Wagijo Mary-Ann R, Crone Mathilde R, van Zwicht Birgit S, van Lith Jan M M, Schindler Rising Sharon, Rijnders Marlies E B
Department of Public Health and Primary Care, Leiden, The Netherlands.
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Birth. 2022 Jun;49(2):329-340. doi: 10.1111/birt.12610. Epub 2022 Jan 28.
CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved pregnancy outcomes. However, motivating women to participate in CP can be difficult. As such, we explored the characteristics associated with CP uptake and attendance and then investigated whether participation differs between health care facilities. In addition, we examined the reasons why women may decline participation and the reasons for higher or lower attendance rates.
Data from a stepped-wedge cluster randomized controlled trial were used. Univariate and multivariate logistic regression models were used to determine associations among women's health behavior, sociodemographic and psychosocial characteristics, health care facilities, and participation and attendance in CP.
A total of 2562 women were included in the study, and the average participation rate was 31.6% per health care facility (range of 10%-53%). Nulliparous women, women <26 years old or >30 years old, and women reporting average or high levels of stress were more likely to participate in CP. Participation was less likely for women who had stopped smoking before prenatal intake, or who scored below average on lifestyle/pregnancy knowledge. For those participating in CP, 87% attended seven or more out of the 10 sessions, and no significant differences were found in women's characteristics when compared for higher or lower attendance rates. After the initial uptake, group attendance rates remained high.
A more comprehensive understanding of the variation in participation rate between health care facilities is required, in order to develop effective strategies to improve the recruitment of women, especially those with less knowledge and understanding of health issues and smoking habits.
“以孕妇为中心的孕期保健模式（CenteringPregnancy，CP）”于2012年在荷兰实施，旨在改善围产期健康；CP与改善妊娠结局相关。然而，促使女性参与CP可能具有挑战性。因此，我们探究了与CP参与率和出席率相关的特征，随后调查了不同医疗机构之间的参与情况是否存在差异。此外，我们还研究了女性拒绝参与的原因以及出席率较高或较低的原因。
使用了一项阶梯式楔形整群随机对照试验的数据。单因素和多因素逻辑回归模型用于确定女性的健康行为、社会人口学和心理社会特征、医疗机构与CP参与率和出席率之间的关联。
共有2562名女性纳入研究，每个医疗机构的平均参与率为31.6%（范围为10% - 53%）。未生育的女性、年龄小于26岁或大于30岁的女性以及报告压力水平为中等或较高的女性更有可能参与CP。在产前检查前戒烟的女性或生活方式/妊娠知识得分低于平均水平的女性参与CP的可能性较小。对于参与CP的女性，87%在10次课程中出席了7次或更多次，在比较出席率较高或较低的女性特征时未发现显著差异。在最初的参与之后，小组出席率仍然很高。
需要更全面地了解不同医疗机构之间参与率的差异，以便制定有效的策略来提高女性的招募率，尤其是那些对健康问题和吸烟习惯了解较少的女性。
