Experiencias del equipo de salud en la aplicación del contacto piel con piel / Experiences of the Health Team in the Application of Skin-To- Skin Contact

Introducción: La Organización Panamericana de la Salud refiere que a nivel mundial pocos son los países que aplican el contacto piel con piel cuando lo realizan es por un tiempo inadecuado a pesar de los múltiples beneficios para la madre y el recién nacido. Objetivo: Describir la aplicación del contacto piel con piel desde la experiencia del equipo de salud en un centro materno infantil del sector público en Perú. Métodos: Investigación cualitativa con diseño descriptivo, de tipo estudio de caso, en una muestra no probabilística de 10 integrantes del equipo de salud, elegidos por conveniencia y determinado por saturación y redundancia. Los datos se recolectaron a través de la entrevista semiestructurada en línea. La información se procesó de manera manual, mediante el análisis de contenido temático. Resultados: Se obtuvieron tres categorías: a) aplicación del contacto piel con piel en la atención inmediata del recién nacido, b) estrategias implementadas para la aplicación del contacto piel con piel y c) barreras afrontadas por el equipo de salud para aplicar el contacto piel con piel. Conclusiones: Desde la experiencia del personal de salud, es posible aplicar el contacto pial a piel previa capacitación y sensibilización al equipo de salud, y acondicionamiento del ambiente, a fin de implementarlo como política del establecimiento de salud(AU)

Introduction: The Pan American Health Organization reports that few countries worldwide apply skin-to-skin contact and when they use it is during an inadequate amount of time despite the multiple benefits for the mother and the newborn. Objective: To describe the application of skin-to-skin contact from the experience of the health team in a public maternal and child center in Peru. Methods: A qualitative research with a descriptive design, case study, was carried out in a non-probabilistic sample of 10 members of the health team, chosen by convenience and determined by saturation and redundancy. Data were collected through semi-structured online interviews. The information was processed manually, through thematic content analysis. Results: Three categories were obtained: a) application of skin-to-skin contact in the immediate care of the newborn, b) strategies implemented for the application of skin-to-skin contact, and c) barriers faced by the health team to apply skin-to-skin contact. Conclusions: From the experience of health personnel, it is possible to apply skin-to-skin contact after training and sensitization to the health team and conditioning of the environment, in order to implement it as a policy of the health facility(AU)

Policy Engagement Framework for Public Health: A Tool to Enhance Maternal and Child Health Workforce Capacity.

PURPOSE: This paper proposes a framework for characterizing policy engagement that expands options available to MCH and other public health professionals. Its aim is to inform workforce capacity building and empower practitioners to better leverage policy for advancing population health and equity. DESCRIPTION: Policies of all types strongly influence population health and equity. Recognizing this, public health leaders identify policy engagement skills as key for public health professionals generally, and for maternal and child health (MCH) professionals specifically. Practitioners likewise see the importance of these skills and report deficiencies in them. Despite this gap, no literature to-date itemizes the range of policy engagement possibilities for public health professionals. ASSESSMENT: The Policy Engagement Framework for Public Health addresses this gap by providing a language and organizing structure for the numerous ways engagement may take shape. The possibilities are combinations of a particular target policy source (the what) and jurisdiction (the where), a policy process phase (the when), and an engagement role (the how). Policy source and jurisdiction are broken down to highlight the many types to consider for a given topic and population. Established public health constructs are adapted to enumerate policy phases and public health roles. CONCLUSIONS FOR PRACTICE: The Policy Engagement Framework can enhance workforce capacity by expanding mindsets about ways public health and MCH practitioners can consider engaging. It can facilitate communication and clarity within an organization regarding what activities are permitted in staff's official capacity. Finally, it can guide the strategic development of workforce education and training.

Using a LIFE Framework to Develop MCH Leaders.

INTRODUCTION: The Maternal Child Health (MCH) Bureau created MCH Leadership Competencies to support current and future leaders by defining the knowledge and skills necessary to lead in this field. The Michigan-LEND (MILEND) training program developed a 'LIFE. framework', an acronym that stands for Leadership, Interdisciplinary, Family-Professional Partnerships, and Equity, to codify the 12 MCH leadership competencies into an easy to remember and easy to apply structure. This manuscript addresses the question, Does the LIFE framework align with the 12 MCH Leadership Competencies? Our hypothesis is that MI-LEND trainees will demonstrate improvement in their self-assessment of the 12 MCH leadership competencies after completing the MI-LEND program which uses the LIFE framework. METHODS: Data were collected from 24 MI-LEND long-term trainees (> 300 hours) who completed a 100-itemleadership self-assessment questionnaire based on the MCH Navigator at the beginning and the end of the training year. Non-parametric sign tests were used to test the median difference, item by item for each of the questions under each competency. Parametric paired-sample t-tests were used to analyze mean difference, competency by competency when the assumption of normality was met. RESULTS: All basic and advanced-level competencies had a statistically significant improvement between the beginning and end of the training year. The greatest changes were seen in Family-Professional Partnerships, Policy, Interdisciplinary Team Building, MCH Knowledge Base and Critical Thinking - all areas emphasized in the L.I.F.E. DISCUSSION: While the LIFE framework may oversimplify MCH Leadership Competencies, it is an effective mnemonic tool to organize and articulate MCH leadership competencies and could foster consistency across MCH programs.

Training the MCH workforce: the Time for Change is now.

INTRODUCTION: Maternal and child health (MCH) services are critical for vulnerable populations. Workforce shortages, poor retention, and gaps in necessary trainings impede the capacity of public health systems to address needs. This manuscript characterizes the current MCH workforce, MCH program applicants and graduates, and describe findings within a national context to devise elements of a recruitment and retention strategy. METHODS: Data were obtained for public health program applicants, first-destination employment outcomes, and worker perceptions and demographics. Data were stratified according to the MCH and total public health workforce and by local, state, and national totals. Data were characterized by degree type, discipline, demographics, and employment outcomes. RESULTS: MCH staff constitute 11% of the state and local governmental public health workforce. MCH staff are approximately as diverse, have higher educational attainment, and are more likely to hold nursing degrees than the rest of the public health workforce. Yet, just 14% of MCH staff hold any type of public health degree. The MCH pipeline from academia appears modestly sized, with approximately 5% of applicants between 2017 and 2021 applying to a MCH master's degree. DISCUSSION: The MCH workforce has a lower proportion of formal training or degrees in public health, though trends seem to indicate improvements. However, it is critical that a multi-faceted recruitment and retention strategy be coordinated by a broad range of stakeholders. These efforts will serve to improve the capability and capacity of the public health system to address critical needs of increasingly diverse MCH populations. SIGNIFICANCE: In order to modernize and reimagine the academic-public health pipeline, it is critical to better understand how many applicants and graduates exist within Maternal and Child Health programs across the US, and their characteristics. This manuscript connects that information with the most recently available public health workforce information on demographics, workplace perceptions, and intent to leave among staff at state and local health departments. Data presented in this paper allow the most comprehensive characterization of the MCH academia->practice pipeline to-date, identifies a fundamental disconnect in those career pathways, and offers options to repair that break.

Enhancing Title V Workforce Capacity to Address Complex Challenges: Impact of the National Maternal and Child Health Workforce Development Center.

INTRODUCTION: The National Maternal and Child Health Workforce Development Center provides training, coaching, and consultation to Title V programs. The flagship experience is the Cohort program, a 6-8-month leadership development program where Title V programs convene a multisector team to address a pre-selected state/jurisdictional challenge related to health systems transformation. The overall objective of this paper is to demonstrate the impact of skills developed via the Cohort program on state/jurisdictional capacities to address complex challenges. METHODS: Qualitative, post-Cohort evaluation data were analyzed using inductive and deductive coding and the "Sort and Sift, Think and Shift" method. Themes and supporting text were summarized using episode profiles for each team and subsequently organized using the EvaluLEAD methodology for identifying and documenting impact. RESULTS: Teams brought an array of challenges related to health systems transformation and 94% of teams reported achieving progress on their challenge six-months after the Cohort program. Teams described how the Cohort program improved workforce skills in strategic thinking, systems thinking, adaptive leadership, and communication. Teams also reported the Cohort program contributed to stronger partnerships, improved sustainability of their project, produced mindset shifts, and increased confidence. The Cohort program has also led to improved population health outcomes. DISCUSSION: Through working with the Center, Title V leaders and their teams achieved episodic, developmental, and transformative results through application of Center tools and skills to complex challenges. Investment in the MCH workforce through skill development is critical for achieving transformative results and solving "wicked" public health problems.

The Critical Value of Maternal and Child Health (MCH) to Graduate Training in Public Health: A Framework to Guide Education, Research and Practice.

INTRODUCTION: In light of persistent health inequities, this commentary describes the critical role of maternal and child health (MCH) graduate training in schools and programs of public health (SPPH) and illustrates linkages between key components of MCH pedagogy and practice to 2021 CEPH competencies. METHODS: In 2018, a small working group of faculty from the HRSA/MCHB-funded Centers of Excellence (COEs) was convened to define the unique contributions of MCH to SPPH and to develop a framework using an iterative and consensus-driven process. The working group met 5 times and feedback was integrated from the broader faculty across the 13 COEs. The framework was further revised based on input from the MCHB/HRSA-funded MCH Public Health Catalyst Programs and was presented to senior MCHB leaders in October 2019. RESULTS: We developed a framework that underscores the critical value of MCH to graduate training in public health and the alignment of core MCH training components with CEPH competencies, which are required of all SPPH for accreditation. This framework illustrates MCH contributions in education, research and evaluation, and practice, and underscores their collective foundation in the life course approach. CONCLUSIONS: This new framework aims to enhance training for the next generation of public health leaders. It is intended to guide new, emerging, and expanding SPPH that may currently offer little or no MCH content. The framework invites further iteration, adaptation and customization to the range of diverse and emerging public health programs across the nation.

Insights from the national maternal and Child Health Workforce Development Center on Title V Teams' collaborative readiness and goal accomplishment.

PURPOSE: State Title V programs collaborate with diverse partners to improve maternal and child health. Since 2014, the National Maternal and Child Health Workforce Development Center has trained Title V leaders in facilitating system change. This article describes aspects of initial collaborative readiness differentiating state and jurisdiction teams that later reported meeting their goals to greater or lesser degrees. DESCRIPTION: We used quantitative data from initial team leader reports to characterize readiness to collaborate with external partners, and their responses twelve months later to a prompt about how fully they had accomplished their goals. In addition, we coded excerpts from team leader accounts six and twelve months into their work with the Center, and retrospective coach perspectives, to identify collaborative readiness patterns. ASSESSMENT: Teams whose leaders reported higher goal accomplishment twelve months after beginning work with the Center had initially reported higher levels of collaboration with key partners. Our analyses suggest that such teams were also better able to use their cohort experience with the Center to improve collaboration, including information sharing with external stakeholders. Challenges working with Medicaid were reported both by teams with more and less goal accomplishment. CONCLUSIONS: Title V teams with lower levels of initial collaborative readiness may benefit from additional support in skill development, connections to key partners, and convening power. Given the crucial and increasing role of Medicaid in maternal and child health systems, more attention may be warranted to supporting all Title V programs in partnering with this funder.

Developing State Leadership in Maternal and Child Health: Process Evaluation Findings from a Work-Based Learning Model for Leadership Development.

OBJECTIVES: Since 2013 the MCH Bureau has supported the National MCH Workforce Development Center to strengthen the Title V MCH workforce. This article describes the Center's Cohort Program and lessons learned about work-based learning, instruction, and coaching. DESCRIPTION: The Cohort Program is a leadership development program that enrolls state-level teams for skill development and work-based learning to address a self-identified challenge in their state. Teams attend a Learning Institute that teaches concepts, skills, and practical tools in systems integration; change management and adaptive leadership; and evidence-based decision-making and implementation. Teams then work back home on their challenges, aided by coaching. The Program's goals are for teams to expand and use their skills to address their challenge, and that teams would strengthen programs, organizations, and policies, use their skills to address other challenges, and ultimately improve MCH outcomes. METHODS: This process evaluation is based on evaluation forms completed by attendees at the three-day Learning Institute; six-month follow-up interviews with team leaders; and a modified focus group with staff. RESULTS: Participants and staff believe the Cohort Program effectively merges a practical skill-based curriculum, work-based learning in teams, and coaching. The Learning Institute provides a foundation of skills and tools, strengthens the team's relationship with their coach, and builds the team. The work-based learning period provides structure, accountability, and a "practice space" for teams to apply the Cohort Program's skills and tools to address their challenge. In this period, teams deepen collaborations and often add partners. The coach provides accessible and tailored guidance in teamwork and skill application. These dimensions helped teams in develop skills and address state-level MCH challenges. CONCLUSIONS FOR PRACTICE: Continuing professional development programs can help leaders learn to address complex state-level MCH challenges through integrated classroom-based skills development, work-based learning on state challenges, and tailored coaching.

Maternal and Child Health Pipeline Training Programs: A Description of Training Across 6 Funded Programs.

PURPOSE: The HRSA-funded maternal and child health pipeline training programs (MCHPTPs) are a response to the critical need to diversify the MCH workforce, as a strategy to reduce health disparities in MCH populations. These MCHPTPs support students from undergraduate to graduate education and ultimately into the MCH workforce. DESCRIPTION: The models and components of training across the six MCHPTPs funded in 2016-2021 are summarized, to examine the design and delivery of undergraduate pipeline training and the insights gained across programs. ASSESSMENT: Strategies that emerged across training programs were organized into three themes: recruitment, support for student persistence (in education), and pipeline-to-workforce intentionality. Support for student persistence included financial support, mentoring, creating opportunity for students to develop a sense of belonging, and the use of research as a tool to promote learning and competitiveness for graduate education. Finally, the link to Maternal and Child Health Bureau (MCHB) long-term training and other MCHB opportunities for professional development contributed significant nuance to the pipeline-to-workforce objectives of these programs. CONCLUSIONS: The MCHPTPs not only increase the diversity of the MCH workforce, they also actively prepare the next generation of MCH leaders. The intentional connection of undergraduates to the infrastructure and continuum of MCH training, underscores the comprehensive impact of this funding.

Parental experiences and breastfeeding outcomes of early support to new parents from family health care centres-a mixed method study.

BACKGROUND: Early parenthood is a sensitive period for parents. Parents may feel uncertain about their new roles and unsure about where to find trusted information and support. The aim of this study was to explore the association between breastfeeding and early home visits and a proactive telephone support intervention and to describe parental experiences. METHOD: This study was conducted as a mixed method study with a convergent design using qualitative data from the written comments of parents, and the quantitative data consisted of demographics, breastfeeding, and Likert questions about parents' satisfaction with the early home visit and telephone support. Historic control (2017-2018) and intervention (2019-2020) data were collected from one family health care centre, and control (2019-2020) data were collected from another family health care centre. RESULTS: In total, 838 infants, 42 mothers and 38 fathers contributed to the data in the study. The intervention group had a statistically significantly earlier home visit than the control groups. Early home visits and proactive telephone support to parents with newborn infants were not associated with breastfeeding outcomes up to six months after birth, but we could not exclude the possibility that this was a consequence of our observational study design. However, the early home visit was appreciated by the parents where they received both practical and emotional support. CONCLUSIONS: Although the intervention was not associated with breastfeeding, the parents appreciated the service. This shows the importance of continuing to investigate how and which support parents of newborn infants need and the effects of such support, including interventions to provide optimal support to facilitate continued breastfeeding.

Tools for Supporting the MCH Workforce in Addressing Complex Challenges: A Scoping Review of System Dynamics Modeling in Maternal and Child Health.

OBJECTIVES: System Dynamics (SD) is a promising decision support modeling approach for growing shared understanding of complex maternal and child health (MCH) trends. We sought to inventory published applications of SD to MCH topics and introduce the MCH workforce to these approaches through examples to support further iteration and use. METHODS: We conducted a systematic search (1958-2018) for applications of SD to MCH topics and characterized identified articles, following PRISMA guidelines. Pairs of experts abstracted information on SD approach and MCH relevance. RESULTS: We identified 101 articles describing applications of SD to MCH topics. APPROACH: 27 articles present qualitative diagrams, 10 introduce concept models that begin to quantify dynamics, and 67 present more fully tested/analyzed models. PURPOSE: The most common purposes described were to increase understanding (n = 55) and support strategic planning (n = 26). While the majority of studies (n = 53) did not involve stakeholders, 40 included what we considered to be a high level of stakeholder engagement - a strength of SD for MCH. TOPICS: The two Healthy People 2020 topics addressed most frequently were early and middle childhood (n = 30) and access to health services (n = 26). The most commonly addressed SDG goals were "End disease epidemics" (n = 26) and "End preventable deaths" (n = 26). CONCLUSIONS FOR PRACTICE: While several excellent examples of the application of SD in MCH were found, SD is still underutilized in MCH. Because SD is particularly well-suited to studying and addressing complex challenges with stakeholders, its expanded use by the MCH workforce could inform an understanding of contemporary MCH challenges.

Building the MCH Public Health Workforce of the Future: A Call to Action from the MCHB Strategic Plan.

INTRODUCTION: In 2021, the Maternal and Child Health Bureau (MCHB) released a new strategic plan to guide its work over the next 10-15 years. The plan highlights four goals-access, equity, workforce capacity, and impact-that are essential to achieving MCHB's vision. METHODS: We present 13 recommendations to highlight opportunities for ongoing and new activities aligned with Goal 3 of the plan-"Strengthen Public Health Capacity and Workforce for MCH." RESULTS: Recommendations 1-3 highlight the need to support pathways into state and local MCH public health (PH) positions, to offer accessible and high-quality training for the practicing workforce, and to build capacity to address health and social inequities. Recommendations 4-7 discuss the need to build a racially and ethnically diverse workforce, ensure equity and anti-racism are foundational concepts in training, and strengthen engagement of community members and those with lived experience as part of the MCH PH workforce. Recommendations 8-10 outline opportunities to enhance MCH workforce data and measurement frameworks, and support practice-based research. Recommendations 11-12 discuss the importance of academic-practice partnerships and the need to spur innovation. Recommendation 13 highlights the need to define and amplify the unique skillset of the MCH PH workforce. CONCLUSIONS: The release of the MCHB strategic plan comes at a time of critical need to build and sustain a MCH PH workforce to achieve equity for MCH populations. We encourage the field to engage in dialogue around the recommendations presented in this paper, and to offer additional actions to build and support the MCH PH workforce.

Safe Pregnancy intervention for intimate partner violence: a randomised controlled trial in Norway among culturally diverse pregnant women.

BACKGROUND: Intimate partner violence (IPV) during pregnancy is a global health problem with adverse consequences for mothers, infants and families. We hypothesise that information about IPV and safety behaviours during pregnancy has the potential to increase quality of life and the use of safety behaviours and prevent IPV. METHODS: A multicentre randomised controlled trial among culturally diverse pregnant women in Norway, to test the effect of a tablet-based video intervention about IPV and safety behaviours. Women attending routine antenatal check-ups alone (baseline) were screened for violence (Abuse Assessment Screen) by responding to questions on a tablet, and randomised (1:1) by computer to receive an intervention or a control video. The intervention video presented information about IPV and safety behaviours. The controls viewed a video promoting healthy pregnancy in general. Outcome measures were assessed three months post-partum: The World Health Organization Quality of Life-BREF, the Composite Abuse Scale on violence during the last 12 months and use of safety behaviours based on a 15-item checklist. A general linear model for repeated measures was used to examine the intervention's effect. The analyses were conducted by intention to treat. RESULTS: Among 1818 eligible women, 317 reported IPV and were randomised to an intervention (157) or a control group (160). A total of 251 (79.2%) women completed the follow-up questionnaire: 120 (76.4%) in the intervention group and 131 (81.9%) in the control group. At follow-up, 115 (45.8%) women reported a history of IPV. Few women (n = 39) reported IPV during the last 12 months. No differences in quality-of-life domains and overall quality of life and health were found between the intervention and the control groups. We detected no differences between the use of safety behaviours or IPV frequency and severity during the last 12 months. CONCLUSION: Our intervention did not improve women's quality of life, use of safety behaviours or exposure to violence. Nevertheless, a tablet-based tool may motivate women experiencing IPV to seek help and support. More research is needed regarding tablet-based interventions for women experiencing IPV, particularly culturally sensitive interventions. TRIAL REGISTRATION: NCT03397277 registered in clinicaltrials.gov on 11/01/2018.

Multi-country case studies on planning RMNCH services using WISN methodology: Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea.

BACKGROUND: Globally, many countries are adopting evidence-based workforce planning that facilitates progress towards achieving sustainable development goals for reproductive, maternal newborn and child health. We reviewed case studies on workforce planning for reproductive maternal newborn child health services at primary care level facilities using workload indicators of staffing need in five countries. METHOD: Using available workload indicators for staffing need reports from Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea, we generated descriptive statistics to explore comparable workload components and activity standards, health service delivery models with an emphasis on the primary care levels and the specific health occupations offering interventions associated with reproductive maternal, newborn and child health services. RESULTS: The health services delivery models vary from one country to another. The results showed variability in the countries, in the workload components and activity standards of each regardless of facility level or occupational groups involved. All the countries have decentralized health services with emphasis on comprehensive primary care. Reproductive, maternal and new-born child health care services include antenatal, postnatal, immunization, family planning, baby wellness clinics, delivery and management of integrated minor childhood illnesses. Only Sultanate of Oman offers fertility services at primary care. Kenya has expanded interventions in the households and communities. CONCLUSION: Since the health care services models, health services delivery contexts and the health care worker teams vary from one country to another, the study therefore concludes that activity standards cannot be adopted or adapted from one country to another despite having similar workload components. Evidence based workforce planning must be context-specific, and therefore requires that each country develop its own workload components and activity standards aligned to their local contexts.

Developing an Anti-Racist Foundations Course in MCH for MPH Students.

INTRODUCTION: Over the past decade, foundational courses in MCH have been revised and revamped to integrate the life course perspective and social determinants of health in ways that bring these essential issues to the core of the learning experience. Yet the racial reckoning of 2020 and the racially disparate health impacts of the COVID-19 pandemic underscore that a deeper, more focused approach to anti-racist pedagogy is now imperative for MCH educators and others responsible for developing the MCH workforce. METHODS: In this paper, we discuss our experience of building a 'community of practice' of anti-racist MCH trainees through our course, 'Foundations of Maternal and Child Health Policy, Practice, and Science.' RESULTS: We identify four principles which guided our course: (1) building on students' experience, knowledge, identities and social justice commitments; (2) creating a common purpose and shared vocabulary related to racism; (3) organizing classroom activities to reflect real-world problems and professional practices related to addressing structural racism as a root cause of health inequities; and (4) building students' skills and confidence to recognize and address structural racism as MCH professionals. DISCUSSION: We hope that this description of our principles, along with examples of how they were put into practice, will be useful to MCH educators who seek to build anti-racist frameworks to guide MCH workforce development.

Developing a Public Health Maternal and Child Health Training Program: Lessons Learned from Five Schools of Public Health.

Maternal and child health (MCH), as a core sub-field of public health, continues to be an essential area in which additional workforce development and investment are needed. Recent public health workforce assessments in the United States reveal there will be a significant number of vacancies in MCH public health positions in the near future, creating the need for a well-trained and skilled public health MCH workforce. In order to address this potential critical workforce gap, the U.S. Department of Health and Human Services, Health Resources and Services Administration's Maternal and Child Health Bureau initiated the Maternal and Child Health Public Health Catalyst Program in 2015 to support the creation of MCH training programs in accredited schools of public health that previously did not have a MCH concentration. This article details the accomplishments and lessons learned from the first five MCH Catalyst Program grantees: Drexel University; Florida International University; Rutgers, The State University of New Jersey; Texas A&M University; and the University at Albany.

A Call to Transform Maternal and Child Health Mentorship to Build Inclusivity, Honor Diversity of Experiences, and Tackle the Root of Health Disparities.

INTRODUCTION: Mentorship should be a transformative experience that propels mentees from one point in their career to another and drives personal growth. Within the field of maternal and child health (MCH), it is considered a critical professional duty. However, MCH has yet to explicitly embrace mentorship practice as a means to address workforce challenges including turnover, knowledge loss, and undue burden on the part of historically oppressed individuals and communities to overturn oppressive systems. CALL TO ACTION: We advocate for public calls for diversity and equity to be met with strategic enhancement of the practice of MCH mentorship. Transformative MCH mentorship should be used to promote positive identity formation, understanding of self in context, efficacy, and sustained commitment to working with MCH populations in ways that are inclusive and prevent the perpetration of the problematic power dynamics that lead to inequitable outcomes. RECOMMENDATIONS: We present recommendations to strengthen MCH mentorship practice. At the individual level, there should be a refreshment of norms and expectations, where mentorship is seen as a uniquely flexible opportunity for mutual learning. At the organizational level, embedding mentorship in all aspects of practice helps establish and sustain a culture of belonging. This transformative organizational culture can attract and retain future generations of professionals that are not only more representative of the populations that MCH programs support but are prepared to authentically elevate the needs and strengths of those populations. These suggestions incorporate best practices from other fields and include ideas for the MCH field in particular.

Stability of healthcare quality measures for maternal and child services: Analysis of the continuous service provision assessment of health facilities in Senegal, 2012-2018.

OBJECTIVE: High-quality healthcare is essential to ensuring maternal and newborn survival. Efficient measurement requires knowing how long measures of quality provide consistent insight for intended uses. METHODS: We used a repeated health facility assessment in Senegal to calculate structural and process quality of antenatal care (ANC), delivery and child health services in facilities assessed 2 years apart. We tested agreement of quality measures within facilities and regions. We estimated how much input-adjusted and process quality-adjusted coverage measures changed for each service when calculated using quality measurements from the same facilities measured 2 years apart. RESULTS: Over 6 waves of continuous surveys, 628 paired assessments were completed. Changes at the facility level were substantial and often positive, but inconsistent. Structural quality measures were moderately correlated (0.40-0.69) within facilities over time, more so in hospitals; correlation was <0.20 for process measures based on direct observation of ANC and child visits. Most measures were more strongly correlated once averaged to regions; process quality of child services was not (-0.32). Median relative difference in national-adjusted coverage estimates was 6.0%; differences in subnational estimates were largest for process quality of child services (19.6%). CONCLUSION: Continuous measures of structural quality demonstrated consistency at regional levels and in higher level facilities over 2 years; results for process measures were mixed. Direct observation of child visits provided inconsistent measures over time. For other measures, linking population data with health facility assessments from up to 2 years prior is likely to introduce modest measurement error in adjusted coverage estimates.

Aconselhamento diretivo como instrumento para melhoria nos índices de aleitamento materno exclusivo: uma revisão integrativa / La consejería directiva como herramienta para mejorar las tasas de lactancia materna exclusiva: una revisión integradora / Advice as an instrument for improvement in exclusive breastfeeding indices: and integrative review

Objetivo: identificar, na literatura científica, publicações sobre como o aconselhamento diretivo serve de instrumentopara melhoria nos índices de aleitamento materno exclusivo. Método: trata-se de um estudo qualitativo, do tipo revisão integrativa, realizado nas bases de dados Scielo, PubMed, Lilacs, Cinahl e BVS, na série temporal de 2009 a 2019, nos idiomas português e inglês, com os descritores e operadores booleanos. Resultados: foram encontrados 757 artigos que após identificação dos critérios e análise, apenas 21 artigos foram selecionados. Evidenciou-se que não receber informações sobre amamentação no pré-natal interfere na manutenção do aleitamento materno. Nesse sentido, os estudos reforçam a necessidade de práticas de apoio que favoreçam a escolha e manutenção do aleitamento materno. Conclusão: a maioria dos estudos demonstrou impacto positivo na manutenção do aleitamento materno exclusivo quando utilizado o aconselhamento profissional para auxiliar possíveis intervenções no decorrer da amamentação. (AU)

Objective: to identify, in the scientific literature, publications on how directive counseling serves as an instrumentto improve the rates of exclusive breastfeeding. Method: this is a qualitative study, integrative review type, carried out in the Scielo, PubMed, Lilacs, Cinahl and BVS databases, in the time series from 2009 to 2019, in Portuguese and English, with Boolean descriptors and operators. Results: 757 articles were found, after identification of the criteria and analysis, only 21 articles were selected. lt was evident that not receiving information about breastfeeding in the prenatal period interferes with the maintenance of breastfeeding. ln this sense, the studies reinforce the need for supportive practices that favor the choice and maintenance of breastfeeding. Conclusion: most studies have shown a positive impact on maintaining exclusive breastfeeding when professional counseling is used to assist possible interventions during breastfeeding.(AU)

Objetivo: identificar, en la literatura científica, publicaciones sobre cómo lo consejería directiva sirve como instrumentopara mejorar las tasas de lactancia materna exclusiva. Método: se trata de un estudio cualitativo, tipo revisión integradora, realizado en las bases de datos Scielo, PubMed, Lilacs, Cinahl y BVS, en la serie temporal de 2009 a 2019, en portugués e inglés, con descriptores y operadores booleanos. Resultados: se encontraron 757 artículos, luego de identificar los criterios y análisis, solo se seleccionaron 21 artículos. Fue evidente que no recibir información sobre la lactancia materna en el período prenatal interfiere con el mantenimiento de la lactancia materna. En este sentido, los estudios refuerzan la necesidad de prácticas de apoyo que favorezcan la elección y el mantenimiento de la lactancia materna. Conclusión: la mayoría de los estudios han demostrado un impacto positivo en el mantenimiento de la lactancia materna exclusiva cuando se utiliza la asesoría profesional para ayudar a posibles intervenciones durante la lactancia(AU)

Percepção de puérperas atendidas em um centro de parto normal público de Pernambuco / Perception of pregnancy care at a public normal childhood center in Pernambuco

Objetivo: Analisar a percepção de puérperas atendidas em um Centro de Parto Normal público de Pernambuco sobre o parto humanizado. Métodos: Trata-se de um estudo descritivo exploratório de caráter qualitativo, realizado em um Centro de Parto Normal de Pernambuco com 10 puérperas entre julho a agosto de 2020. A coleta de dados ocorreu por meio de entrevistas semiestruturadas, guiadas por um roteiro, gravadas e transcritas na íntegra, e analisadas pela técnica de análise de conteúdo. Resultados: Constatou-se satisfação entre as puérperas frente a vivência e aos procedimentos realizados, principalmente aos cuidados e orientações concedidas pela equipe de Enfermagem quanto processo de parto e puerpério. Conclusão: As puérperas mostraram-se satisfeitas em relação ao atendimento oferecido pelo Centro de Parto Normal, especialmente devido à adesão às boas práticas preconizadas pela Organização Mundial de Saúde.(AU)

Objective: To analyze the perception of puerperal women attended at a Public Normal Birth Center in Pernambuco about humanized childbirth. Methods: This is a descriptive exploratory study of a qualitative nature, carried out in a Normal Childbirth Center in Pernambuco with 10 postpartum women between July and August 2020. Data collection took place through semi-structured interviews, guided by a script, recorded and transcribed in full, and analyzed using the content analysis technique. It is reiterated that the study was approved by an Ethics Committee (4,136,314). Results: There was satisfaction among the puerperal women regarding the experience and procedures performed at the Centro de Parto Normal, especially the care and guidance provided by the nursing team regarding the delivery process and the puerperium. Conclusion: The puerperal women were satisfied with the care offered by the Centro de Parto Normal, especially due to adherence to the good practices recommended by the World Health Organization.(AU)

Objetivo: Analizar la percepción de las puérperas atendidas en un Centro Público de Partos Normales de Pernambuco sobre el parto humanizado. Métodos: Se trata de un estudio exploratorio descriptivo de carácter cualitativo, realizado en un Centro de Parto Normal en Pernambuco con 10 puérperas entre julio y agosto de 2020. La recolección de datos se realizó mediante entrevistas semiestructuradas, guiadas por un guión, grabadas y transcritas íntegramente y analizadas mediante la técnica de análisis de contenido. Se reitera que el estudio fue aprobado por un Comité de Ética (4.136.314). Resultados: Hubo satisfacción entre las puérperas con respecto a la experiencia y procedimientos realizados en el Centro de Parto Normal, especialmente los cuidados y orientación brindados por el equipo de enfermería en relación al proceso de parto y puerperio. Conclusión: Las puérperas se mostraron satisfechas con la atención brindada por el Centro de Parto Normal, especialmente por el apego a las buenas prácticas recomendadas por la Organización Mundial de la Salud.(AU)