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Browsing Journals by Author "Columba, Mbekenga K."

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    Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial
    (Journal of Medical Internet Research, 2024-12-05) Columba, Mbekenga K.
    Background Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. Objective We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. Methods ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Results Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. Conclusions This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. Trial Registration ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305 International Registered Report Identifier (IRRID) DERR1-10.2196/63454 Keywords: mobile health, maternal health, randomized controlled trial, parenting self-efficacy, self-efficacy, maternal, RCT, mother, text message, coaching, postnatal, newborn, child, low-income country, middle-income country, Africa, newborn care education, nurse midwife, Tanzania
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    It’s the Time they Take to Give Feedback; it has Become a Problem” Exploring Barriers and Facilitators for Research Supervision in Postgraduate Medical Education in Tanzania. A Qualitative Study
    (Advances in Medical Education and Practice, 2025-04-28) Columba, Mbekenga K.
    Background Research supervision is a multifaceted task that combines academic knowledge with managing interpersonal relationships. Postgraduate trainees often receive inadequate supervision due to their supervisors’ demanding schedules and limited supervision competencies. Most supervisors, especially in low-resource settings, lack formal training in supervision and thus rely on personal experiences to fulfil this role. Poor supervision contributes to high dropout rates and subpar research output in many universities. We aimed to explore the barriers and facilitators for research supervision in postgraduate medical education in Tanzania. Methods We adopted an exploratory qualitative case study and conducted key informant interviews with three purposively selected faculty in leadership and four focus group discussions with 14 postgraduate trainees and 10 faculty members. Topic guides focusing on experiences, challenges, and needs were used for data collection. The data were audio recorded and transcribed verbatim. A framework matrix was used to summarize and analyze data using an excel workbook. An inductive qualitative data analysis approach was employed using thematic analysis as described by Braun and Clarke. Results Two main thematic areas emerged from analysis: Barriers and facilitators for research supervision in postgraduate medical education. Difficulty balancing workload, delays in feedback, limited access to some resources, funding constraints and limited research skills emerged as key barriers. Participants recognised the role of a well-equipped library in facilitating the supervision process and trainees appreciated flexibility from their supervisors. Conclusion Addressing the identified barriers is crucial to enhance the supervisor-trainee relationship and overall dissertation outcomes. Ensuring protected time for research and strengthening faculty research and supervision skills through targeted training is important to ensure high quality research output.
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    The dilemmas and opportunities of co-creating health interventions to fit local contexts: an ethnographic study on the adaptation of clinical guidelines in Tanzania
    (Health Expectations, 2024-10-24) Columba, Mbekenga K.
    Introduction Healthcare providers' role in co-creating health interventions and implementation strategies has evolved significantly, and yet, there is little documentation of this from low-resource settings. This study aims to share the dilemmas of engaging healthcare providers in co-creating locally adapted clinical guidelines for maternity facilities in Dar es Salaam, Tanzania, and strategies used to address them. Methods An ethnographic study explored the co-creation of locally adapted clinical guidelines for childbirth care within five maternity facilities in Dar es Salaam. Participant observations were conducted during 11 co-creation workshops. Six in-depth interviews explored participant experiences. Data were analyzed using Attride-Stirling's thematic network analysis framework. Results The analysis revealed four themes representing dilemmas in the co-creation process and strategies to improve co-creation: (i) navigating diverse contexts: adapting a single set of guidelines to various, diverse facilities was challenging; this was addressed through engaging in dialogue and flexibility while adjusting care practices. (ii) Competing knowledge systems and sources: differing knowledge sources between researchers and healthcare providers challenged discussions on recommended practices. However, validating scientific recommendations with practical care experience in this context helped bridge this gap. (iii) Fostering meaningful participation: participation was time-consuming for some. However, early stakeholder engagement and facility-led participant selection facilitated the meaningful involvement of healthcare providers. (iv) Power imbalances: power dynamics influenced the co-creation process; involving stakeholders in planning and co-facilitating workshops helped mitigate these imbalances and encourage more equal participation. Conclusion Navigating contextual variation, differences in knowledge systems, meaningful participation and power dynamics were key challenges in the co-creation process. However, reflexivity, open and honest dialogue with stakeholders and early engagement enhanced the co-creation process. Co-creating locally adapted clinical guidelines with frontline healthcare workers and scientific experts is essential for feasibility and safety. Further research is needed to explore context specificity, decision-making and the efficacy of co-creation in low-resource settings.