Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
Indian Institute of Public Health Gandhinagar (IIPH-G), Gandhinagar, Gujarat, India.
BMJ Open. 2022 Feb 21;12(2):e054318. doi: 10.1136/bmjopen-2021-054318.
Recently, a novel community health programme-the integrated microfinance and health literacy (IMFHL) programme was implemented through microfinance-based women's only self-help groups (SHGs) in India to promote birth preparedness and complication readiness (BPCR) to improve maternal health. The study evaluated the impact of the IMFHL programme on BPCR practice by women in one of India's poorest states-Uttar Pradesh-adjusting for the community, household and individual variables. The paper also examined for any diffusion of knowledge of BPCR from SHG members receiving the health literacy intervention to non-members in programme villages.
Quasi-experimental study using cross-sectional survey data.
Secondary survey data from the IMFHL programme were used.
Survey data were collected from 17 244 women in households with SHG member and non-member households in rural India.
Multivariable logistic regression was used to estimate main and adjusted IMFHL programme effects on maternal BPCR practice in their last pregnancy.
Membership in SHGs alone is positively associated with BPCR practice, with 17% higher odds (OR=1.17, 95% CI 1.07 to 1.29, p<0.01) of these women practising BPCR compared with women in villages without the programmes. Furthermore, the odds of practising complete BPCR increase to almost 50% (OR=1.48, 95% CI 1.35 to 1.63, p<0.01) when a maternal health literacy component is added to the SHGs. A diffusion effect was found for BPCR practice from SHG members to non-members when the health literacy component was integrated into the SHG model.
The results suggest that SHG membership exerts a positive impact on planned health behaviour and a diffusion effect of BPCR practice from members to non-members when SHGs are enriched with a health literacy component. The study provides evidence to guide the implementation of community health programmes seeking to promote BPCR practise in low resource settings.
最近，印度实施了一项新的社区卫生计划——基于小额信贷的妇女自助团体（SHG）的综合小额信贷和健康素养（IMFHL）计划，以促进生育准备和并发症准备（BPCR），改善产妇健康。本研究通过调整社区、家庭和个体变量，评估了该 IMFHL 计划对印度最贫困邦之一北方邦妇女实施 BPCR 的影响。本文还研究了从接受健康素养干预的 SHG 成员到项目村庄非成员的 BPCR 知识传播情况。
使用横断面调查数据的准实验研究。
使用 IMFHL 计划的二次调查数据。
调查数据来自印度农村的 SHG 成员家庭和非成员家庭的 17244 名妇女。
多变量逻辑回归用于估计 SHG 成员身份对其上次妊娠中产妇 BPCR 实践的主要和调整后的 IMFHL 计划效果。
仅 SHG 成员身份与 BPCR 实践呈正相关，与没有该计划的村庄的妇女相比，这些妇女实践 BPCR 的可能性高 17%（优势比[OR]=1.17，95%置信区间[CI]1.07 至 1.29，p<0.01）。此外，当将孕产妇健康素养部分纳入 SHG 时，完全实施 BPCR 的可能性增加到近 50%（OR=1.48，95%CI 1.35 至 1.63，p<0.01）。当 SHG 模型中纳入健康素养部分时，发现 BPCR 实践从 SHG 成员向非成员传播。
结果表明，当 SHG 成员人数增加且 SHG 增加健康素养部分时，SHG 成员身份对计划中的健康行为产生积极影响，并且从成员到非成员的 BPCR 实践传播效应。本研究为在资源匮乏环境中促进 BPCR 实践的社区卫生计划提供了实施依据。
