Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA.
Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi.
BMC Health Serv Res. 2023 Oct 14;23(1):1098. doi: 10.1186/s12913-023-10036-2.
Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi.
We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2-4. In-depth interviews (n = 24), and incubator sessions (n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper.
All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period.
Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation.
在中低收入国家（LMICs），需要有应对高孕产妇和婴儿死亡率以及临床医生短缺的响应性和弹性策略。马拉维的孕产妇和婴儿死亡率在全球处于较高水平。团体保健是一种整合了这些策略的服务提供模式。尽管它主要在产前实施，但它在产后期间改善母婴健康结果的潜力尚未实现。本研究的目的是使用以人为中心的设计方法，与马拉维的主要利益相关者一起，调整和共同设计基于证据的团体产后护理模式原型。
我们完成了使用以人为中心设计指导框架的步骤：1）定义问题并组建团队；2）通过证据和灵感收集信息；3）综合；4）干预设计：指导原则和创意。使用定性方法完成步骤 2-4。与主要利益相关者进行了深入访谈（n=24）和孵化器会议（n=6），采用自由列表、堆积排序和排名。使用访谈的内容分析和孵化器会议的框架分析进行数据分析，以生成综合的团体产后和儿童保健模型原型。第五步在另一篇论文中详细介绍。
所有利益相关者都报告说希望在产后期间参与并提供团体护理。利益相关者合作共同创建了原型，其中包括健康促进主题和互动活动课程以及服务提供结构。健康促进主题的重点是卫生、母乳喂养、计划生育、营养和心理健康。推荐的时间表包括与儿童疫苗接种时间表相对应的 6 次课程，在 12 个月的产后期间。
在中低收入国家（LMICs），特别是马拉维，使用以人为中心的设计方法来调整基于证据的团体护理模式是可行且可接受的，主要利益相关者共同制定了原型课程和切实可行的诊所实施策略。
