| Concepts | Definition | Variation example | |
| 1 | Diverse educational backgrounds | Years spent on technical training such as nursing, midwifery and health visitor | Enrolled midwifery school in Uganda for 2.8 years (Ms. C) |
| 2 | Training experience | Experience of providing guidance and training to colleagues prior to in-service training | After the basic training, I came here. I started making changes. If there’s something that’s not right, I would correct it; “that shouldn’t be like this.” During deliver, caring of the mother, even postnatal caring for the mother and how to care for the baby. I started teaching other midwives. (Ms. A) |
| 3 | Mission to save lives | Sense of duty beyond professional obligation to help save lives | Interviewer: What makes you want to continue working as a midwife? Ms. C: I want to save the lives of mothers. (Ms. C) |
| 4 | Acceptance of new knowledge and skills | Realizing “there is always new knowledge” despite years of experience | Ms. A: The number is going down because of in-serve training for midwives. We still need more in-service training. Because there is always something new knowledge. More training. (Ms. A) |
| 5 | Change in recognized scope of practice | Changes in scope of practice before and after in-service training | Now because of this workshop or in-service training, now I know when to refer woman to doctor. I know how to identify risk and time. I know all these things. Discovered lots of things like taking blood pressure. These are all through in-service training. Even know to test HIV at PHCC, and family planning. I know all of these during in-service training not basic one (Ms. A) |
| 6 | Shift in the level of understanding of midwife care | Change in the level of understanding and practice of midwife care after being introduced to new information | Ms. A: We are focusing on antenatal. So you must examine the woman properly. So that you know what is the dangers. Because if you don’t examine this woman properly, maybe you miss something, and then this woman may be at risk because of negligence. Now I’m training these ladies. They are helping me to give health education to mothers. Interviewer: So this is something you were not doing before JICA training? Ms. A: Before we were doing only health education, but we were not doing how to check from head to toe. (Ms. A) |
| 7 | Perception impeding safe delivery | Local practices and people’s perception that could get in a way of safe delivery | Ms. A: What I’m not doing is labor. The style or the position. Because the mothers here don’t accept or agree or don’t want to. Only one position. They don’t want to change. (Ms. A) |
| 8 | Lack of resources from outside organizations | Resources not available from government and donors | Ms. A: The difficulties or the challenges we have, even after our training, we don’t have equipment. Like even taking blood pressure, we have only one machine in Malakia health center. That one machine is spoiled now. We don’t have. (Ms. A) |
| 9 | “Ignorance” of women | Women’s lack of birthrelated knowledge | Sometimes they come and babies already died. Still birth. Most of our people are still ignorant. They don’t know the importance of the hospital. They stay there like prime gravidas, when they try to deliver at home, they fail. Then they bring the child that died. (Ms. C) |
| 10 | Realization for the need to improve current situation | Difficult situations surrounding birth giving midwives reasons to improve practices | Interviewer: Is there anything specific in antenatal care you teach? Ms. A: Just focusing on mothers, advise. Their visits to the clinic. Even if they are supposed to come four visits, but in between if the mother’s sick, let her come to see a doctor so she is treated; early treatment. Let her not wait at home even if her appointed date is not yet to come. So this is where we are focusing. (Ms. A) |
| 11 | Ample supplies from outside organizations | Having resources such as medical supplies available from government and donors | Ms. E: But now there’s many. They brought many to the hospital. Interviewer: Many..? Ms. E: Many oxytocin to the hospital. The government brought it. (Ms. E) |
| 12 | Successful experiences | Experiencing improvement of care and better outcome from application of new skills | …we use drugs, oxytocin. After delivery of the baby, they give the drug, then the placenta comes. (Ms. C) |
| 13 | “More in-service training” | Development of motivation to attend more in-service training after experiencing improvement in practice | Ms. A: The number is going down because of in-serve training for midwives. We still need more in-service training. Because there is always something new knowledge. More training. (Ms. A) |
| 14 | Recognition from others | Evaluation of care provided to mothers | She listened to the baby’s heartbeat, and it was beating very fast. Even the mother was at risk. So she said this one cannot wait here, or she’d be dead. .. So they took her to a hospital, they found the doctor who did cesarean section. The baby and the mother were saved. Up to now both the mother and the baby are healthy. Up to now they respect her for what she did because otherwise both of them had died. (Ms. A) |
| 15 | Application of learned knowledge and new skills to pregnant women | Skills being introduced and practiced to mothers | Interviewer: How are you applying what you learned in training at work? Ms. A: Focused antenatal care. (Ms. A) |
| 16 | “Nobody takes work seriously” | Lack of motivation to work or try to provide appropriate care | Now people don’t take things seriously. Everything is neglected. Nobody takes work seriously. They don’t record. In those days they used to. (Ms. E) |
| 17 | Time constrain on teaching the lifesaving skills | Time being spent on tasks others should be doing but are not; limiting midwives | Interviewer: So they can’t do the physical assessment? Ms. B: No, no. Interviewer: You have to do everything? Ms. B: I have to do everything. I don’t have time to teach! (Ms. B ) |
| 18 | Low level of colleagues’ language skills | Recognized lack of language skills despite their practical skills | Some of the village midwives cannot write. They are skilled and have knowledge but… Even in training, no writing. You have to cram like a song. No reading, no writing. (Ms. A) |
| 19 | Low level of confidence in teaching | Feeling shy or shameful to teach others | So now they don’t feel shame or they don’t feel shy to train others. (Ms. A, pg 10) This training brought for me a big change because they gave me skills how to go train these midwives. (Ms. C) |
| 20 | Colleagues’ positive attitude | Colleagues’ willingness and acceptance of learning new knowledge and skills | They want to know anything. If you invite them, they are ready to come because they want to know more. (Ms. E) |
| 21 | Decrease of time constrains | Training colleagues not just empowers the participants but also frees them from workload | Now because I trained others, it reduce my workload. Now these people can help me. Now that I was trained in TOT, I’m training others and they can train also. (Ms. A) |
| 22 | Effective TOT methods | TOT experience acting as a promoter when training colleagues | This training brought for me a big change because they gave me skills how to go train these midwives. (Ms. C) |
| 23 | Confidence in new skills | Experiencing the expansion of range and level of understanding and practice | Interviewer: Last year, did you have cases where you had to perform resuscitation on babies? Ms. C: Yeah. Interviewer: How many cases? Ms. C: 5. Interviewer: How did it go? Ms. C: They were OK after resuscitation. Interviewer: Did you use the ambu bag? Ms. C: Yes, the ambu bag. |
| 24 | Training of colleagues | Experiences in giving training to other midwives | Yes, I trained about antenatal care and how to examine the mother. (Ms. C) |