Table 3 Influences on midwives’ educational role classified according to Capability, Opportunity and Motivation during participatory learning workshop (N = 40)
Capability | Opportunity | Motivation |
|---|---|---|
• Continuous education and professional development: seminars, workshops, conferences, specialised training programmes • In-hospital training: absence of formal mechanism for transmission of new knowledge and integration of professional development activities in clinical practice • Lack of targeted training in the educational role for the development of practical skills • Lack of specialist role with training in antenatal education and counselling • Digital skills: using online and other digital resources or new technologies • Strengthening communication skills • Cultural competence skills needed in changing multicultural environment • Critical appraisal skills to keep up-to-date with evidence-based practice • Evidence-based practice skills: Ability to refer to and use evidence in the context of educational capacity | • Inappropriate infrastructure / unfriendly spaces, not offering comfort and privacy • Lack of resources: • Lack of educational and informational material and other resources • Insufficient or non-existent financial resources for the creation of material, even if intention exists • Lack of equipment (e.g. computers) or old-age with no regular maintenance • No access to internet and online sources of information in clinical settings • Barriers to access: • Minimal contact with midwives before childbirth (especially in private sector) • Not institutionalization of educational role of midwives by organizations / healthcare system • Need for establishment of autonomous and complementary role • Direct access to midwives without referral from an Obstetrician -Gynecologist within new National Healthcre system, even if limited • Medicalization: • Understaffing and lack of time • Undervalued: non-recognition of the importance of antenatal education by administration / healthcare system vs midwifery-led care) • Professional role boundaries and inter-professional conflict • Lack of common policy and protocols (roles, actions, referrals, etc.) • Interdisciplinarty/ interprofessional activities: • Weak interdisciplinary collaboration in clinical practice • Incompatible interprofessional activities, values and skills • Need for tighter collaboration and partnerships between professional associations and scientific bodies • Limited availability of joint training programs with other healthcare professionals • Linguistic barriers: Inability to communicate with non-Greek healthcare users/ no translators / little to no material in other languages | • Competing priorities due to work overload / reduced control over decision making • Inefficient human resources utilization • Professional status and identity: Unfamiliarity and lack of trust in midwives due to medicalization of birth • No continuity of care: Fragmented contact with midwife reduces motivation • Decentralization: different roles and responsibilities between state and private maternity hospitals • Educational role as a means for • promoting and showcasing autonomous role of midwives • improving job satisfaction - • Strengthening inter-professional cooperation in the context of developing guidelines, protocols and material • Avoidance of educational role • conflicting views with prevailing medicalised care • incompatible policies and contradictory messages e.g. maternity leave less than 6 months vs recommendations for exclusive breastfeeding up to 6 months • Resistance to change/ complacency due to civil servant status in public sector • No continuity of care –No community midwifery • Lack of incentives, recognition or rewards for professional development • Unequal opportunities for professional development • No formal evaluation system for career progression • No wider culture of continuing education and professional development • Establishment of first midwifery-led natural birth centre reason for optimism |