USAID Health Care Improvement Project, University Research Co., LLC, Bethesda, Maryland, USA.
BMC Pregnancy Childbirth. 2010 Nov 22;10:75. doi: 10.1186/1471-2393-10-75.
Antenatal care provides an important opportunity to improve maternal understanding of care during and after pregnancy. Yet, studies suggest that communication is often insufficient. This research examined the effect of a job aids-focused intervention on quality of counseling and maternal understanding of care for mothers and newborns.
Counseling job aids were developed to support provider communication to pregnant women. Fourteen health facilities were randomized to control or intervention, where providers were trained to use job aids and provided implementation support. Direct observation of antenatal counseling sessions and patient exit interviews were undertaken to assess quality of counseling and maternal knowledge. Providers were also interviewed regarding their perceptions of the tools. Data were collected before and after the job aids intervention and analyzed using a difference-in-differences analysis to quantify relative changes over time.
Mean percent of recommended messages provided to pregnant women significantly improved in the intervention arm as compared to the control arm in birth preparedness (difference-in-differences [ΔI-C] = +17.9, 95%CI: 6.7,29.1), danger sign recognition (ΔI-C = +26.0, 95%CI: 14.6,37.4), clean delivery (ΔI-C = +21.7, 95%CI: 10.9,32.6), and newborn care (ΔI-C = +26.2, 95%CI: 13.5,38.9). Significant gains were also observed in the mean percent of communication techniques applied (ΔI-C = +28.8, 95%CI: 22.5,35.2) and duration (minutes) of antenatal consultations (ΔI-C = +5.9, 95%CI: 3.0,8.8). No relative increase was found for messages relating to general prenatal care (ΔI-C = +8.2, 95%CI: -2.6,19.1). The proportion of pregnant women with correct knowledge also significantly improved for birth preparedness (ΔI-C = +23.6, 95%CI: 9.8,37.4), danger sign recognition (ΔI-C = +28.7, 95%CI: 14.2,43.2), and clean delivery (ΔI-C = +31.1, 95%CI: 19.4,42.9). There were no significant changes in maternal knowledge of general prenatal (ΔI-C = -6.4, 95%CI: -21.3,8.5) or newborn care (ΔI-C = +12.7, 95%CI: -6.1,31.5). Job aids were positively perceived by providers and pregnant women, although time constraints remained for health workers with other clinical responsibilities.
This study demonstrates that a job aids-focused intervention can be integrated into routine antenatal care with positive outcomes on provider communication and maternal knowledge. Efforts are needed to address time constraints and other communication barriers, including introduction of on-going quality assessment for long-term sustainability.
产前护理为改善产妇在妊娠期间和产后的护理理解提供了重要机会。然而，研究表明，沟通往往是不够的。本研究旨在探讨以工作辅助为重点的干预措施对产妇和新生儿护理咨询质量和产妇理解的影响。
制定了咨询工作辅助工具，以支持提供者与孕妇进行沟通。将 14 个卫生设施随机分为对照组和干预组，为提供者提供培训，以使用工作辅助工具，并提供实施支持。通过对产前咨询会议的直接观察和患者出口访谈，评估咨询质量和产妇知识。还对提供者进行了关于他们对工具看法的访谈。在工作辅助工具干预前后收集数据，并使用差异分析来量化随时间的相对变化。
与对照组相比，干预组中为孕妇提供的建议信息的比例明显提高，在分娩准备方面（差异-in-差异[ΔI-C] = +17.9，95%置信区间：6.7，29.1）、危险信号识别（ΔI-C = +26.0，95%置信区间：14.6，37.4）、清洁分娩（ΔI-C = +21.7，95%置信区间：10.9，32.6）和新生儿护理（ΔI-C = +26.2，95%置信区间：13.5，38.9）方面。沟通技巧的应用比例（ΔI-C = +28.8，95%置信区间：22.5，35.2）和产前咨询时间（分钟）（ΔI-C = +5.9，95%置信区间：3.0，8.8）也有显著增加。一般产前护理信息（ΔI-C = +8.2，95%置信区间：-2.6，19.1）的相对增加不明显。对于分娩准备（ΔI-C = +23.6，95%置信区间：9.8，37.4）、危险信号识别（ΔI-C = +28.7，95%置信区间：14.2，43.2）和清洁分娩（ΔI-C = +31.1，95%置信区间：19.4，42.9），孕妇的正确知识比例也显著提高。一般产前（ΔI-C = -6.4，95%置信区间：-21.3，8.5）或新生儿护理（ΔI-C = +12.7，95%置信区间：-6.1，31.5）的产妇知识没有显著变化。工作辅助工具得到了提供者和孕妇的积极认可，尽管卫生工作者仍面临其他临床职责的时间限制。
本研究表明，以工作辅助为重点的干预措施可以与常规产前护理相结合，并对提供者的沟通和产妇的知识产生积极影响。需要努力解决时间限制和其他沟通障碍，包括引入持续的质量评估以实现长期可持续性。
