Preparing for implementation: Identifying contextual factors influencing internal quality assurance in midwifery education in Bangladesh.

BACKGROUND: High-quality maternal and newborn care relies on competent midwives, placing high demands on midwifery education. Continuous internal quality assurance is essential for meeting accreditation standards yet remains understudied, particularly in low- and middle-resource settings. AIM: The aim of this study was to identify contextual factors preparing for implementation of an internal quality assurance process in midwifery education in Bangladesh. METHODS: A qualitative inductive design, guided by process evaluation principles for complex interventions. Data was collected through focus group discussions (n = 10) with a total of 76 midwifery faculty across Bangladesh. Transcribed discussions were analysed using qualitative content analysis. FINDINGS: This study identified several contextual factors that influence how systematic internal quality assurance is implemented in midwifery education: governance and national leadership culture, institutional constraints and navigating individual engagement. CONCLUSION: Internal quality assurance in midwifery education requires more than technical tools. Trust-based leadership, psychological safety and integration into institutional routines and national policies are essential. Aligning national quality goals with local capacity and faculty values supports sustainable quality improvement in low- and middle-income settings.