Plain English Summary
Background and study aims
Skills and drills training for health care providers in maternal and newborn health is widely used in Sierra Leone but there is little knowledge on the extent of retention of knowledge and skills (K&S), factors that facilitate or prevent K&S retention after in-service training at primary health care level. Previous studies show significant increase in knowledge and skills immediately after training compared to before the training but also significant reduction 3 and 6 months later.
Mentorship and supportive supervision have been shown to help health care workers develop competence after training in high income countries but few studies have been conducted on the effect of mentorship in low resource settings. The aim of this study is to see if mentorship improves healthcare workers knowledge and skills retention after training.
Who can participate?
Health care workers who are working in the study area
What does the study involve?
All participants receive seven two day training modules about their health care skills. Areas are randomly allocated to one of two groups over eight months. Participants in the first area receive 10 mentorship visits over eight months. Those in the second area do not receive these visits. Participants are followed up three and six months after the to assess their knowledge and skills.
What are the possible benefits and risks of participating?
Health care workers who take part in the trainings are expected to benefit from improved knowledge and skills after the training. It is also expected that these improvements will be translated to improved quality of care for women and newborns who use the service. The mentorship/supportive supervision is expected to complement the effect of the training in the improvement of quality of care.
Trained mentors/supervisors will benefit from training in mentorship and supportive supervision. These transferable skills can improve their overall capacity to provide quality supervision and support for their teams. There may be some risk to provision of clinical services, when staff are attending trainings. This will be minimised because trainings will take place at or very close to facilities where participants work. Also participants will be trained in batches to ensure that service provision is uninterrupted.
Where is the study run from?
This study is being run by the Liverpool School of Tropical Medicine (UK) and takes place in Sierra Leone.
When is the study starting and how long is it expected to run for?
February 2017 to July 2018
Who is funding the study?
Johnson and Johnson (USA)
Who is the main contact?
Dr Charles Ameh
Dr Charles Ameh
Centre for Maternal and newborn Health
Liverpool School of Tropical Medicine
The effect of a new post training mentorship/supportive supervision training package on knowledge and skills retention in Sierra Leone - a Cluster randomized controlled trial
Does mentorship improve the knowledge and skills retention of primary health care workers after training compared to those who do not have mentorship after training?
The aim of this study is to determine the effect of mentorship on knowledge and skills retention post skills and drills training.
1. Liverpool School of Tropical Medicine Research Ethics committee, 13/06/2017, ref: 17-025
2. Sierra Leone Scientific and Ethics review Committee, 13/07/2017, no reference number
Multi centre cluster randomised controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use contact details to request a participation information sheet.
In service training of primary health care workers providing maternal and newborn care in the clusters and centres included.
Randomisation is based on the 4 geographical provinces in Sierra Leone (north, south, east and west). Each province is randomly allocated a number and 2 provinces randomly selected to either the control group (north and east province) or intervention group (south and west province). 250 health workers (in 7 districts) of the 500 trained receive mentoring/supportive supervision (intervention group) and 250 will not (control group).
All participants in both the control and intervention group participate in seven two day training modules, evenly spaced over an eight month period. Participants in the control and intervention groups are asked to complete knowledge and skills tests immediately prior to and after each training module. The seven 2-day RMNCAH modules based on the Sierra Leone basic package of essential health services (BPEHS) to improve reproductive, maternal, newborn, adolescent and child health (RMNCAH) services are antenatal care, care during labour and delivery, emergency obstetric and newborn care, postnatal care, family planning, adolescent sexual and reproductive health, and nutrition.
Participants from the intervention group receive 10 mentorship visits over the same eight month period. Participants are asked to keep a diary of each visit to record number, duration, purpose, challenges, and practice developments at each visit.
Mentors are asked to keep a log of all visits, including number of visits, duration, frequency, content and activities undertaken at each visit.
Participants from both the control and intervention groups are asked to complete knowledge and skills tests on modules 1 and 2 at three and 6 six months post baseline (the date of the training module) to assess retention of knowledge and skills.
Study participants in both study arms are reassessed at three and six-month post training. At the three and six-month reassessment points, all those who participated in the tests were then debriefed as a group, during which poorly performed/potentially life threatening skills were demonstrated and discussed.
A search of the literature shows there is no set standard for number of mentees per mentor. The UK Nursing and Midwifery Council recommend a maximum of three mentees per mentor. We will take advice from the Sierra Leone Chief Nursing and Midwifery Officer and the Sierra Leone Nurses and Midwives Board, and aim to have a maximum of 5 health care providers to one mentor receiving mentorship. Within the timescale and budget allowed for the study LSTM will be able to support a maximum of 45 supervisors/mentors. Assuming a maximum of six mentees per mentor there will be a total of 250 mentees.
Primary outcome measure
Changes in Knowledge and skills are measured using the 7 pre and post training module test and the knowledge and skills retention tests at 3 and 6 months post baseline for modules 1 and 2 only.
Secondary outcome measures
1. Number and frequency of supervision/mentoring sessions is measured using the log book kept by the mentor and diary kept by the participant at eight months
2. Factors affecting retention of knowledge and skills is measured using both quantitative and qualitative data from the mentor log book and participant diary at 8 months (the end of the mentorship period)
3. Satisfaction of supervision measured using qualitative data from the mentor log book and participant diaries at 8 months
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Health care providers of any gender and age who have attended the in -service capacity building training programme
2. District health management team supervisors working with health care providers at primary health care level in 4 provinces
Target number of participants
14 clusters in the 4 provinces of Sierra Leone: 125 primary health care workers in each Province (35-37 health care workers per cluster). 24 mentors in each of the intervention provinces (total 48)
Participant exclusion criteria
Health workers and supervisors/ mentors who do not wish to consent to take part in the study.
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Liverpool School of Tropical Medicine
Centre for Maternal and Newborn Health Wolfson Building Liverpool School of Tropical Medicine Pembroke Place, Liverpool L3 5QA
Johnson and Johnson
Johnson & Johnson, J&J
Funding Body Type
private sector organisation
Funding Body Subtype
For-profit companies (industry)
United States of America
Results and Publications
Publication and dissemination plan
Results will be disseminated in Sierra Leone to the Ministry of Health and Sanitation and District Health Management teams; in peer reviewed journals and at academic conferences.
IPD sharing statement:
The datasets generated during and/or analysed during the current study are/will be available upon request from PI Charles Ameh Charles.Ameh@lstmed.ac.uk
Intention to publish date
Participant level data
Available on request
Basic results (scientific)