“Now we are each other’s keepers”: A qualitative study assessing acceptability, experience and perceived influence of a midwife-led peer support club on provider well-being and resilience in Ghana and Mali

Despite recognition that midwives and nurses work in stressful, under-resourced environments that are affected by power dynamics; less is known about ways to support provider emotional well-being, a critical element in strengthening health systems. This study describes the acceptability of a pilot peer-support club that uses a set of cards to prompt conversation and offer emotional support, Club Courage/ConvoCare Club (CC). This qualitative study draws on 52 in-depth interviews with midwives/nurses providing maternal newborn healthcare services and participating in CC in, Mali (n=24) and Ghana (n=29). Interviews were audio-recorded, transcribed, translated, and analyzed by a mixed coding approach and memo-writing to develop results themes. Participants across age groups and cadres described CC as acceptable with respect to engaging in meetings, the consequences of CC, and factors affecting their participation. With meaningful, fun club processes and inclusive sub-group dynamics, midwives reported that their participation in CC led to increased abilities to recognize and coping mechanisms to stress, improved quality of personal and professional relationships, with enhanced clinical collaboration and provision of care. Despite logistical challenges and initial hesitance, the safe environment offered by CC as well as its informal and flexible nature motivated midwives/nurses to sustain the peer-support club. Acceptability of CC among midwives/nurses in Ghana and Mali demonstrates its adaptability and integrability within health systems, and community settings as a social club among peers to support emotional well-being and promote health worker resilience. Further investigation of CC, including embedding it into respectful care and health systems strengthening efforts, is recommended. • Club Courage/ConvoCare Club (CC) is a peer-support club centered around healthcare providers. • CC created space to reduce stress and improve emotional well-being, and relationship quality. • CC improved communication between providers and patients and enhanced service provision. • Facilities can integrate CC into routine health systems strengthening practices.