Exploring barriers and enablers of compassionate and respectful care implementation in pre-service education in Ethiopia

Abstract

Background: The health sector mainly demands a better result of health outcomes and impacts by ensuring integrated compassionate and respectful care into pre-service education that dramatically changes health workforce pride, ethics, compassion, and person-centered care. It brings high-quality healthcare systems. It is critical to building sustainable, equitable, and healthy teaching environments. Therefore, this study aimed at exploring the implementation of compassionate and respectful care in pre-service education in Ethiopia.

Methods: An implementation research with qualitative approach was conducted in April 2021. We interviewed 20 participants (n = 18 men and n = 2 women) and observed 18 curricula. Purposively, 8 institutions found in the two Regional States and one City Administration of the Federal Democratic Republic of Ethiopia were selected. We included 4 Higher Education Institutes, 2 Health Science colleges, the Ministry of Science and Higher Education, and the Ministry of Health. Data were collected through key informant in-depth interview, and observational checklist. Data were transcribed, translated from Amharic into English language, and coded using Open Code V.4.02 software. Thematic framework analysis was used for analysis. The codebook was developed and all the data were coded and under five main themes and two sub-themes.

Results: We identified relevant themes that emerged from interviewed participants. Accordingly, five main themes and two sub-themes were emerged. These were the importance of compassionate and respectful care, integration of compassionate and respectful care, barriers of CRC (internal and external barriers), enablers for compassionate and respectful care and strategies to tackle barriers. Compassionate and respectful care in pre-service education was enhanced the students' ability to engage in reflective practice, deal with clinical challenges, evaluation, and gained confidence. Internal and external compassionate and respectful care barriers in higher education was identified in the participants' in-depth interview at department level, school level, college level, and ministerial level to foster compassionate and respectful care delivery in pre-service education.

Conclusions and recommendations: The implementation of compassionate and respectful care which was poorly integrated in pre-service education in Ethiopia needs strong establishment for further incorporation. It is important to include it in education and a 360‐degree evaluation of student's module, patient awareness about compassionate and respectful care, and high commitment of stakeholders engagement to avail of compassionate and respectful care in pre-service curricula. The sustainability of compassionate and respectful care in pre-service education should be maintained through collaboration work with Ministry of Sciences and Higher Education, Ministry of Health and Higher Education Institutions to integrate and implement in pre-service education curricula of all health science education and improve the health workforce skills through in-service training.