Barriers to successful participation in ASOS related to resource limitations and not motivation of the clinician investigators. Practical solutions to individual barriers may increase the success of multi-centre perioperative research in Africa.

BACKGROUND: It is unknown whether the implementation of an information video on spinal anesthesia for cesarean delivery, narrated in a patient’s first language, reduces anxiety, increases satisfaction, and improves doctor–patient communication if there is a language barrier. In South Africa, most doctors speak English, and patients speak Xhosa, with educational and cultural disparities existing in many doctor–patient interactions. METHODS: One hundred seventy-five Xhosa patients scheduled for elective cesarean delivery were enrolled in the study. The first 92 patients received “usual care” verbal explanations of the spinal anesthesia procedure (control group); the next 83 patients watched a spinal anesthesia information video (intervention group), narrated in Xhosa. Videos were displayed using smartphones. Maternal anxiety was assessed before and after spinal explanation, using a Numerical Visual Analog Anxiety Scale (NVAAS). A difference in postexplanation NVAAS score of 1.5 points between intervention and control groups was regarded as clinically significant. Patient satisfaction was assessed using the Maternal Satisfaction Scale for Cesarean Section (MSSCS). RESULTS: The mean (standard deviation [SD]) age (31.5 years [5.2 years] and 32.1 years [5.4 years]) and preexplanation NVAAS score (4.2 [3.2] and 4.0 [3.0]) of the intervention and control groups, respectively, showed no difference at baseline. The mean (SD) postexplanation decrease in NVAAS score was greater in the intervention than in the control group (1.6 [3.5] vs 0.7 [2.3]; P = .046; unadjusted mean difference, 0.9 points [95% confidence interval {CI}, 0.02–1.8]). A linear regression model for the postexplanation NVAAS score showed that the intervention effect was significantly associated with the preexplanation score (P = .002), adjusted for age and English fluency. Patients with preexplanation NVAAS scores ≥5 showed a statistically significant intervention effect. There was no significant difference in patient satisfaction between the intervention and control groups. The smartphone was an accessible and convenient display medium for the video. Ninety-nine percent of patients exposed to the intervention would recommend watching the video before the procedure. CONCLUSIONS: In this pilot study, lower NVAAS scores were observed in anxious patients, when a Xhosa information video was used to ameliorate challenges posed by a doctor–patient language barrier. It is easily implemented and demonstrates a novel use of mobile health technology. The study provides baseline data to inform sample size calculations for future studies. A high level of patient recommendation for the video suggests that this is an agreeable practice.

Background: Anaesthesia nurses form a critical part of the team providing perioperative care to patients, but no accredited training exists for them in South Africa. In this setting, short in-service training interventions are a pragmatic attempt at improving nurse performance and patient outcomes. Traditional didactic teaching formats have limitations, and mLearning (the use of mobile telephones to facilitate education) has proved equivalent or superior to traditional teaching methods in several settings. Despite very high levels of mobile phone ownership amongst healthcare workers in Africa, this form of educational delivery has not been tested in the hospital-based nursing population. Methods: A telephonic true/false pre-test was performed with 12 nurses of varying levels of training, to assess their preexisting knowledge of anaesthesia. A pre-learning package was then delivered to them in the form of daily SMSs for a month, covering relevant anaesthesia content. A telephonic post-intervention test was performed to assess whether anaesthesia theory knowledge had improved. Results: Median test scores out of 30 were compared using a Wilcoxon signed rank test and were statistically higher in the postintervention test: 25 ) (p = 0.018). Conclusions:The results demonstrate an association between a cheap and widely available educational vehicle, and an increase in nurse knowledge scores. The use of mobile telephones in medical education in limited-resource settings should be explored further.

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