Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
Department of ObGyn & Reproductive Sciences, UCSF/SFGH, San Francisco, CA, USA.
BMC Health Serv Res. 2020 Jun 18;20(1):559. doi: 10.1186/s12913-020-05430-z.
CenteringPregnancy (CP) is a group antenatal care (G-ANC) model that has proven beneficial for mothers and their newborns. We conducted a feasibility study beginning in 2016 as part of the Mexican effort to implement G-ANC locally. This study reports on fidelity to the essential elements of CP during its implementation in Mexico.
We collected prospective data using a standardized checklist at four primary-care centers that implemented our adapted G-ANC model. We performed a descriptive analysis of fidelity to 28 processes per G-ANC session (71 sessions made up of 10 groups and 129 women across 4 health centers). We calculated fidelity to each process as a proportion with 95% confidence intervals. We present overall results and stratified by health center and by facilitation team.
Overall fidelity to the G-ANC intervention was 82%, with variability by health center (78-88%). The elements with the highest fidelity were having space for activities such as checking vital signs, conversation in a circle, and medical check-ups (100% each) and the element with the lowest fidelity was using music to enhance privacy (27.3%). Fidelity was not significantly different by center.
Our study suggests good model fidelity during the implementation of G-ANC in Mexico. Our findings also contribute useful information about where to focus efforts in the future to maintain and improve G-ANC model fidelity.
核心孕期护理（CenteringPregnancy，CP）是一种群体产前护理（Group antenatal care，G-ANC）模式，已被证明对母亲及其新生儿有益。我们于 2016 年开始进行了一项可行性研究，作为墨西哥在当地实施 G-ANC 的努力的一部分。本研究报告了在墨西哥实施 CP 过程中对其基本要素的忠实程度。
我们在四家实施我们改编的 G-ANC 模式的基层医疗中心使用标准化清单收集前瞻性数据。我们对每个 G-ANC 会议的 28 个流程（由 10 个小组和 4 个医疗中心的 129 名女性组成的 71 个会议）的忠实度进行了描述性分析。我们将每个流程的忠实度计算为比例，并给出 95%置信区间。我们呈现了总体结果，并按医疗中心和促进团队进行了分层。
G-ANC 干预的总体忠实度为 82%，各医疗中心之间存在差异（78%-88%）。忠实度最高的元素是为活动（如检查生命体征、圆圈对话和医疗检查）提供空间（每个元素的忠实度为 100%），而忠实度最低的元素是使用音乐来增强隐私（27.3%）。中心之间的忠实度没有显著差异。
我们的研究表明，在墨西哥实施 G-ANC 期间，该模式具有较好的忠实度。我们的研究结果还提供了有关未来在何处集中精力以保持和提高 G-ANC 模式忠实度的有用信息。
