Implementation of a midwifery preceptor program in Sierra Leone: a qualitative evaluation using the Consolidated...

Sierra Leone has the world's third highest incidence of maternal mortality, with 443 deaths per 100,000 live births. Strengthening the country's midwifery workforce is essential to providing adequate maternal healthcare and reducing preventable perinatal mortality. In support of this goal, we developed and implemented a midwifery preceptor program (MPP) to train experienced midwives to effectively mentor new and student midwives. The aim of this study was to qualitatively evaluate barriers and facilitators to the implementation of the MPP using the Consolidated Framework for Implementation Research (CFIR).

At the end of the first year of MPP implementation, all preceptors, facilitators, and stakeholders from both implementation sites in Sierra Leone were invited for virtual, individual interviews; 26 participated. Using deductive content analysis, interview transcripts were coded according to the five CFIR domains - innovation, outer setting, inner setting, individuals, and process - and an added sixth domain: future directions. Barriers and facilitators to MPP implementation were assessed per domain.

Participants identified barriers and facilitators to MPP implementation across all six domains. Facilitators included a well-designed program that comprehensively integrated theory and practice, the support of program facilitators, and effective stakeholder collaborations. Barriers included limited resources and time constraints, which occasionally made it difficult to balance professional responsibilities with program activities. Nonetheless, participants advocated for formalizing the MPP to sustain the program's impact.

The findings indicate that the MPP is a valuable innovation for enhancing midwifery education in Sierra Leone, which in turn can help to improve perinatal health outcomes. By identifying key barriers and facilitators to implementation, this study provides actionable insights to inform the adaptation, scaling, and sustainability of the MPP not only in Sierra Leone but also in other resource-limited settings facing similar workforce challenges.