UCL Centre for International Health and Development, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
BMC Int Health Hum Rights. 2010 Oct 22;10:25. doi: 10.1186/1472-698X-10-25.
Few large and rigorous evaluations of participatory interventions systematically describe their context and implementation, or attempt to explain the mechanisms behind their impact. This study reports process evaluation data from the Ekjut cluster-randomised controlled trial of a participatory learning and action cycle with women's groups to improve maternal and newborn health outcomes in Jharkhand and Orissa, eastern India (2005-2008). The study demonstrated a 45% reduction in neonatal mortality in the last two years of the intervention, largely driven by improvements in safe practices for home deliveries.
A participatory learning and action cycle with 244 women's groups was implemented in 18 intervention clusters covering an estimated population of 114 141. We describe the context, content, and implementation of this intervention, identify potential mechanisms behind its impact, and report challenges experienced in the field. Methods included a review of intervention documents, qualitative structured discussions with group members and non-group members, meeting observations, as well as descriptive statistical analysis of data on meeting attendance, activities, and characteristics of group attendees.
Six broad, interrelated factors influenced the intervention's impact: (1) acceptability; (2) a participatory approach to the development of knowledge, skills and 'critical consciousness'; (3) community involvement beyond the groups; (4) a focus on marginalized communities; (5) the active recruitment of newly pregnant women into groups; (6) high population coverage. We hypothesize that these factors were responsible for the increase in safe delivery and care practices that led to the reduction in neonatal mortality demonstrated in the Ekjut trial.
Participatory interventions with community groups can influence maternal and child health outcomes if key intervention characteristics are preserved and tailored to local contexts. Scaling-up such interventions requires (1) a detailed understanding of the way in which context affects the acceptability and delivery of the intervention; (2) planned but flexible replication of key content and implementation features; (3) strong support for participatory methods from implementing agencies.
很少有大型且严格的参与式干预评估系统地描述其背景和实施情况，或试图解释其影响背后的机制。本研究报告了参与式学习和行动周期与妇女团体合作，以改善印度东部恰尔肯德邦和奥里萨邦产妇和新生儿健康结果的 Ekjut 集群随机对照试验的过程评估数据（2005-2008 年）。该研究表明，干预的最后两年新生儿死亡率降低了 45%，这主要是由于在家分娩的安全做法得到了改善。
在覆盖估计人口为 114141 人的 18 个干预集群中实施了一个由 244 个妇女团体组成的参与式学习和行动周期。我们描述了该干预的背景、内容和实施情况，确定了其影响背后的潜在机制，并报告了实地遇到的挑战。方法包括对干预文件的审查、与团体成员和非团体成员进行定性结构讨论、会议观察，以及对会议出席、活动和团体参与者特征的数据进行描述性统计分析。
有六个广泛的、相互关联的因素影响了干预的效果：（1）可接受性；（2）以参与的方式发展知识、技能和“批判意识”；（3）超越团体的社区参与；（4）关注边缘化社区；（5）积极招募新怀孕的妇女加入团体；（6）高人口覆盖率。我们假设，这些因素是导致 Ekjut 试验中展示的安全分娩和护理做法增加的原因，从而导致新生儿死亡率降低。
如果保留并针对当地情况调整参与式社区团体干预的关键干预特征，那么这种干预可以影响母婴健康结果。扩大此类干预措施需要（1）深入了解背景影响干预的可接受性和实施方式的方式；（2）有计划但灵活地复制关键内容和实施特征；（3）实施机构对参与式方法的大力支持。
