PROMISES研究：一种混合方法，用于探索印度农村地区孕妇和训练有素的一线医护人员对唾液孕酮检测早产风险的可接受性。

The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India.

作者信息

Ashworth Danielle, Sharma Pankhuri, Silverio Sergio A, Khan Simi, Kathuria Nishtha, Garg Priyanka, Ghule Mohan, Shivkumar V B, Tayade Atul, Mehra Sunil, Shivkumar Poonam V, Tribe Rachel M

机构信息

Department of Women & Children's Health, King's College London, London, UK.

Research and Innovation Unit, Mamta Health Institute for Mother and Child, New Delhi, Delhi, India.

出版信息

BMJ Open. 2021 Jan 8;11(1):e040268. doi: 10.1136/bmjopen-2020-040268.

DOI:10.1136/bmjopen-2020-040268

PMID:33419904

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7798670/

Abstract

INTRODUCTION

India has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.

METHODS

A pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.

RESULTS

Before training, ASHAs' knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs' knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.

CONCLUSION

This study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

摘要

引言

印度新生儿总体死亡率为每1000例活产中有28例死亡，印度农村地区的死亡率更高。印度每年约有350万例妊娠受到早产影响，约占全球早产病例的四分之一。在“PROMISES研究”（旨在验证一种低成本唾液孕酮检测方法以早期检测早产风险）中，我们开展了一项关于唾液孕酮检测的混合方法解释性序列可行性子研究。

方法

使用麦克尼马尔检验分析了一份培训前和培训后的问卷，以评估经认证的社会健康活动家（ASHA）（n = 201）对早产和唾液孕酮采样的知识与经验。呈现了对400名孕妇进行横断面调查的描述性统计数据，其中评估了该检测方法对孕妇的可接受性。对10名ASHA和9名孕妇进行了结构化访谈，并使用主题框架分析进行分析，以探讨影响印度农村地区使用该检测方法的障碍和促进因素。

结果

培训前，ASHA对早产（包括风险因素、病因、产后支持和检测）的了解非常有限。培训计划后，ASHA对早产的了解有了显著改善。所有400名女性都表示唾液检测是可以接受的，大多数人认为该检测简单，但不快，也不比抽血更好。对于研究的定性方面，对ASHA和女性的访谈数据进行分析，我们的主题框架包括三个主要领域：干预措施的实施；影响网络和医疗保健的可及性。定性数据进行了分层，并呈现为障碍和促进因素。