马拉维诊所中整合的产后和儿童保健综合小组模式实施效果评估。
Evaluation of implementation outcomes of an integrated group postpartum and well-child care model at clinics in Malawi.
机构信息
Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA.
Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi.
出版信息
BMC Pregnancy Childbirth. 2023 Apr 12;23(1):240. doi: 10.1186/s12884-023-05545-1.
BACKGROUND
Persistently elevated rates of maternal and infant mortality and morbidities in Malawi indicate the need for increased quality of maternal and well-child care services. The first-year postpartum sets the stage for long-term health for the childbearing parent and infant. Integrated group postpartum and well-child care may improve maternal and infant health outcomes. The purpose of this study was to examine implementation outcomes for this model of care.
METHODS
We used mixed methods to examine implementation outcomes of integrated group postpartum and well-child care. We piloted sessions at three clinics in Blantyre District, Malawi. During each session we evaluated fidelity using a structured observation checklist. At the end of each session, we administered three surveys to health care workers and women participants, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Focus groups were conducted to gain greater understanding of people's experience with and evaluation of the model.
RESULTS
Forty-one women with their infants participated in group sessions. Nineteen health care workers across the three clinics co-facilitated group sessions, 9 midwives and 10 health surveillance assistants. Each of the 6 sessions was tested once at each clinic for a total of 18 pilot sessions. Both women and health care workers reported group postpartum and well-child care was highly acceptable, appropriate, and feasible across clinics. Fidelity to the group care model was high. During each session as part of structured observation the research team noted common health issues, the most common one among women was high blood pressure and among infants was flu-like symptoms. The most common services received within the group space was family planning and infant vaccinations. Women reported gaining knowledge from health promotion group discussions and activities. There were some challenges implementing group sessions.
CONCLUSION
We found that clinics in Blantyre District, Malawi were able to implement group postpartum and well-child care with fidelity and that it was highly acceptable, appropriate, and feasible to women and health care workers. Due to these promising results, we recommend future research examine the effectiveness of the model on maternal and child health outcomes.
背景
马拉维的孕产妇和婴儿死亡率及发病率持续居高不下，表明需要提高孕产妇和儿童保健服务的质量。产后第一年为母婴的长期健康奠定了基础。综合团体产后和儿童保健可以改善母婴健康结果。本研究旨在研究该护理模式的实施结果。
方法
我们使用混合方法研究了综合团体产后和儿童保健的实施结果。我们在布兰太尔区的三个诊所试行该课程。在每次会议期间，我们使用结构化观察清单评估保真度。在每次会议结束时，我们向卫生保健工作者和女性参与者管理三个调查，分别是干预措施接受度测量、干预措施适宜度测量和干预措施可行性测量。我们还进行了焦点小组讨论，以更深入地了解人们对该模型的体验和评估。
结果
共有 41 名妇女及其婴儿参加了团体课程。三个诊所的 19 名卫生保健工作者共同主持了团体课程，其中 9 名助产士和 10 名健康监测助理。每个诊所的 6 个课程各进行了一次测试，总共进行了 18 次试点课程。女性和卫生保健工作者均报告说，团体产后和儿童保健在各诊所均具有高度的可接受性、适宜性和可行性。对团体护理模式的保真度很高。在每次会议中，作为结构化观察的一部分，研究小组注意到常见的健康问题，妇女中最常见的是高血压，婴儿中最常见的是流感样症状。在团体空间中最常提供的服务是计划生育和婴儿疫苗接种。妇女报告说从健康促进团体讨论和活动中获得了知识。在实施团体课程方面存在一些挑战。
结论
我们发现，马拉维布兰太尔区的诊所能够以高度的保真度实施团体产后和儿童保健，并且对妇女和卫生保健工作者来说，它是高度可接受、适宜和可行的。由于这些有希望的结果，我们建议未来的研究检验该模式对母婴健康结果的有效性。
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