and a high degree of satisfaction in all settings.
  
  
  
  The IMPROVE programme has been well received in Australia and in three different international settings and is now being made available through ISA. Future research is required to determine whether the immediate improvements in knowledge are sustained with less causes of death being classified as unknown, changes in clinical practice and improvement in parents' experiences with care. The suitability for this programme in low-income countries also needs to be established.
authors.affiliation: Mater Research Institute, The University of Queensland, Level 2 Aubigny Place, South Brisbane, QLD 4101, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardiner
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.|Medical School, Australian National University, Canberra, Australia.|Centenary Hospital for Women and Children, Canberra, Australia.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Kent
authors.affiliation: Mater Research Institute, The University of Queensland, Level 2 Aubigny Place, South Brisbane, QLD 4101, Australia.
authors.forename: Viviana
authors.initials: V
authors.lastname: Rodriguez
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.
authors.forename: Aleena M
authors.initials: AM
authors.lastname: Wojcieszek
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.|School of Medicine, Griffith University, Brisbane, Australia.|Gold Coast University Hospital, Southport, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ellwood
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.|Charles Perkins Centre, The University of Sydney, Sydney, Australia.|Newborn Care, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Gordon
authors.affiliation: Mater Health Services, Brisbane, Australia.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Wilson
authors.affiliation: Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.|Newborn Care, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia.|Kolling Institute, The University of Sydney, Sydney, Australia.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Bond
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Charles
authors.affiliation: Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.|Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Arbuckle
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.|Mater Health Services, Brisbane, Australia.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Gardener
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.|Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Oats
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|University of Groningen, Groningen, The Netherlands.
authors.forename: Jan Jaap
authors.initials: JJ
authors.lastname: Erwich
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Department of Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands.
authors.forename: Fleurisca J
authors.initials: FJ
authors.lastname: Korteweg
authors.affiliation: Institute for Reproductive and Family Health, Hanoi, Vietnam.
authors.forename: T H Nguyen
authors.initials: TH
authors.lastname: Duc
authors.affiliation: International Stillbirth Alliance, Bristol, UK.
authors.forename: Susannah Hopkins
authors.initials: SH
authors.lastname: Leisher
authors.affiliation: College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji.
authors.forename: Kamal
authors.initials: K
authors.lastname: Kishore
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Health Services Center, University of Utah, Salt Lake City, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Maternal and Fetal Health Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Heazell
authors.affiliation: International Stillbirth Alliance, Bristol, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Storey
authors.affiliation: International Stillbirth Alliance, Bristol, UK. vicki.flenady@mater.uq.edu.au.|Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia. vicki.flenady@mater.uq.edu.au.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
mesh_terms: D001315:Australia; D005260:Female; D005367:Fiji; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007231:Infant, Newborn; D009426:Netherlands; D018743:Perinatal Care / Q000592:standards*; D066087:Perinatal Death; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015397:Program Evaluation; D050497:Stillbirth / Q000523:psychology; D011795:Surveys and Questionnaires; D014744:Vietnam
keywords: Clinical practice; Education; Neonatal death; Perinatal death; Stillbirth; Training