Effect of mentorship and a mHealth application in updating provider skills and knowledge in maternal and newborn care in two informal settlements of Nairobi

Abstract

Background Children and women in urban informal settlements have fewer choices to access quality maternal and newborn health care. Facilities serving these communities are under-resourced, staffed by providers with limited access to skills updates. We present evidence of the combined effect of mentorship and a self-guided online learning platform for maternal health providers to increase their capacity in providing general and emergency obstetric and newborn care in 24 facilities from two informal settlements in Nairobi. Methods Mixed methods research with before and after cross-sectional provider surveys conducted at baseline and endline. Descriptive analysis compared individual knowledge elements using a chi square test of proportions between baseline and endline and a summary score generated to develop a composite score. A negative binomial regression model was fitted to explore the relationship between the primary outcome (composite knowledge score) and exposure to the intervention. During endline, 18 in-depth interviews were conducted with mentors, mentees exposed to the intervention, and providers not exposed to explore experience of the intervention on quality maternal health services. Data was managed using NVIVO 20 (QSR International) and analyzed thematically. Results Overall, out of 95 knowledge elements examined, there were statistically significant improvements of both individual and overall scores from 29/95 at baseline (30.5%) to 44.3/95 (46.6%) during endline representing a 16-percentage point increase (p < 0.001). These improvements were evident the in public health facilities representing a 17.3 percentage point increase (from 30.9% at baseline to 48.2% at endline, p < 0.001). Providers working in private facilities exhibited a 15.8 percentage point increase in knowledge from 29.7% at baseline to 45.5% at endline (p = 0.0001).Scores of providers at hospital level increased from 34–51% at endline representing a 17-percentage point increase (p = 0.0001). Those working in health centers improved their score from around 28% to 46, a 16-percentage increase (p < 0.001); however, there were no significant changes among providers working in dispensaries (25.4% at baseline to 32.1% at endline, p = 0.351). Conclusion The combined effects of mentorship and a self-guided online learning platform for maternal health providers improve provider competency, skills, and knowledge of maternal and newborn health services working in informal settlements.