Leiden University Medical Center, Leiden, the Netherlands.
Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname.
BMC Pregnancy Childbirth. 2023 Aug 18;23(1):592. doi: 10.1186/s12884-023-05904-y.
Suriname is a uppermiddle-income country with a relatively high prevalence of preventable pregnancy complications. Access to and usage of high-quality maternity care services are lacking. The implementation of group care (GC) may yield maternal and child health improvements. However, before introducing a complex intervention it is pivotal to develop an understanding of the local context to inform the implementation process.
A context analysis was conducted to identify local needs toward maternity and postnatal care services, and to assess contextual factor relevant to implementability of GC. During a Rapid Qualitative Inquiry, 63 online and face-to-face semi-structured interviews were held with parents, community members, on-and off-site healthcare professionals, policy makers, and one focus group with parents was conducted. Audio recordings were transcribed in verbatim and analysed using thematic analysis and Framework Method. The Consolidated Framework for Implementation Research served as a base for the coding tree, which was complemented with inductively derived codes.
Ten themes related to implementability, one theme related to sustainability, and seven themes related to reaching and participation of the target population in GC were identified. Factors related to health care professionals (e.g., workload, compatibility, ownership, role clarity), to GC, to recipients and to planning impact the implementability of GC, while sustainability is in particular hampered by sparse financial and human resources. Reach affects both implementability and sustainability. Yet, outer setting and attitudinal barriers of health professionals will likely affect reach.
Multi-layered contextual factors impact not only implementability and sustainability of GC, but also reach of parents. We advise future researchers and implementors of GC to investigate not only determinants for implementability and sustainability, but also those factors that may hamper, or facilitate up-take. Practical, attitudinal and cultural barriers to GC participation need to be examined. Themes identified in this study will inspire the development of adaptations and implementation strategies at a later stage.
苏里南是一个中上收入国家，其可预防的妊娠并发症发生率相对较高。人们获取和使用高质量的孕产妇保健服务的机会有限。实施小组护理（GC）可能会改善母婴健康。然而，在引入复杂的干预措施之前，了解当地情况对于为实施过程提供信息至关重要。
进行了一项背景分析，以确定当地对孕产妇和产后护理服务的需求，并评估与实施 GC 相关的实施能力的相关背景因素。在快速定性探究中，与父母、社区成员、现场和场外医疗保健专业人员、政策制定者进行了 63 次在线和面对面的半结构化访谈，并进行了一次父母焦点小组讨论。音频记录被逐字转录，并使用主题分析和框架方法进行分析。实施研究综合框架作为编码树的基础，该编码树补充了归纳得出的代码。
确定了 10 个与实施能力相关的主题、1 个与可持续性相关的主题以及 7 个与 GC 目标人群的参与和参与相关的主题。与医疗保健专业人员相关的因素（例如，工作量、兼容性、所有权、角色明确性）、与 GC 相关的因素、与接受者相关的因素以及与规划相关的因素都会影响 GC 的实施能力，而可持续性尤其受到稀缺的财政和人力资源的阻碍。覆盖范围会影响实施能力和可持续性。然而，卫生专业人员的外部环境和态度障碍可能会影响覆盖面。
多层背景因素不仅会影响 GC 的实施能力和可持续性，还会影响父母的覆盖面。我们建议未来的 GC 研究人员和实施者不仅要调查实施能力和可持续性的决定因素，还要调查那些可能阻碍或促进采用的因素。需要检查参与 GC 的实际、态度和文化障碍。本研究确定的主题将为以后阶段的调整和实施策略的制定提供灵感。
