Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
BMJ Open. 2023 Jan 25;13(1):e066000. doi: 10.1136/bmjopen-2022-066000.
OBJECTIVES: Comparing language-supported group antenatal care (gANC) and standard antenatal care (sANC) for Somali-born women in Sweden, measuring overall ratings of care and emotional well-being, and testing the feasibility of the outcome measures. DESIGN: A quasi-experimental trial with one intervention and one historical control group, nested in an intervention development and feasibility study. SETTING: Midwifery-led antenatal care clinic in a mid-sized Swedish town. PARTICIPANTS: Pregnant Somali-born women (<25 gestational weeks); 64 women in gANC and 81 in sANC. INTERVENTION: Language-supported gANC (2017-2019). Participants were offered seven 60-minute group sessions with other Somali-born women led by one to two midwives, in addition to 15-30 min individual appointments with their designated midwife. OUTCOMES: Primary outcomes were women's overall ratings of antenatal care and emotional well-being (Edinburgh Postnatal Depression Scale (EPDS)) in gestational week ≥35 and 2 months post partum. Secondary outcomes were specific care experiences, information received, social support, knowledge of pregnancy danger signs and obstetric outcomes. RESULTS: Recruitment and retention of participants were challenging. Of eligible women, 39.3% (n=106) declined to participate. No relevant differences regarding overall ratings of antenatal care between the groups were detected (late pregnancy OR 1.42, 95% CI 0.50 to 4.16 and 6-8 weeks post partum OR 2.71, 95% CI 0.88 to 9.41). The reduction in mean EPDS score was greater in the intervention group when adjusting for differences at baseline (mean difference -1.89; 95% CI -3.73 to -0.07). Women in gANC were happier with received pregnancy and birth information, for example, caesarean section where 94.9% (n=37) believed the information was sufficient compared with 17.5% (n=7) in standard care (p<0.001) in late pregnancy. CONCLUSIONS: This evaluation suggests potential for language-supported gANC to improve knowledge acquisition among pregnant Somali-born women with residence in Sweden ˂10 years. An adequately powered randomised trial is needed to evaluate the effectiveness of the intervention. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03879200).
目的：比较瑞典出生的索马里孕妇接受语言支持的群体产前护理（gANC）和标准产前护理（sANC），测量护理和情绪健康的总体评分，并测试结局测量的可行性。 设计：一项具有一个干预组和一个历史对照组的准实验性试验，嵌套在干预措施的开发和可行性研究中。 地点：瑞典一个中等规模城镇的助产士主导的产前护理诊所。 参与者：孕妇，索马里出生；gANC 组 64 名，sANC 组 81 名，妊娠 <25 周。 干预措施：语言支持的 gANC（2017-2019 年）。参与者被提供七次由一名或两名助产士带领的，时长 60 分钟的群体会议，与其他索马里出生的女性一起，另外还与指定的助产士进行 15-30 分钟的个体预约。 结局：主要结局是孕妇妊娠 35 周及产后 2 个月时对产前护理的总体评价和情绪健康（爱丁堡产后抑郁量表（EPDS））。次要结局是特定的护理体验、获得的信息、社会支持、对妊娠危险信号和产科结局的了解。 结果：参与者的招募和保留具有挑战性。符合条件的女性中，有 39.3%（n=106）拒绝参与。两组之间对产前护理的总体评价没有发现相关差异（妊娠晚期 OR 1.42，95%CI 0.50 至 4.16 和产后 6-8 周 OR 2.71，95%CI 0.88 至 9.41）。在调整基线差异后，干预组的 EPDS 评分平均下降更大（平均差异-1.89；95%CI-3.73 至-0.07）。在接受妊娠和分娩信息方面，接受 gANC 的女性更快乐，例如，94.9%（n=37）的人认为剖腹产的信息足够充分，而标准护理（n=7）的人只有 17.5%（p<0.001）。 结论：这项评估表明，对于在瑞典居住时间 <10 年的索马里孕妇，语言支持的群体产前护理有改善知识获取的潜力。需要一项足够有力的随机试验来评估干预措施的有效性。 试验注册：ClinicalTrials.gov 注册（NCT03879200）。
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