开发和评估一种文化适应的数字平台集成多方面干预措施，以促进孕产妇医疗保健服务的利用：一项单臂试点研究。

Development and evaluation of a culturally adapted digital-platform integrated multifaceted intervention to promote the utilization of maternal healthcare services: a single-arm pilot study.

机构信息

Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China.

Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Int J Equity Health. 2023 Oct 17;22(1):217. doi: 10.1186/s12939-023-02033-y.

DOI:10.1186/s12939-023-02033-y

PMID:37848902

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10583400/

Abstract

BACKGROUND

The utilization of hospital delivery and antenatal care (ANC) is essential for improving maternal and newborn outcomes. However, social and cultural barriers in underdeveloped rural areas hindered maternal care utilization. This study aims to design and evaluate the effectiveness of a culturally adapted digital-platform intervention to promote maternal care utilization among women in ethnic minority communities in China.

METHODS

From January 1st, 2020, to December 31st, 2021, all pregnant women in Mianshan town, Liangshan Autonomous Prefecture, were invited to participate in the intervention. The multifaceted intervention included participatory and cultural-tailored health education on a popular social media platform, transportation subsidies, and capacity building and economic incentives for healthcare providers. The effectiveness of the intervention was evaluated by comparing two groups: mothers who gave live birth before the intervention (January 1st to December 31st, 2019) and mothers whose entire pregnancy period was covered by the intervention. The primary outcomes were the rate of hospital delivery and ANC utilization. Data on pregnant women were retrospectively collected through telephone surveys and the maternal and newborn's health monitoring system.

RESULTS

A total of 237 intervention sample and 138 pre-intervention sample were included. The intervention group demonstrated significantly higher rates of hospital delivery (97.5% vs. 87.7%, p < 0.001), timely initiation of ANC (73.0% vs. 62.3%, p = 0.031), and timely completion of five-time ANC visits (37.1% vs.4.3%, p < 0.001) compared to the pre-intervention group. The intervention group was more likely to utilize hospital delivery (OR = 9.26, 95%CI [2.83-30.24], p < 0.001) and ANC, including timely initiation of ANC (OR = 2.18, 95%CI [1.31-3.62], p = 0.003), completion of five ANC visits (OR = 1.72, 95%CI [1.05-2.83], p = 0.032), and timely completion of five ANC visits (OR = 15.12, 95%CI [6.24-36.64], p < 0.001).

CONCLUSIONS

The culturally adapted digital-platform integrated multifaceted intervention effectively promoted the utilization of hospital delivery, timely initiation of ANC, and completion of ANC visits in the Yi ethnic community in China. This study provides valuable insights for future interventions targeting maternal healthcare services in underdeveloped ethnic minority communities worldwide.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2300073219. Registered 4 July 2023 - Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=199202 .

摘要

背景

利用医院分娩和产前护理（ANC）对于改善母婴结局至关重要。然而，欠发达农村地区的社会和文化障碍阻碍了孕产妇护理的利用。本研究旨在设计和评估一种文化适应的数字平台干预措施，以促进中国少数民族社区妇女的孕产妇护理利用。

方法

从 2020 年 1 月 1 日至 2021 年 12 月 31 日，邀请绵山镇所有孕妇参加干预。多方面的干预措施包括在流行的社交媒体平台上进行参与式和文化适应的健康教育、交通补贴以及医疗保健提供者的能力建设和经济激励。通过比较两组来评估干预的效果：在干预之前分娩的母亲（2019 年 1 月 1 日至 12 月 31 日）和整个孕期都接受干预的母亲。主要结局是医院分娩和 ANC 利用率。通过电话调查和母婴健康监测系统回顾性收集孕妇数据。

结果

共纳入 237 例干预样本和 138 例干预前样本。与干预前组相比，干预组的医院分娩率（97.5% vs. 87.7%，p<0.001）、ANC 及时启动率（73.0% vs. 62.3%，p=0.031）和及时完成五次 ANC 访视率（37.1% vs. 4.3%，p<0.001）均显著更高。与干预前组相比，干预组更有可能利用医院分娩（OR=9.26，95%CI [2.83-30.24]，p<0.001）和 ANC，包括及时启动 ANC（OR=2.18，95%CI [1.31-3.62]，p=0.003）、完成五次 ANC 访视（OR=1.72，95%CI [1.05-2.83]，p=0.032）和及时完成五次 ANC 访视（OR=15.12，95%CI [6.24-36.64]，p<0.001）。