Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
EPPI Centre, UCL Social Research Institute, University College London, London, UK.
BMC Public Health. 2023 Sep 23;23(1):1851. doi: 10.1186/s12889-023-16718-0.
Caesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use.
We re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success.
We found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components.
We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.
剖宫产率在全球范围内呈上升趋势，给母婴带来风险。为了降低剖宫产率，全球已针对孕妇实施了教育干预措施，但效果各异。为了优化这些干预措施的效益，了解哪些干预措施的组成部分会影响其成功至关重要。在本研究中，我们旨在确定可使专注于孕妇的干预措施成功实施以优化剖宫产率的基本干预措施组成部分。
我们重新分析了用于制定和更新世界卫生组织非临床干预措施以优化剖宫产率指南的现有系统评价。为了确定干预措施组成部分（例如，干预措施的实施方式和背景特征）的特定组合是否与成功实施相关，我们进行了定性比较分析（QCA）。我们将成功的干预措施定义为能够降低剖宫产率的干预措施。我们纳入了 36 篇论文，其中包括 17 项剖宫产干预研究和另外 19 项针对这些干预措施的姊妹研究（例如，二次分析，过程评估），以确定干预措施组成部分。我们在六个阶段进行了 QCA：1）确定条件并校准数据；2）构建真值表；3）检查真值表的质量；4）通过布尔最小化识别简约配置；5）检查解决方案的质量；6）解决方案的解释。我们使用现有的已发表定性证据综合来制定推动干预成功的潜在理论。
我们发现成功的干预措施是通过基于小组的干预措施提供社会或同伴支持、向妇女提供沟通材料、鼓励伴侣或家庭成员参与情感支持以及为妇女提供与卫生保健提供者互动的机会来实施的。不成功的干预措施的特点是至少缺少其中两个组成部分。
我们确定了四个关键的基本干预措施组成部分，这些组成部分可以使针对减少剖宫产率的孕妇的干预措施取得成功。这四个组成部分是 1）基于小组的交付方式，2）提供信息、教育和沟通材料，3）伴侣或家庭成员的参与，以及 4）妇女与卫生保健提供者互动的机会。旨在更好地让妇女为阴道分娩做好准备并降低剖宫产率的孕产妇保健服务和医院可以考虑纳入已确定的组成部分，以优化妇女和婴儿的健康和福祉效益。
