The state of the art of twinning, a concept analysis of twinning in healthcare

Abstract

BackgroundInequities in health have garnered international attention and are now addressed in Sustainable Development Goal 3 (SDG3), which seeks to ‘promote well-being for all’. To attain this goal globally requires innovative approaches, one of which is twinning. According to the International Confederation of Midwives, twinning focusses on empowering professionals, who can subsequently be change-agents for their communities. However, twinning in healthcare is relatively new and because the definition and understanding of twinning lacks clarity, rigorous monitoring and evaluation are rare. A clear definition of twinning is essential for the development of a scientific base for this promising form of collaboration.MethodWe conducted a Concept Analysis (CA) of twinning in healthcare using Morse’s method. A qualitative study of the broad literature was performed, including scientific papers, manuals, project reports, and websites. We identified relevant papers through a systematic search using scientific databases, backtracking of references, and experts in the field.ResultsWe found nineteen papers on twinning in healthcare. This included twelve peer reviewed research papers, four manuals on twinning, two project reports, and one website. Seven of these papers offered no definition of twinning. In the other twelve papers definitions varied. Our CA of the literature resulted in four main attributes of twinning in healthcare. First, and most frequently mentioned, was reciprocity. The other three attributes were that twinning: 2) entails the building of personal relationships, 3) is dynamic process, 4) is between two named organisations across different cultures. The literature also indicated that these four attributes, and especially reciprocity, can have an empowering effect on healthcare professionals.ConclusionsBased on these four attributes we developed the following operational definition: Twinning is a cross-cultural, reciprocal process where two groups of people work together to achieve joint goals. A greater understanding and a mature definition of twinning results in clear expectations for participants and thus more effective twinning. This can be the starting point for new collaborations and for further international studies on the effect of twinning in healthcare.

From equity to power: Critical Success Factors for Twinning between midwives, a Delphi study

“…ICM represents 131 midwifery organizations worldwide and uses twinning as one of its strategies to strengthen these organizations (ICM; International Confederation of Midwives, 5 August 2014). In addition, experts were identified using the literature search performed for a concept analysis of Twinning (Cadée et al., ). An initial 56 experts, at least one Twinning expert from every known midwifery Twinning project, were invited in English by e‐mail (Figure ).…”

“…This was followed by an open ended questionnaire where experts shared their experiences regarding factors that could either hinder or facilitate the Twinning process in general and specifically for the preparation, implementation, monitoring, evaluation and sustainability of a Twinning project. The attributes of Twinning as identified by the concept analysis of Twinning were also integrated into this open ended questionnaire (Cadée et al., ). Experts were encouraged to give their viewpoint as an individual “twin” participant as well as on an organizational level and asked to elaborate in approximately 250 words per question.…”

“…A clear and systematic method for the implementation and evaluation of these projects has yet to be developed. There is insufficient and contradictory information available about how to organize successful Twinning (Cadée et al., ). A recent concept analysis (CA) provided an important step in addressing this gap in knowledge, offering a clear definition of Twinning in health care —“ a cross‐cultural reciprocal process where two groups of people work together to achieve joint goals” —and identifying four main attributes of Twinning: (1) reciprocity; (2) building personal relationships; (3) dynamic process; (4) participation of two named organizations across different cultures (Cadée et al., , p. 1).…”

“…There is insufficient and contradictory information available about how to organize successful Twinning (Cadée et al., ). A recent concept analysis (CA) provided an important step in addressing this gap in knowledge, offering a clear definition of Twinning in health care —“ a cross‐cultural reciprocal process where two groups of people work together to achieve joint goals” —and identifying four main attributes of Twinning: (1) reciprocity; (2) building personal relationships; (3) dynamic process; (4) participation of two named organizations across different cultures (Cadée et al., , p. 1). The implementation of twinning is a dynamic process, an important step in the implementation of Twinning is the identification of factors critical for effective Twinning, using the knowledge midwives have gained as a result of their experience with these projects.…”

Developing a national standard for midwifery mentorship in Uganda

“…It promotes twinning partnerships between professional midwives' associations for mutual benefit and organisational strengthening (ICM, 2014). Twinning is described as a cross-cultural, reciprocal process where two groups of people work together to achieve joint goals and is an example of an innovative approach that may enable attainment of Sustainable Development Goal 3, the promotion of well-being for all (Cadee, 2016). The Royal College of Midwives UK (RCM) and the Uganda Private Midwives Association (UPMA) have had a long-term twinning partnership since 2012 and jointly delivered the Global Midwifery Twinning Project (GMTP) (RCM, 2015b(RCM, ) between 2012(RCM, -2015, funded by UK-Aid and The Tropical Health and Education Trust (THET) through the Health Partnership Scheme (HPS).…”