The Effectiveness of Modified Early Obstetric Warning System Training on Midwives’ Knowledge and Interpersonal Skills for Early Detection of Maternal Complications in Indonesia
Abstract
Background: The maternal mortality rate in Indonesia is still high. Efforts are needed to increase the capacity of midwives. The study aims to evaluate the effectiveness of Modified Early Obstetric Warning System (MEOWS) training on midwives’ knowledge and interpersonal skills, while also assessing the feasibility of employing MEOWS training, as perceived by participants. Materials and Methods: We used a mixed‑methods study. The study was carried out from November to December 2022 in Indonesia. A purposive sampling technique was employed to select 60 midwives for the quantitative study and 20 midwives for the qualitative study, equally divided between the blended and online groups. The intervention consisted of 82 sessions that were equal for both groups, with each session lasting 45 minutes. Quantitative data were collected using questionnaires and Likert scales, while qualitative data were gathered through focus group discussions. Quantitative data were analyzed using t‑tests, while thematic content analysis was employed for the qualitative data. Results: Significant improvements in midwives’ knowledge were seen in both groups. The mean (SD) knowledge was 97.10 (5.80) in the intervention group and 94.00 (8.80) in the control group (p = 0.12). Midwives reported greater engagement with blended training, perceiving it as feasible and valuable, and expressing eagerness for its implementation to enhance early detection of maternal complications. Conclusions: While both blended and online training effectively enhanced knowledge and self‑efficacy in the early detection of maternal complications, participants found blended training to be more practical. Continuous evaluation is necessary for the retention of knowledge over time.
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Raina N, Khanna R, Gupta S, Jayathilaka CA, Mehta R, Behera S. Progress in achieving SDG targets for mortality reduction among mothers, newborns, and children in the WHO South East Asia Region. Lancet Reg Health Southeast Asia 2023;18:100307.
WHO. Maternal Mortality. 2023. Available from: https://www. who.int/news-room/fact-sheets/detail/maternal-mortality. [Last accessed on 2023 Nov 21].
Ministry of Health of the Republic of Indonesia. Indonesia Health Profile 2021. 2021. Available from: https://kemkes.go.id/id/profil-kesehatan-indonesia-2021 [Last accessed on 2023 Mar 31].
Syairaji M, Nurdiati DS, Wiratama BS, Prüst ZD, Bloemenkamp KW, Verschueren KJ. Trends and causes of maternal mortality in Indonesia: A systematic review. BMC Pregnancy Childbirth 2024;24:515.
Agus Y, Horiuchi S, Iida M. Women’s choice of maternal healthcare in Parung, West Java, Indonesia: Midwife versus traditional birth attendant. Women Birth 2018;31:513 9.
Musie MR, Tagutanazvo OB, Sepeng NV, Mulaudzi FM, Hlongwane T. A scoping review on continuing professional development programs for midwives: Optimising management of obstetric emergencies and complications. BMC Med Educ 2025;25:296.
Petersen EE. Vital signs: Pregnancy related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017. MMWR. Morbidity and mortality weekly report 2019;68:423 9.
Singhal S, Acharya N, Madaan S, Mohammad S, Acharya S. Use of the modified early obstetric warning system chart as a predictor of peri partum obstetric morbidity in a rural teaching institute: A two year cross sectional study. J Family Med Prim Care 2022;11:7644 51.
Xu Y, Zhu S, Song H, Lian X, Zeng M, He J, et al. A new modified obstetric early warning score for prognostication of severe maternal morbidity. BMC Pregnancy Childbirth 2022;22:901.
Bordoloi R, Das P, Das K. Perception towards online/blended learning at the time of Covid 19 pandemic: An academic analytics in the Indian context. Asian Association Open Univ J 2021;16:41 60.
Ashraf MA, Yang M, Zhang Y, Denden M, Tlili A, Liu J, et al. A systematic review of systematic reviews on blended learning: Trends, gaps and future directions. Psychol Res Behav Manag 2021;14:1525 41.
Mulyadi M, Tonapa SI, Rompas SS, Wang RH, Lee BO. Effects of simulation technology based learning on nursing students’ learning outcomes: A systematic review and meta analysis of experimental studies. Nurse Educ Today 2021;107:105127.
Leavy P. Research design: Quantitative, qualitative, mixed methods, arts based, and community based participatory research approaches. Guilford Publications; 2022.
Gay LR, Diehl PL. Research methods for business and management. In Hil R. editor, What Sampel Size Is “Enough” in Internet Survey Research? Interpersonal Computing and Technology: An Electronic Journal for the 21st Century; 1998.
Pereira TJ, Puggina AC. Validation of the self assessment of communication skills and professionalism for nurses. Rev Bras Enferm 2017;70:588 94.
Bonsaksen T, Kottorp A, Gay C, Fagermoen MS, Lerdal A. Rasch analysis of the General Self Efficacy Scale in a sample of persons with morbid obesity. Health Qual Life Outcomes 2013;11:202.
Janes G, Ekpenyong MS, Mbeah Bankas H, Serrant L. An international exploration of blended learning use in pre registration nursing and midwifery education. Nurse Educ Pract 2023;66:103514.
Jen E, Hoogeveen L. Design an international blended professional development model for gifted education: An evaluation study. Eval Program Plann 2022;91:102034.
Nieder J, Schwerdtle PN, Sauerborn R, Barteit S. Massive open online courses for health worker education in low and middle income countries: A scoping review. Front Public Health 2022;10:891987.
Tuyishime E, Ingabire H, Mvukiyehe JP, Durieux M, Twagirumugabe T. Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: A cross sectional study. BMC Pregnancy Childbirth 2020;20:568.
Arnolds DE, Carey KA, Braginsky L, Holt R, Edelson DP, Scavone BM, et al. Comparison of early warning scores for predicting clinical deterioration and infection in obstetric patients. BMC Pregnancy Childbirth 2022;22:295.
Sung TC, Hsu HC. Improving critical care teamwork: Simulation based interprofessional training for enhanced communication and safety. J Multidiscip Healthc 2025;18:355 67.
Yazew KG, Gebrie MH, Aynalem ZB. Nurses’ communication skills and determinant factors in Amhara Region Referral Hospitals, Northwest Ethiopia, 2019. Int J African Nurs Sci 2021;14:100310.
Yang J, Kim S. An online communication skills training program for nursing students: A quasi experimental study. PLoS One 2022;17:e0268016.
Nove A, Friberg IK, de Bernis L, McConville F, Moran AC, Najjemba M, et al. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: A lives saved tool modelling study. Lancet Glob Health 2021;9:e24 32.
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