Department of Obstetrics & Gynaecology, Temerty Faculty of Medicine, University of Toronto, Suite 1200, 123 Edward Street, Toronto, ON, M5G 1E2, Canada.
Academic Model Providing Access to Healthcare (AMPATH), P.O Box 4606-30100, Eldoret, Kenya.
BMC Pregnancy Childbirth. 2022 Sep 1;22(1):674. doi: 10.1186/s12884-022-04869-8.
The majority of women living in rural Kenya access antenatal care (ANC) late in pregnancy, and approximately 20% have an unmet need for family planning (FP). This study aimed to determine whether training community health volunteers (CHVs) to deliver urine pregnancy testing (UPT), post-test counselling, and referral to care was an acceptable and feasible intervention to support timely initiation of ANC and uptake of FP.
We applied community-based participatory methods to design and implement the pilot intervention between July 2018 and May 2019. We conducted qualitative content analysis of 12 pre-intervention focus group discussions (FGDs) with women, men, and CHVs, and of 4 post-intervention FGDs with CHVs, each with 7-9 participants per FGD group. Using a pragmatic approach, we conducted inductive line-by-line coding to generate themes and subthemes describing factors that positively or negatively contributed to the intervention's acceptability and feasibility, in terms of participants' views and the intervention aims.
We found that CHV-delivered point of care UPT, post-test counselling, and referral to care was an acceptable and feasible intervention to increase uptake of ANC, FP, and other reproductive healthcare services. Factors that contributed to acceptability were: (1) CHV-delivery made UPT more accessible; (2) UPT and counselling supported women and men to build knowledge and make informed choices, although not necessarily for women with unwanted pregnancies interested in abortion; (3) CHVs were generally trusted to provide counselling, and alternative counselling providers were available according to participant preference. A factor that enhanced the feasibility of CHV delivering UPT and counselling was CHV's access to appropriate supplies (e.g. carrying bags). However, factors that detracted from the feasibility of women actually accessing referral services after UPT and counselling included (1) downstream barriers like cost of travel, and (2) some male community members' negative attitudes toward FP. Finally, improved financial, educational, and professional supports for CHVs would be needed to make the intervention acceptable and feasible in the long-term.
Training CHVs in rural western Kenya to deliver UPT, post-test counselling, and referral to care was acceptable and feasible to men, women, and CHVs in this context, and may promote early initiation of ANC and uptake of FP. Additional qualitative work is needed to explore implementation challenges, including issues related to unwanted pregnancies and abortion, the financial burden of volunteerism on CHVs, and educational and professional supports for CHVs.
肯尼亚农村地区大多数妇女在妊娠晚期接受产前护理（ANC），约 20%的妇女对计划生育（FP）有未满足的需求。本研究旨在确定培训社区卫生志愿者（CHV）进行尿液妊娠检测（UPT）、检测后咨询和转介护理是否是一种可以接受和可行的干预措施，以支持及时开始 ANC 和采用 FP。
我们应用基于社区的参与式方法设计并于 2018 年 7 月至 2019 年 5 月实施了该试点干预措施。我们对 12 名女性、男性和 CHV 参与者进行了预干预焦点小组讨论（FGD）的定性内容分析，并对 4 名 CHV 参与者进行了干预后 FGD，每组 FGD 有 7-9 名参与者。采用实用主义方法，我们进行了逐行归纳编码，以生成主题和子主题，描述参与者的观点和干预目标方面，对干预措施的可接受性和可行性产生积极或消极影响的因素。
我们发现，CHV 提供的即时护理 UPT、检测后咨询和转介护理是一种可以接受和可行的干预措施，可提高 ANC、FP 和其他生殖保健服务的利用率。可接受性的因素包括：（1）CHV 提供服务使 UPT 更便利；（2）UPT 和咨询支持妇女和男子增加知识并做出知情选择，尽管对于希望堕胎的意外怀孕妇女不一定如此；（3）CHV 普遍被信任提供咨询，根据参与者的偏好还可以选择其他咨询提供者。提高 CHV 提供 UPT 和咨询的可行性的因素包括 CHV 获得适当供应品（例如携带袋）的机会。但是，妇女在 UPT 和咨询后实际获得转介服务的可行性受到以下因素的影响：（1）下游障碍，如旅行费用；（2）一些社区男性成员对 FP 的负面态度。最后，需要为 CHV 提供更多的财务、教育和专业支持，以使其长期具有可接受性和可行性。
在这一背景下，培训肯尼亚西部农村地区的 CHV 进行 UPT、检测后咨询和转介护理，对于男性、女性和 CHV 来说是可以接受和可行的，并且可能促进 ANC 的早期启动和 FP 的采用。需要进行更多的定性研究来探索实施挑战，包括意外怀孕和堕胎相关问题、志愿服务对 CHV 的经济负担、以及对 CHV 的教育和专业支持。
