Department of Community Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1072, Blindern, 0316, Oslo, Norway.
Athena Institute for Research on Innovation and Communication in Health and Life sciences, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1105, 1081 HV, Amsterdam, Netherlands.
BMC Pregnancy Childbirth. 2017 Aug 31;17(1):270. doi: 10.1186/s12884-017-1448-8.
The recent WHO report on health promotion interventions for maternal and newborn health recommends birth preparedness and complications readiness interventions to increase the use of skilled care at birth and to increase timely use of facility care for obstetric and newborn complications. However, these interventions are complex and relate strongly to the context in which they are implemented. In this article we explore factors to consider when implementing these interventions.
This paper reports a secondary analysis of 64 studies on birth preparedness and complication readiness interventions identified through a systematic review and updated searches. Analysis was performed using the Supporting the Use of Research Evidence (SURE) framework to guide thematic analysis of barriers and facilitators for implementation.
Differences in definitions, indicators and evaluation strategies of birth preparedness and complication readiness interventions complicate the analysis. Although most studies focus on women as the main target group, multi-stakeholder participation with interventions occurring simultaneously at both community and facility level facilitated the impact on seeking skilled care at birth. Increase in formal education for women most likely contributed positively to results. Women and their families adhering to traditional beliefs, (human) resource scarcities, financial constraints of women and families and mismatches between offered and desired maternity care services were identified as key barriers for implementation.
Implementation of birth preparedness and complication readiness to improve the use of skilled care at birth can be facilitated by contextualizing interventions through multi-stakeholder involvement, targeting interventions at multiple levels of the health system and ensuring interventions and program messages are consistent with local knowledge and practices and the capabilities of the health system.
世界卫生组织最近关于母婴健康促进干预措施的报告建议开展生育准备和并发症准备干预措施，以增加熟练护理的使用率，并增加及时利用医疗机构治疗产科和新生儿并发症。然而，这些干预措施较为复杂，与实施干预措施的背景密切相关。本文探讨了实施这些干预措施时需要考虑的因素。
本文对通过系统评价和更新检索确定的 64 项生育准备和并发症准备干预措施研究进行了二次分析。分析使用支持研究证据使用（SURE）框架，对实施的障碍和促进因素进行主题分析。
生育准备和并发症准备干预措施的定义、指标和评估策略的差异使分析变得复杂。尽管大多数研究都将妇女作为主要目标群体，但多利益攸关方参与，同时在社区和医疗机构层面开展干预措施，有助于促进寻求熟练护理的分娩。女性接受正规教育的增加很可能对结果产生积极影响。妇女及其家庭坚持传统信仰、（人力）资源短缺、妇女和家庭的经济限制以及提供的和期望的产妇保健服务之间不匹配，被认为是实施的主要障碍。
通过多利益攸关方参与使生育准备和并发症准备干预措施本地化、针对卫生系统的多个层面开展干预措施以及确保干预措施和项目信息与当地知识和实践以及卫生系统的能力保持一致，可以促进提高熟练护理的使用率。
