Using the cascade model to improve antenatal screening for the hemoglobin disorders

Introduction: The inherited hemoglobin disorders constitute a major public health problem. Facilitators (experienced
hemoglobin counselors) were trained to deliver knowledge and skills to “frontline” practitioners to enable
them to support parents during antenatal screening via a cascade (train-the-trainer) model. Objectives of evaluation
were to explore the extent that the cascade model was perceived to be embedded in practice, identify enablers
and barriers to effective cascading, assess the feasibility of incorporating e-learning into the model, and obtain the
facilitators’ perceptions of the change process.
Methods: Focus groups and interviews were undertaken with 50 facilitators. Data were analyzed thematically.
Results: Cascading was influenced by contextual factors operating in the work environment, especially workload,
existing roles and responsibilities and adequate preparation. Facilitators’ confidence and perceptions of success
varied for individuals in the same workplace exposed to the same opportunities to receive and deliver training.
Cascading could by enhanced by carefully selecting potential facilitators, training needs assessment to identify the
knowledge and skills required by individuals and follow-up to offer ongoing support.
Discussion: Evaluation demonstrated the importance of contextual and individual factors to successful cascading
and the feasibility of combining it with e-learning. Future evaluations should consider the perspectives of all
stakeholders, namely managers, recipients of cascading and clients, and cost-effectiveness.