Evaluation of Educational Activity About Preeclampsia With Traditional Midwives in the Remote Petén Department of Guatemala.

INTRODUCTION

The Guatemalan Ministry of Health has offered traditional midwives (TMs) training programs in Spanish since 1955. Many Guatemalan TMs speak indigenous dialects, with limited reading and writing skills, and may not fully comprehend this information. Additionally, TMs have previously requested instruction on how to measure blood pressure in order to improve outcomes for women developing preeclampsia. Prompt diagnosis of preeclampsia would enable TMs to make more timely decisions for transport to a hospital. The purpose of this quality improvement project therefore was to develop culturally sensitive oral educational activities in the native language of participants to improve their knowledge of preeclampsia and improve their skills in assessing blood pressure.

PROCESS: The project used an action research methodology based on Leininger's cultural care theory. Trainers employed a variety of teaching methods such as repetition, triangulation, role-plays, storytelling, hands-on practice, return demonstrations, and pictorial Preeclampsia Reminder Cards. During a 2-week period in August 2024, 179 TMs attended educational activities about preeclampsia in 11 groups located in the remote Petén. A 26-item written pretest and posttest was used to evaluate changes in knowledge about preeclampsia. An 11-item checklist was used to assess ability to correctly measure blood pressure.

OUTCOMES: Among 179 TM participants, 49% were found to have limited reading and writing skills. Following the education methods, however, the group demonstrated a significant improvement in knowledge when comparing the 26-item pretest (N = 179, mean [SD], 16.02 [4.04]) with the posttest (mean [SD], 21.5 [4.69]); t178 = 12.262; P < .001. Some participants with limited reading and writing skills were provided 1:1 assistance writing down answers they provided to the tests. Additionally, 94% correctly demonstrated all 11 items on a blood pressure assessment checklist. The majority of participants reported the educational activity was useable, feasible, and satisfying.

DISCUSSION: The success of these methods in educating TMs in remote Guatemala has wide-reaching implications for improving maternal and infant health outcomes in low- and middle-income countries.