Butrick Elizabeth, Lundeen Tiffany, Phillips Beth S, Tengera Olive, Kambogo Antoinette, Uwera Yvonne Delphine Nsaba, Musabyimana Angele, Sayinzoga Felix, Nzeyimana David, Murindahabi Nathalie, Musange Sabine, Walker Dilys
Institute for Global Health Sciences, University of California San Francisco, San Franciso, CA, 94158, USA.
School of Nursing and Midwifery, National University of Rwanda, Kigali, Rwanda.
Gates Open Res. 2020 Jan 7;4:7. doi: 10.12688/gatesopenres.13090.1. eCollection 2020.
For a large trial of the effect of group antenatal care on perinatal outcomes in Rwanda, a Technical Working Group customized the group care model for implementation in this context. This process analysis aimed to understand the degree of fidelity with which the group antenatal care model was implemented during the trial period. We used two discreet questionnaires to collect data from two groups about the fidelity with which the group antenatal care model was implemented during this trial period. Group care facilitators recorded descriptive data about each visit and self-assessed process fidelity with a series of yes/no checkboxes. Master Trainers assessed process fidelity with an 11-item tool using a 5-point scale of 0 (worst) to 4 (best). We analyzed 2763 questionnaires completed by group care facilitators that documented discreet group visits among pregnant and postnatal women and 140 questionnaires completed by Master Trainers during supervision visits. Data recorded by both groups was available for 84 group care visits, and we compared these assessments by visit. Approximately 80% of all group visits were provided as intended, with respect to both objective measures (e.g. group size) and process fidelity. We did not find reliable correlations between conceptually-related items scored by Master Trainers and self-assessment data reported by group visit facilitators. We recommend both the continued participation of expert observers at new and existing group care sites and ongoing self-assessment by group care facilitators. Finally, we present two abbreviated assessment tools developed by a Rwanda-specific Technical Working Group that reviewed these research results.
在卢旺达进行的一项关于小组产前护理对围产期结局影响的大型试验中，一个技术工作组针对该背景定制了小组护理模式以进行实施。本过程分析旨在了解在试验期间小组产前护理模式的实施保真度。我们使用两份独立问卷从两组收集关于试验期间小组产前护理模式实施保真度的数据。小组护理促进者记录每次访视的描述性数据，并通过一系列是/否复选框对过程保真度进行自我评估。主培训师使用一个11项工具，采用从0（最差）到4（最佳）的5分制来评估过程保真度。我们分析了小组护理促进者填写的2763份问卷，这些问卷记录了孕妇和产后妇女之间的独立小组访视情况，以及主培训师在监督访视期间填写的140份问卷。两组记录的数据可用于84次小组护理访视，我们按访视对这些评估进行了比较。就客观指标（如小组规模）和过程保真度而言，所有小组访视中约80%按计划进行。我们未发现主培训师评分的概念相关项目与小组访视促进者报告的自我评估数据之间存在可靠的相关性。我们建议专家观察员继续参与新的和现有的小组护理场所，并建议小组护理促进者持续进行自我评估。最后，我们展示了卢旺达特定技术工作组开发的两个简化评估工具，该工作组审查了这些研究结果。
