Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México.
University of California San Francisco. San Francisco General Hospital. Department of ObGyn & Reproductive Sciences. San Francisco, CA, USA.
Rev Saude Publica. 2020 Dec 14;54:140. doi: 10.11606/s1518-8787.2020054002175. eCollection 2020.
Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel's perspective.
We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication).
The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women's care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico's implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women.
Analyzing the GPC model's implementation in Mexico, from the health care personnel's perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training.
从医疗保健人员的角度确定在墨西哥实施团体产前保健模式（GPC）的障碍和促进因素。
我们于 2016 年 6 月至 2018 年 8 月在墨西哥两个州（莫雷洛斯州和伊达尔戈州）的卫生部的四个诊所进行了一项定性描述性研究。我们对 11 名医疗服务提供者进行了半结构化访谈，并检查了他们在实施 GPC 模式期间的看法和经验。我们从两个维度确定了采用该模式的障碍和促进因素：a）结构（空间、资源、卫生人员、患者量、社区）和 b）态度（动机、领导力、可接受性、解决问题、工作氛围和沟通）。
报告的最相关的结构层面障碍是卫生单位的物理空间可用性和卫生人员的工作负荷过大。我们发现，在孕妇护理方面，态度层面上难以建立较少的等级关系。态度层面的主要促进因素是提供者对该模式的可接受性。墨西哥实施背景的一个具体发现是对变革的抵制，即很难放弃现有的医患关系，转而与孕妇建立更平等的关系。
从医疗保健人员的角度分析 GPC 模式在墨西哥的实施情况，揭示了与其他背景下类似的障碍和促进因素。未来采用该模式的努力应重点关注已确定障碍的及时关注，特别是那些在态度维度上确定的障碍，这些障碍可以通过定期对医疗保健人员进行培训来加以修改。
