Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, NY, United States of America.
Mailman School of Public Health, ICAP-Columbia University, New York, NY, United States of America.
PLoS One. 2021 Mar 24;16(3):e0248685. doi: 10.1371/journal.pone.0248685. eCollection 2021.
Uptake and retention in antenatal care (ANC) is critical for preventing adverse pregnancy outcomes for both mothers and infants.
We implemented a rapid quality improvement project to improve ANC retention at seven health facilities in Eswatini (October-December 2017). All pregnant women attending ANC visits were eligible to participate in anonymous tablet-based audio assisted computer self-interview (ACASI) surveys. The 24-question survey asked about women's interactions with health facility staff (HFS) (nurses, mentor mothers, receptionists and lab workers) with a three-level symbolic response options (agree/happy, neutral, disagree/sad). Women were asked to self-report HIV status. Survey results were shared with HFS at monthly quality improvement sessions. Chi-square tests were used to assess differences in responses between months one and three, and between HIV-positive and negative women. Routine medical record data were used to compare retention among pregnant women newly enrolled in ANC two periods, January-February 2017 ('pre-period') and January-February 2018 ('post-period') at two of the participating health facilities. Proportions of women retained at 3 and 6 months were compared using Cochran-Mantel-Haenszel and Wilcoxon tests.
A total of 1,483 surveys were completed by pregnant women attending ANC, of whom 508 (34.3%) self-reported to be HIV-positive. The only significant change in responses from month one to three was whether nurses listened with agreement increasing from 88.3% to 94.8% (p<0.01). Overall, WLHIV had significantly higher proportions of reported satisfaction with HFS interactions compared to HIV-negative women. A total of 680 pregnant women were included in the retention analysis; 454 (66.8%) HIV-negative and 226 (33.2%) WLHIV. In the pre- and post-periods, 59.4% and 64.6%, respectively, attended at least four ANC visits (p = 0.16). The proportion of women retained at six months increased from 60.9% in the pre-period to 72.7% in the post-period (p = 0.03). For HIV-negative women, pre- and post-period six-month retention significantly increased from 56.6% to 71.6% (p = 0.02); however, the increase in WLHIV retained at six months from 70.7% (pre-period) to 75.0% (post-period) was not statistically significant (p = 0.64).
The type of rapid quality improvement intervention we implemented may be useful in improving patient-provider relationships although whether it can improve retention remains unclear.
在产前护理（ANC）中的参与和保留对于预防母婴不良妊娠结局至关重要。
我们在斯威士兰的七家卫生机构实施了一项快速质量改进项目，以提高 ANC 的保留率（2017 年 10 月至 12 月）。所有参加 ANC 就诊的孕妇都有资格参加匿名基于平板电脑的音频辅助计算机自我访谈（ACASI）调查。这个 24 个问题的调查询问了妇女与卫生机构工作人员（护士、导师母亲、接待员和实验室工作人员）的互动情况（n = 1483），使用了三级符号反应选项（同意/高兴、中立、不同意/难过）。妇女被要求自我报告 HIV 状况。每月的质量改进会议上与卫生保健人员分享调查结果。卡方检验用于评估第一个月和第三个月之间以及 HIV 阳性和阴性妇女之间的反应差异。使用 Cochran-Mantel-Haenszel 和 Wilcoxon 检验比较在两个参与卫生机构的两个时期（2017 年 1 月至 2 月的“前时期”和 2018 年 1 月至 2 月的“后时期”）新参加 ANC 的孕妇的保留率。使用 Cochran-Mantel-Haenszel 和 Wilcoxon 检验比较 3 个月和 6 个月时的保留率。
共有 1483 名参加 ANC 的孕妇完成了调查，其中 508 名（34.3%）自我报告为 HIV 阳性。从第一个月到第三个月唯一有显著变化的是护士是否同意倾听，从 88.3%增加到 94.8%（p < 0.01）。总体而言，HIV 阳性妇女对与卫生保健人员互动的满意度报告比例明显高于 HIV 阴性妇女。共有 680 名孕妇纳入保留分析；454 名（66.8%）为 HIV 阴性，226 名（33.2%）为 WLHIV。在前和后期间，分别有 59.4%和 64.6%的孕妇至少参加了四次 ANC 就诊（p = 0.16）。在前期间，60.9%的妇女在 6 个月时保留，在后期间增加到 72.7%（p = 0.03）。对于 HIV 阴性妇女，前和后期间 6 个月的保留率从 56.6%显著增加到 71.6%（p = 0.02）；然而，在 6 个月时，WLHIV 的保留率从 70.7%（前期间）增加到 75.0%（后期间）并没有统计学意义（p = 0.64）。
我们实施的快速质量改进干预类型可能有助于改善医患关系，但能否提高保留率仍不清楚。
