Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Using the Cascade Model to Improve Antenatal Screening for the Hemoglobin Disorders

Gould, Dinah PhD, RN; Papadopoulos, Irena PhD, MA, BA, DipNEd, DipN, RGN, RM, FHEA; Kelly, Daniel MSc, PhD, PGCE, RN

Journal of Continuing Education in the Health Professions: July 2012 - Volume 32 - Issue 3 - p 181–186
doi: 10.1002/chp.21143
Original Research

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.

Disclosures: This work was supported by the National Health Service Sickle and Thalassaemia Screening Antenatal Programme.

Dr Gould: Professor of Applied Health, City University London; Dr. Papadopoulos: Professor of Transcultural Health and Nursing, Middlesex University; Dr. Kelly: Royal College of Nursing Chair of Nursing Research, Cardiff University.

Correspondence: Professor Dinah Gould, City University London, St Bartholomew's Close, London EC1A 7QN; e-mail:

• Published online in Wiley Online Library (

Copyright © 2015 Wiley Periodicals, Inc., A Wiley Company
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website