School of Public Health, College of Medicine and Health Sciences, University of Rwanda, P.O Box 3286, Kigali, Rwanda.
Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd floor, San Francisco, CA, 94158, USA.
Reprod Health. 2019 Jun 27;16(1):90. doi: 10.1186/s12978-019-0750-5.
The Preterm Birth Initiative-Rwanda is conducting a 36-cluster randomized controlled trial of group antenatal and postnatal care. In the context of this trial, we collected qualitative data before and after implementation. The purpose was two-fold. First, to inform the design of the group care program before implementation and second, to document women's experiences of group care at the mid-point of the trial to make ongoing programmatic adjustments and improvements.
We completed 8 focus group discussions among women of reproductive age before group care implementation and 6 focus group discussions among women who participated in group antenatal care and/or postnatal care at 18 health centers that introduced the model, approximately 9 months after implementation.
Before implementation, focus group participants reported both enthusiasm for the potential for support and insight from a group of peers and concern about the risk of sharing private information with peers who may judge, mock, or gossip. After implementation, group care participants reported benefits including increased knowledge, peer support, and more satisfying relationships with providers. When asked about barriers to group care participation, none of them cited concern about privacy but instead cited lack of financial resources, lack of cooperation from a male partner, and long distances to the health center. Finally, women stated that the group care experience would be improved if all participants and providers arrived on time and remained focused on the group care visit throughout.
These results are consistent with other published reports of women's perceptions of group antenatal care, especially increased pregnancy- and parenting-related knowledge, peer support, and improved relationships with health care providers. Some results were unexpected, especially the consequences of staff allocation patterns that resulted in providers arriving late for group visits or having to leave during group visits to attend to other facility services, which diminished women's experiences of care.
Group antenatal and postnatal care provide compelling benefits to women and families. If the model requires the addition of human resources at the health center, intensive reminder communications, and large-scale community outreach to benefit the largest number of pregnant and postnatal mothers, those additional resources required must be factored into any future decision to scale a group care model.
This trial is registered at clinicaltrials.gov as NCT03154177 .
卢旺达早产倡议正在进行一项 36 个集群的随机对照试验，以评估小组产前和产后护理。在该试验的背景下，我们在实施前后收集了定性数据。目的有两个。首先，在实施之前为小组护理方案的设计提供信息，其次，记录女性在试验中期接受小组护理的经验，以便进行持续的方案调整和改进。
在实施小组护理之前，我们完成了 8 组针对育龄妇女的焦点小组讨论，在实施后约 9 个月，在引入该模式的 18 个卫生中心，我们完成了 6 组参加小组产前护理和/或产后护理的妇女的焦点小组讨论。
在实施之前，焦点小组参与者报告说，他们既对从一群同龄人那里获得支持和洞察力感到兴奋，也对与可能评判、嘲笑或八卦的同龄人分享私人信息的风险感到担忧。实施后，小组护理参与者报告说有很多好处，包括增加知识、同伴支持，以及与提供者建立更满意的关系。当被问及参加小组护理的障碍时，她们都没有提到对隐私的担忧，而是提到缺乏经济资源、缺乏男性伴侣的合作以及到卫生中心的路途遥远。最后，妇女们表示，如果所有参与者和提供者都按时到达，并在整个小组护理访问期间保持专注，那么小组护理体验将会得到改善。
这些结果与其他已发表的关于妇女对小组产前护理的看法的报告一致，特别是在与怀孕和育儿相关的知识、同伴支持以及与医疗保健提供者的关系方面有所改善。一些结果出乎意料，特别是工作人员分配模式的后果导致提供者迟到参加小组访问或在小组访问期间不得不离开去处理其他设施服务，这降低了妇女的护理体验。
小组产前和产后护理为妇女和家庭提供了令人信服的好处。如果该模式需要在卫生中心增加人力资源，需要强化提醒沟通，并进行大规模的社区外展活动，以使大多数孕妇和产后母亲受益，那么在决定扩大小组护理模式时，必须考虑到这些额外的资源需求。
本试验在 clinicaltrials.gov 注册为 NCT03154177 。
