{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:59:55Z","timestamp":1790002795829,"version":"4.0.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Auxiliary nurse midwives (ANMs), a key cadre within India\u2019s National Health Programs (NHPs). However, gaps in training, particularly in practical application, limit their effectiveness. This study evaluates the impact of a comprehensive training package on the knowledge and skills of ANMs in Haryana, India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology:<\/jats:title>\n                    <jats:p>\n                      A quasi-experimental pre\u2013post design with no control group was conducted among 250 ANMs across 149 subcenters in Ambala and Panchkula districts, Haryana. A universal sampling method was used. Data collection included a self-administered questionnaire (SAQ) and an objective structured clinical examination (OSCE) checklist to assess knowledge and skills. A training intervention consisting of a modular training package and video demonstrations was implemented. Data analysis involved paired\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -tests and multivariate regression to evaluate changes in knowledge and skill scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Baseline data revealed significant knowledge gaps, particularly in mental health and tobacco control. Following the training, knowledge scores improved by 46% and skill scores by 37% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001). Notable skill improvements were observed in areas, such as pregnancy detection, blood pressure measurement, newborn resuscitation, and ORS preparation at home, with most ANMs shifting from the poor\/average categories to the good category (&gt;70% score). The greatest overall gains were seen in the National Tuberculosis Elimination Program (NTEP) and Reproductive Maternal and Child Health (RMNCH + A). Factors positively influencing knowledge scores included working alongside a second ANM and receiving the training intervention (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). However, a decline was noted in certain skills, such as tetanus toxoid (TT) administration, highlighting the need for targeted refresher training.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A structured, job-oriented training package significantly enhances ANMs\u2019 competencies. Integrating practical, hands-on training with existing theoretical models is essential for improving public health outcomes. Policymakers should prioritize periodic refresher training and comprehensive capacity-building strategies to optimize the impact of trainings on ANMs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijcm.ijcm_419_25","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T18:00:10Z","timestamp":1772647210000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Comprehensive Training Package of National Health Programs on Knowledge and Skills of Auxiliary Nurse Midwives in Haryana, India"],"prefix":"10.4103","author":[{"given":"Harleen","family":"Arora","sequence":"first","affiliation":[{"name":"Project Manager, Vancouver Community Primary Care Program, Vancouver Coastal Health, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonu","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravita","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay Laxmi","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Zoology, Panjab University, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Sharma","sequence":"additional","affiliation":[{"name":"Business Operations Manager, Renal Program, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"R1-20260921","first-page":"38","article-title":"The midwifery role of the auxiliary nurse midwife","author":"Mavalankar","year":"2010","journal-title":"Health Providers in India:On the Frontlines of Change"},{"key":"R2-20260921","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1478-4491-12-8","article-title":"Community health workers:To train or to restrain?A longitudinal survey to assess the impact of training community health workers in the Bolama Region, Guinea-Bissau","volume":"12","author":"Lopes","year":"2014","journal-title":"Hum Resour Health"},{"key":"R3-20260921","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1478-4491-4-27","article-title":"Training competent and effective primary health care workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia","volume":"4","author":"Keni","year":"2006","journal-title":"Hum Resour Health"},{"key":"R4-20260921","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s10734-004-6391-8","article-title":"The significance of practical training in linking theoretical studies with practice","volume":"51","author":"Katajavuori","year":"2006","journal-title":"High Educ"},{"key":"R5-20260921","doi-asserted-by":"crossref","first-page":"125","DOI":"10.4103\/2347-9019.129126","article-title":"Primary healthcare system in India:Evolution and challenges","volume":"1","author":"Pandve","year":"2013","journal-title":"Int J Health Syst Disaster Manage"},{"key":"R6-20260921","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12936-020-03534-9","article-title":"Significance of training, monitoring and assessment of malaria workers in achieving malaria elimination goal of Malaria Elimination Demonstration Project","volume":"20","author":"Rajvanshi","year":"2021","journal-title":"Malaria J"},{"key":"R7-20260921","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.jana.2008.06.001","article-title":"HIV knowledge improvement among nurses in India:Using a train-the-trainer program","volume":"19","author":"Nyamathi","year":"2008","journal-title":"J Assoc Nurses AIDS Care"},{"issue":"(Suppl 1)","key":"R8-20260921","doi-asserted-by":"crossref","first-page":"S67","DOI":"10.4103\/0970-0218.94712","article-title":"Integrating services for noncommunicable diseases prevention and control:Use of primary health care approach","volume":"36","author":"Narain","year":"2011","journal-title":"Indian J Community Med"},{"key":"R9-20260921","first-page":"100553","article-title":"Evaluation of simulation using objective structured clinical examination (OSCE) among undergraduate nursing students:A systematic review","volume":"18","author":"Kassabry","year":"2023","journal-title":"Int J Afr Nurs Sci"},{"key":"R10-20260921","doi-asserted-by":"crossref","first-page":"801762","DOI":"10.3389\/fpubh.2022.801762","article-title":"Community health workers. 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