Perceived self-efficacy to teach comprehensive abortion care among nursing and midwifery faculty in higher learning institutions in Rwanda: A mixed method study.

INTRODUCTION: Comprehensive abortion care is an emerging intervention being integrated into nursing and midwifery curricula. Yet, no studies have been conducted in Rwanda to determine whether faculty perceive themselves as capable of teaching comprehensive abortion care. This study aims to evaluate the perceived self-efficacy to teach comprehensive abortion care among nursing and midwifery faculty in higher learning institutions in Rwanda. MATERIALS AND METHODS: The University of Rwanda College of Medicine and Health Sciences Institutional Review Board approved this study (UR-CMHS-IRB No 335/CMHSIRB/2022). In quantitative, a self-administered questionnaire was administered to 98 study participants. Data were entered into Statistical Package for the Social Sciences (SPSS) version 26 and analyzed using Chi-square test with a p-value of 0.05 set as the significance level. In the qualitative part, an interview guide was developed based on quantitative data to understand comprehensive abortion care teaching fully. Data were collected from four focus group discussions with eight participants in each group, entered in Dedoose, and analyzed thematically. RESULTS: Among the 98 study participants who were invited to participate in this study, only 85 filled out the questionnaires. This translates into 86.7% of the response rate. More than half 58.8% had adequate self-efficacy in teaching comprehensive abortion care. A Chi-square test has revealed that being a male, being a midwife, and having more years of working experience in nursing education were significantly associated with self-efficacy in teaching comprehensive abortion care (p value <0.05). In the qualitative phase, 32 study participants participated in four focus group discussions and four themes were identified: a) variability in confidence levels to teach comprehensive abortion care; b) readiness about teaching comprehensive abortion care; c) facilitators of teaching comprehensive abortion care; and d) contextual challenges to teach comprehensive abortion care. CONCLUSIONS: The findings revealed that faculty's self-efficacy in teaching comprehensive abortion care was not adequate. Personal and religious beliefs and institutional barriers were also reported to hinder self-efficacy in teaching comprehensive abortion care. Therefore, intensive comprehensive abortion care training for nursing and midwifery faculty in higher learning institutions should be provided, including values clarification and attitude transformation training for attitudes and beliefs. It is also critical for higher learning institutions to develop strategies for overcoming the challenges faculty face when teaching comprehensive abortion care.

Perceived self-efficacy and willingness to teach family planning among nursing and midwifery faculty in higher learning institutions in Rwanda.

BACKGROUND: Promoting family planning (FP) is a key strategy for health, economic and population growth, and achieving sustainable development goals (SDGs) especially SDG 3, which promotes health and well-being for all. The quality of FP services depends on the training of competent nursing and midwifery graduates before entering the workforce. In order to ensure graduates are well-trained and capable of meeting the needs of the population, their teachers need to demonstrate high self-efficacy and willingness to teach FP. However, there is a lack of research on the capacity and willingness of nursing and midwifery faculty to teach FP at higher learning institutions (HLIs) in Rwanda. The objective is to investigate and articulate the perceived self-efficacy and willingness of the nursing and midwifery faculty to instruct HLIs students on FP. RESEARCH DESIGN/METHODOLOGY: We conducted a mixed methods study using a sequential explanatory design among almost all the HLIs (n = 6, 1 institution declined) that train nurses and midwives in Rwanda. One hundred thirty-six nursing and midwifery faculty who were actively teaching FP either in class, simulation lab, or clinical practice were invited to participate in a self-administered questionnaire and four qualitative focused group discussions. Participants answered questions ranking their self-efficacy in four domains from 0 - not confident to 3 - completely confident. Scores were calculated for each domain. A semi-structured interview guide was developed based on quantitative survey findings to gain a deep understanding of the ability and willingness to teach FP. Data were analyzed using thematic analysis. Ethical approval was obtained from the University of Rwanda, College of Medicine and Health Sciences Institutional Review Board. RESULTS: A total number of 89 nursing and midwifery faculty participated in the study and only 85 completed the questionnaires fully, yielding a response rate of 95.5%. The mean age was 40.39 and there were more females (62.4%) compared to their male counterparts (37.6%). Respondents scored highest for perceived self-efficacy in course preparation (mean = 2.37), evaluation and examination (mean = 2.12) and instructor behavior and delivery (mean = 2.35). However, the score was low for clinical practices (mean = 1.79). There was a significant correlation among the four items of self-efficacy (p < 0.05). Being a female, a midwife, and having more years of experience in nursing education were each significantly associated with perceived self-efficacy to teach FP (p < 0.05). In the qualitative phase, 32 study participants participated in four focus group discussions. Four themes were identified: (a) educational background as a determinant of confidence to teach FP; (b) willingness to teach FP; (c) enabling factors of teaching FP; and (d) structural challenges. CONCLUSION: Nursing and midwifery faculty reported inadequate self-confidence in teaching FP in clinical practice. Addressing personal and structural challenges in teaching FP should be a top priority. This requires a collective effort between nursing and midwifery faculty and HLIs to dismantle individual and systemic barriers that hinder self-efficacy and willingness to teach FP. There is a need for HLIs and different stakeholders to invest in training the nursing and midwifery faculty on FP practical skills to have a nursing and midwifery workforce providing up-to-date clinical FP services that will help Rwanda reach the SDGs.

Lessons learned from a sexual and reproductive health and rights peer education program to prevent adolescent pregnancies in high schools in Rwanda.

Adolescent pregnancies that occur in schools remain a major public concern in Rwanda. Sexual and Reproductive Health and Rights (SRHR) school based programs are less effective and discussing sexual health with adolescents is considered as taboo in Rwandan societies. Yet, adolescents still seek information about SRHR from their peers and research shows that peers are often incorrectly informed about SRHR topics. One of the effective strategies to reduce adolescent pregnancies in secondary schools is equipping adolescents with accurate and reliable knowledge. In 2019, we conducted our first network event with different stakeholders. The stakeholders included: school directors, head teachers, biology teachers, local political delegates, religious people among others to help gain insights into SRHR. A survey was conducted and administered to in-school adolescents in Kirehe district (S3 - S6 level, n=563) with the aim of examining adolescents' level of knowledge and attitudes regarding SRHR. In addition, six focus group discussions (FGDs) were conducted to obtain a deeper understanding of the SRHR needs and the possible contributions and content of a peer -to- peer education program (PEP). The lessons learned included: a) engaging parents in the network event and development of PEP; b) constant communication utilizing the different social media platforms, c) enhanced collaboration between the project implementers and stakeholders a facet of bottom-up approaches to expedite this project; and d) the project should have better anticipated on possible and unforeseen external barriers. Implementing a PEP in Kirehe secondary schools resulted in substantive changes such as positively transforming peer educators (PEs) and the elimination of teenage pregnancies in the selected schools. Overall, the number of PEs was not adequate to cover the number of students and anti-bullying training should have been provided to all students before the project implementation.