A conceptual framework for assessing the barriers and facilitators to implementing an intervention aiming to change a health professional role: the case of the midwifery profession in Morocco
Sabina Abou Malham, Marie Hatem and Nicole Leduc
University of Sherbrooke, Canada
University of Montreal, Canada
: J Womens Health, Issues Care
Abstract
This paper presents a conceptual framework for understanding the implementation process of a complex intervention aiming to change a health professional role. It is designed to evaluate the implementation of an action plan/intervention based on the three systems’- educational, sociocultural and professional- interaction aiming to reinforce a health professional’s role. The proposed framework holds that the intervention must address these three interacting systems (socio-cultural, educational and professional) through which a health professional role evolves. Each system is operationalized by four dimensions (values, methods, actors and targets). As for the implementation, the framework posits that it can be analysed, by depicting the barriers and facilitators located within the dimensions of the three interacting systems and within the intervention involved in the process through using the “menu of constructs” approach suggested by the Consolidated Framework for Implementation Research (CFIR). The objective of the presentation is to discuss the conceptual framework’s capacity in assessing the barriers and facilitators to implementing an intervention aiming to strengthen the midwifery profession in Morocco and to explain how the intervention’s dimensions and characteristics can influence the implementation success and challenge reaching its outcomes. An embedded case study design was adopted for this purpose and data were collected through training session observations, documents, and 11 semi-structured interviews, 20 focus groups conducted with 106 multi-stakeholders (health professionals, academic staff, students, medical administrative officers and health programmers) and one international consultant selected purposefully from two Moroccan regions. Our research confirms that a combination of favourable contextual conditions at the dimensions of the three systems is required to achieve the goal of the government's strategy which is to provide qualified midwives according to the International Confederation of Midwives global standards for midwifery, able to provide quality reproductive health care, and to contribute to reducing maternal and neonatal mortality.
Biography
Sabina Abou Malham holds PhD degree in Public Health-Healthcare Management from University of Montreal. Her thesis focused on implementation analysis of an action plan to strengthen the midwifery professional role in Morocco. She completed a two-year Postdoctoral Fellowship at the Charles Lemoyne Research Center, Faculty of Medicine and Health Sciences, University of Sherbrooke. She has two complementary degrees in research and interdisciplinary research in reproductive health and developed a strong base knowledge in dissemination and implementation theory. Her research focused on implementation analysis and impact/outcomes assessment of innovations/organizational interventions aiming to improve access to primary health care services. Her research focuses also on developing, implementing and assessing interventions/innovations aiming to change the role of human resources for health in general, midwives and nurses in particular. She is also interested in managing reproductive health care services, developing, implementing, analyzing and evaluating reproductive health interventions/programs in a global health setting. She works at present as a Field Coordinator on a project, Global Maternal Sepsis conducted by the World Health Organization, Geneva. She has published scientific papers in reputed journals like BMC Health Services Research and International Journal of Family Medicine.
