1
|
Holman-Allgood I, Cline C, Durand C, Purvis RS, Mendoza Kabua P, Ayers BL. Providers' Perspectives of a Culturally Adapted CenteringPregnancy Intervention for Marshallese Women in Arkansas. Nurs Womens Health 2024; 28:117-127. [PMID: 38460942 PMCID: PMC10999336 DOI: 10.1016/j.nwh.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 12/07/2023] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To explore health care providers' perspectives on the successes, challenges, and suggestions for future directions regarding the implementation of CenteringPregnancy for Marshallese women in Arkansas. DESIGN A descriptive qualitative design was used as an exploratory method. SETTING/LOCAL PROBLEM This study took place in northwest Arkansas. Arkansas is home to the largest Marshallese Pacific Islander population in the United States. Marshallese Pacific Islanders residing in the United States have disproportionally high rates of poor maternal and infant health outcomes, even compared to other Pacific Islanders. PARTICIPANTS Seven CenteringPregnancy providers from the University of Arkansas for Medical Sciences Northwest. INTERVENTION/MEASUREMENTS Individual interviews were conducted from February to March of 2023. Data were managed using MAXQDA12 software. Content analysis was used to analyze the data. Initial coding was completed to identify each data segment with short summations of emergent themes. The focused thematic codes that emerged were used to identify and develop the most salient thematic categories of the data, which became the thematic codes. RESULTS Three overarching themes emerged: Implementation Successes, Challenges to Implementation, and Future Suggestions to Improve Implementation and Sustainability. Each theme had representative subthemes. CONCLUSION Findings provide insight for future implementation of CenteringPregnancy for Marshallese and other Pacific Islander individuals.
Collapse
|
2
|
Meriwether KV, Ravichandran N, Darley CJ, Panter V, Komesu YM. Centering Group Treatment for Women With Interstitial Cystitis/Bladder Pain Syndrome: A Prospective, Parallel-Group Cohort Study. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:410-421. [PMID: 37695251 PMCID: PMC10629831 DOI: 10.1097/spv.0000000000001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
IMPORTANCE Women with interstitial cystitis/bladder pain syndrome (ICBPS) face isolation and treatment challenges. Group medical visits using Centering models have successfully treated other conditions but have not been explored in ICBPS. OBJECTIVE This study aimed to describe ICBPS pain and symptom control comparing standard treatment alone versus standard treatment augmented with Centering visits. STUDY DESIGN This prospective cohort study recruited women with ICBPS receiving standard care (control) or standard care augmented with group Centering. We administered validated questionnaires at baseline and monthly for 12 months. The primary outcome was change in the pain numerical rating scale, with Patient-Reported Outcomes Measurement Information System Pain Interference Scale and Bladder Pain/Interstitial Cystitis Symptom Score change as secondary measures. RESULTS We enrolled 45 women (20 Centering, 25 controls). Centering had significantly better numerical rating scale pain scores at 1 month (mean difference [diff], -3.45) and 2 months (mean diff, -3.58), better Patient-Reported Outcomes Measurement Information System Pain Interference Scale scores at 1 month (mean diff, -10.62) and 2 months (mean diff, -9.63), and better Bladder Pain/Interstitial Cystitis Symptom Score scores at 2 months (mean diff, -13.19), and 3 months (mean diff, -12.3) compared with controls. In modeling, treatment group (Centering or control) and educational levels were both associated with all the outcomes of interest. Beyond 6 months, there were too few participants for meaningful analyses. CONCLUSIONS Women with ICBPS participating in a Centering group have, in the short term, less pain, pain interference, and ICBPS-specific symptoms than patients with usual care alone. Larger studies with more follow-up are needed to determine if this treatment effect extends over time.
Collapse
Affiliation(s)
- Kate V. Meriwether
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of New Mexico, Albuquerque, NM
| | | | - Cassandra J. Darley
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of New Mexico, Albuquerque, NM
| | - Virginia Panter
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of New Mexico, Albuquerque, NM
| | - Yuko M. Komesu
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of New Mexico, Albuquerque, NM
| |
Collapse
|
3
|
Ayers BL, Eswaran H, CarlLee S, Reece S, Manning N, McElfish PA. Exploring the feasibility, acceptability, and preliminary effectiveness of a culturally adapted group prenatal program, CenteringPregnancy, to reduce maternal and infant health disparities among Marshallese Pacific Islanders: A study protocol. Contemp Clin Trials Commun 2023; 33:101127. [PMID: 37091509 PMCID: PMC10120290 DOI: 10.1016/j.conctc.2023.101127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Background Marshallese Pacific Islanders residing in the United States have higher rates of adverse perinatal outcomes than the general population and experience numerous barriers to prenatal care. CenteringPregnancy is a group prenatal care model which occurs in the patient's community. CenteringPregnancy, when applied to the Marshallese population, presents a potentially highly successful group-based intervention that can mitigate adverse perinatal outcomes among Marshallese Pacific Islanders. Methods This article describes the protocol of a mixed-methods study designed to examine the feasibility, acceptability, and preliminary effectiveness of the implementation of CenteringPregnancy for Marshallese Pacific Islander women. The mixed-methods design collects qualitative and quantitative data at the onset of CenteringPregnancy and during their last session and then augments the data with post-partum data abstraction. Conclusion This will be the first study to culturally adapt and implement CenteringPregnancy with Marshallese pregnant women in the United States. This study will be an important first step to exploring the feasibility, acceptability, and preliminary effectiveness of CenteringPregnancy and will better prepare the research team to assess and refine the intervention moving forward. Trial registration This study was registered at ClinicalTrials.gov on September 22, 2020 under identifier NCT04558619 and can be accessed at https://clinicaltrials.gov/ct2/show/NCT04558619?term=K%C5%8Dmmour+Prenatal&draw=2&rank=1.
Collapse
Affiliation(s)
- Britni L. Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
- Corresponding author.
| | - Hari Eswaran
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - Nirvana Manning
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| |
Collapse
|
4
|
Centering Group Treatment for Women With Interstitial Cystitis/Bladder Pain Syndrome: A Qualitative Analysis. Female Pelvic Med Reconstr Surg 2022; 28:695-704. [PMID: 35759784 PMCID: PMC10013932 DOI: 10.1097/spv.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Women with interstitial cystitis/bladder pain syndrome (ICBPS) face challenging treatment and feelings of isolation. Centering models of group medical visits have been successful in other spheres but have not been explored in ICBPS therapy. OBJECTIVE We sought to describe opinions of women with ICBPS regarding Centering visits, including advantages, experience, and barriers to participation and efficacy. STUDY DESIGN Patients who attended Centering visits participated in a focus group and/or filled out written commentary in evaluations, and control patients were individually interviewed. We coded transcripts using NVivo software for emergent themes. RESULTS We conducted 4 control patient individual interviews, had one focus group of Centering patients, and collected comments from 34 post-Centering surveys. Emergent themes of interest included motivations and barriers to joining, cost, leadership, connecting with others, diversity, learning, alternative treatments, and areas for improvement. Regardless of participation in Centering, patients noted the importance of self-care and sharing with other women with ICBPS, and they emphasized feelings of isolation in their disease and discouraging health care experiences. Women in Centering noted that the biggest advantages of Centering were learning from other women with ICBPS, the creation of a welcoming and safe space, and the feeling that Centering was more of a support group than a medical visit. Women noted that barriers to Centering included cost and logistical issues, such as time and format. CONCLUSIONS Women with ICBPS treatment note that Centering group visits provide a sense of learning and community that opens them to a wider variety of options.
Collapse
|
5
|
Dai J, Yu Y, Wang Y, Huang Y, Liu J, Lin Y, Fan X, Zhang M, Xu X, Bai J, Chen H, Liu Y. The Experience of Pregnant Women in the Health Management Model of Internet-Based Centering Pregnancy: A Qualitative Study. Int J Womens Health 2022; 14:1281-1289. [PMID: 36105790 PMCID: PMC9464633 DOI: 10.2147/ijwh.s375675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background CenteringPregnancy Care is a promising group prenatal care innovation that combines assessment, education, and peer support. In China, it is not clear how best to integrate the CenteringPregnancy Care into existing maternal health care models. This qualitative study aimed to explore Chinese pregnant women’s experience in the Internet-based CenteringPregnancy management model. Methods The Internet-based CenteringPregnancy was applied in a tertiary hospital between 2018 and 2019 in Wuhan, Hubei Province. Through purposive sampling, a total of 9 pregnant women who had experienced Internet-based CenteringPregnancy were recruited. A semi-structured interview was used to collect qualitative data, and Colaizzi’s 7-step method of phenomenological data analysis was used to analyze the collected data. Results Three themes were extracted from the participants’ interviews, including: 1) empowerment; 2) psychological and social support; 3) challenges of the Internet-based CenteringPregnancy. The Internet-based CenteringPregnancy management model retained advantages of CenteringPregnancy, emphasizing the pregnant woman as the subject of health care and promoting them to participate in health care. Participants believed that they could exchange pregnancy knowledge, help each other, and improve mood both timely and efficiently from the new model. However, it was found that there were challenges in seminar time arrangement, topic selection, and discussion management. Conclusion The Internet-based CenteringPregnancy management model positively affected pregnant women’s empowerment, psychological, and social support. It is recommended to improve the seminar’s design in future studies.
Collapse
Affiliation(s)
- Jiamiao Dai
- School of Nursing, Wuhan University, Wuhan, People's Republic of China
| | - Yun Yu
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Yuchen Wang
- Department of Nursing, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yinying Huang
- Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Juan Liu
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Yumin Lin
- Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Xiaoxiao Fan
- School of Nursing, Wuhan University, Wuhan, People's Republic of China
| | - Mingjing Zhang
- Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Xiaofang Xu
- Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Hong Chen
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Yanqun Liu
- School of Nursing, Wuhan University, Wuhan, People's Republic of China
| |
Collapse
|
6
|
Jain D, Jain AK, Metz GAS, Ballanyi N, Sood A, Linder R, Olson DM. A Strategic Program for Risk Assessment and Intervention to Mitigate Environmental Stressor-Related Adverse Pregnancy Outcomes in the Indian Population. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:673118. [PMID: 36304060 PMCID: PMC9580833 DOI: 10.3389/frph.2021.673118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
The Problem: Global environmental stressors of human health include, but are not limited to, conflict, migration, war, natural disasters, climate change, pollution, trauma, and pandemics. In combination with other factors, these stressors influence physical and mental as well as reproductive health. Maternal stress is a known factor for adverse pregnancy outcomes such as preterm birth (PTB); however, environmental stressors are less well-understood in this context and the problem is relatively under-researched. According to the WHO, major Indian cities including New Delhi are among the world's 20 most polluted cities. It is known that maternal exposure to environmental pollution increases the risk of premature births and other adverse pregnancy outcomes which is evident in this population. Response to the Problem: Considering the seriousness of this problem, an international and interdisciplinary group of researchers, physicians, and organizations dedicated to the welfare of women at risk of adverse pregnancy outcomes launched an international program named Optimal Pregnancy Environment Risk Assessment (OPERA). The program aims to discover and disseminate inexpensive, accessible tools to diagnose women at risk for PTB and other adverse pregnancy outcomes due to risky environmental factors as early as possible and to promote effective interventions to mitigate these risks. OPERA has been supported by the Worldwide Universities Network, World Health Organization (WHO) and March of Dimes USA. Addressing the Problem: This review article addresses the influence of environmental stressors on maternal-fetal health focusing on India as a model population and describes the role of OPERA in helping local practitioners by sharing with them the latest risk prediction and mitigation tools. The consequences of these environmental stressors can be partially mitigated by experience-based interventions that build resilience and break the cycle of inter- and-transgenerational transmission. The shared knowledge and experience from this collaboration are intended to guide and facilitate efforts at the local level in India and other LMIC to develop strategies appropriate for the jurisdiction for improving pregnancy outcomes in vulnerable populations.
Collapse
Affiliation(s)
- Divyanu Jain
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- *Correspondence: Divyanu Jain
| | - Ajay K. Jain
- Department of Obstetrics & Gynecology and In-vitro Fertilization Center, Jaipur Golden Hospital, New Delhi, India
- IVF Center, Muzaffarnagar Medical College, Muzaffarnagar, India
| | - Gerlinde A. S. Metz
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Nina Ballanyi
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Abha Sood
- Department of Obstetrics & Gynecology and In-vitro Fertilization Center, Jaipur Golden Hospital, New Delhi, India
| | - Rupert Linder
- Specialist for Gynecology, Obstetrics, Psychosomatics and Psychotherapy, Birkenfeld, Germany
| | - David M. Olson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- Departments of Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
7
|
Ibañez-Cuevas M, Heredia-Pi IB, Fuentes-Rivera E, Andrade-Romo Z, Alcalde-Rabanal J, Cacho LBB, Guzmán-Delgado X, Jurkiewicz L, Darney BG. Group Prenatal Care in Mexico: perspectives and experiences of health personnel. Rev Saude Publica 2020; 54:140. [PMID: 33331532 PMCID: PMC7703532 DOI: 10.11606/s1518-8787.2020054002175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel's perspective. METHODS We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication). RESULTS The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women's care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico's implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women. CONCLUSION Analyzing the GPC model's implementation in Mexico, from the health care personnel's perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training.
Collapse
Affiliation(s)
- Midiam Ibañez-Cuevas
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Ileana Beatriz Heredia-Pi
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Evelyn Fuentes-Rivera
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Zafiro Andrade-Romo
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Jacqueline Alcalde-Rabanal
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | | | - Xochitl Guzmán-Delgado
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, MOR, México
| | - Laurie Jurkiewicz
- University of California San Francisco. San Francisco General Hospital. Department of ObGyn & Reproductive Sciences. San Francisco, CA, USA
| | - Blair G Darney
- Oregon Health & Science University. Department of Obstetrics & Gynecology. Portland, OR, USA
| |
Collapse
|
8
|
Pekkala J, Cross-Barnet C, Kirkegaard M, Silow-Carroll S, Courtot B, Hill I. Key Considerations for Implementing Group Prenatal Care: Lessons from 60 Practices. J Midwifery Womens Health 2019; 65:208-215. [PMID: 31642589 DOI: 10.1111/jmwh.13047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Group prenatal care combines clinical care with peer support and education. Research has indicated neutral or positive results for group care when compared with traditional individual prenatal visits. A national initiative, Strong Start II, was implemented to determine if specific prenatal care interventions such as group prenatal care can reduce the rate of preterm birth, improve health outcomes, and lower costs. This study explored barriers to implementation and sustainability and strategies for overcoming barriers and sustaining the model. METHODS Results from prenatal care provider-level qualitative case studies for the independent evaluation of Strong Start were examined. Case studies for sites implementing group prenatal care were based on a total of 313 interviews with 441 Strong Start key informants (eg, prenatal care providers, project staff, and health administrators involved in group care) and 53 focus groups with 428 Strong Start participants from 2013 to 2016. Supplemental interviews with 25 additional stakeholders were also conducted. Case study data were queried using content analysis followed by a grounded theory-based analysis of these findings. RESULTS Barriers to implementation existed at patient, provider, administrator, system, and funding levels and included inflexible appointment times, lack of childcare, lack of appropriate meeting space, new scheduling and training needs, meeting requirements of graduate medical education programs, prenatal care provider and administrator reluctance to adopt new practices, and Medicaid payment policies. Sites newly implementing group prenatal care had varying degrees of success sustaining their programs. Both new and established sites identified provider champions and opt-out enrollment approaches as critical for maintaining buy-in. DISCUSSION Successful implementation of group prenatal care depends on systematic strategies at the practice, payer, provider, patient, and policy levels to implement, reimburse for, and sustain the model. Strategies for overcoming barriers can assist practices in offering this transformative approach, including practices with graduate medical education programs or those serving women with clinical, demographic, or psychosocial risk factors for preterm birth.
Collapse
Affiliation(s)
- Jodi Pekkala
- Health Management Associates, New York, New York
| | | | - Margaret Kirkegaard
- Amita Hinsdale Family Medicine Residency Program, Hinsdale, Illinois.,Health Management Associates, Chicago, Illinois
| | | | - Brigette Courtot
- Health Policy Center, Urban Institute, Washington, District of Columbia
| | - Ian Hill
- Health Policy Center, Urban Institute, Washington, District of Columbia
| |
Collapse
|
9
|
Lundeen T, Musange S, Azman H, Nzeyimana D, Murindahabi N, Butrick E, Walker D. Nurses' and midwives' experiences of providing group antenatal and postnatal care at 18 health centers in Rwanda: A mixed methods study. PLoS One 2019; 14:e0219471. [PMID: 31295335 PMCID: PMC6622527 DOI: 10.1371/journal.pone.0219471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The East Africa Preterm Birth Initiative-Rwanda began a cluster randomized controlled trial of group antenatal care (ANC) and postnatal care (PNC) in Rwanda in 2017. That trial will report its primary outcome, gestational length at birth, after data collection concludes in 2019. This nested study includes providers of ANC and/or PNC at the 18 health centers randomized to provide the group model of ANC/PNC and the 18 health centers randomized to continue providing ANC/PNC in the traditional, individual visit model. The objective of this study is to understand the experiences of providers of group ANC/PNC and compare their job satisfaction and perceived stress with individual ANC/PNC providers. METHODS We collected both quantitative and qualitative data from providers (nurses and midwives) who were recruited by health center directors to participate as group ANC and PNC facilitators at intervention sites and from a similar number of providers of standard ANC and PNC at control sites. Quantitative data was collected with questionnaires administered at baseline and approximately 9 months later (follow up). Qualitative data was collected in 3 focus groups of group ANC/PNC providers conducted one year after group care began. RESULTS Eighty-six percent of nurses and midwives surveyed who implemented group ANC and PNC reported that they prefer group care to the traditional individual model of ANC and PNC. Perceived stress levels and job satisfaction results were similar between groups. Mixed focus group discussions among both nurses and midwives experienced in group ANC and PNC suggest that the group model of care has advantages for both service beneficiaries and providers. When providers described implementation challenges, their peers in the focus groups offered them suggestions to cope and improve service delivery. DISCUSSION These results are consistent with studies of providers of group ANC and PNC in other LMIC contexts with respect to the perceived benefits of group care. This study adds new insights into the ways peer providers can help one another solve implementation problems. When given the opportunity to meet as a group, these study participants offered one another peer support and shared knowledge about best practices for successful implementation of group ANC/PNC. This trial is registered at clinicaltrials.gov as NCT03154177.
Collapse
Affiliation(s)
- Tiffany Lundeen
- University of California San Francisco, Institute of Global Health Sciences, San Francisco, California, United States of America
| | - Sabine Musange
- University of Rwanda School of Public Health, Kigali, Rwanda
| | - Hana Azman
- University of California San Francisco, Institute of Global Health Sciences, San Francisco, California, United States of America
| | - David Nzeyimana
- University of Rwanda School of Public Health, Kigali, Rwanda
| | | | - Elizabeth Butrick
- University of California San Francisco, Institute of Global Health Sciences, San Francisco, California, United States of America
| | - Dilys Walker
- University of California San Francisco, Institute of Global Health Sciences, San Francisco, California, United States of America
- University of California San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, California, United States of America
| |
Collapse
|
10
|
MacMillan Uribe AL, Woelky KR, Olson BH. Exploring Family-Medicine Providers' Perspectives on Group Care Visits for Maternal and Infant Nutrition Education. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:409-418. [PMID: 30773444 DOI: 10.1016/j.jneb.2019.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Explore current maternal and infant nutrition education practices and family medicine primary care providers' views on a group care model to deliver nutrition education to mother-infant dyads. DESIGN In-depth interviews. SETTING Family medicine clinics in 1 Midwestern US hospital system. PARTICIPANTS Family medicine primary care providers (n = 17) who regularly see infants during well-baby visits. PHENOMENON OF INTEREST Current maternal and infant nutrition education practices; views on ideal way to deliver nutrition education to mother-infant dyads; feedback on group care model to deliver nutrition education to mother-infant dyads. ANALYSIS Audio recordings transcribed verbatim and coded using conventional content analysis. RESULTS Family medicine primary care providers are limited in the ability to provide maternal and infant nutrition education and desire a different approach. Group care was the preferred method; it was shared most frequently as the ideal approach to nutrition education delivery and participants reacted favorably when presented with this model. However, there were many concerns with group care (eg, moderating difficult conversations, program implementation logistics, sufficient group volume, and interruption in patient-provider relationship). CONCLUSION AND IMPLICATIONS Family medicine primary care providers desire a different approach to deliver nutrition education to mother-infant dyads in clinic. A group care model may be well-accepted among family medicine primary care providers but issues must be resolved before implementation. These results could inform future group care implementation studies and influence provider buy-in.
Collapse
Affiliation(s)
| | - Kaitland R Woelky
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Beth H Olson
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI.
| |
Collapse
|
11
|
Heredia-Pi IB, Fuentes-Rivera E, Andrade-Romo Z, Bravo Bolaños Cacho MDL, Alcalde-Rabanal J, Jurkiewicz L, Darney BG. The Mexican Experience Adapting CenteringPregnancy: Lessons Learned in a Publicly Funded Health Care System Serving Vulnerable Women. J Midwifery Womens Health 2018; 63:602-610. [PMID: 30199143 PMCID: PMC6220951 DOI: 10.1111/jmwh.12891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Abstract
Group antenatal care is an innovative model of health care in which all components of antenatal care-clinical, educational, and supportive-happen in a group context with health care professionals as facilitators. CenteringPregnancy is the most studied model of group antenatal care, now widely implemented in the United States. This model has been shown to be effective in improving health and behavioral outcomes in the United States, but there is less known about the experience adapting group antenatal care in settings outside the US health care system. This article describes the adaptation of the CenteringPregnancy model to a Mexican context. We describe the Mexican health care context and our adaptation process and highlight key factors to consider when adapting the content and modality of the CenteringPregnancy model for diverse populations and health systems. Our findings are relevant to others seeking to implement group antenatal care in settings outside the US health care system.
Collapse
|
12
|
Quintanilha M, Mayan MJ, Raine KD, Bell RC. Nurturing maternal health in the midst of difficult life circumstances: a qualitative study of women and providers connected to a community-based perinatal program. BMC Pregnancy Childbirth 2018; 18:314. [PMID: 30075762 PMCID: PMC6091112 DOI: 10.1186/s12884-018-1951-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 07/26/2018] [Indexed: 12/02/2022] Open
Abstract
Background Many socioecological and structural factors affect women’s diets, physical activity, and her access and receptivity to perinatal care. We sought to explore women’s and providers’ perceptions and experiences of health in the pre- and post-natal period while facing difficult life circumstances, and accessing a community-based program partially funded by Canada Prenatal Nutrition Program (CPNP) in Alberta, Canada. Methods Following the principles of community-based participatory research, we conducted a focused ethnography that involved five focus groups with women (28 in total), eight one-on-one interviews with program providers, and observations of program activities. Data were analyzed through qualitative content analysis to inductively derive codes and categories. Results Women perceived eating healthy foods, taking prenatal vitamins, and being physically active as key health behaviours during pregnancy and postpartum. However, they were commonly coping with many difficult life circumstances, and faced health barriers for themselves and their babies. These barriers included pregnancy or birth complications, family and spousal issues, financial difficulties, and living rurally. On the other hand, women and providers identified many aspects of the community-based program that addressed the burden of adversities as enablers to better health during pregnancy and postpartum. Conclusion Community-based programs have an important role in alleviating some of the burden of coping with difficult life circumstances for women. With such potential, community-based programs need to be well supported through policies. Policies supporting these programs, and ensuring adequate funding, can enable more equitable services to rural women and truly promote maternal health during pregnancy and postpartum. Electronic supplementary material The online version of this article (10.1186/s12884-018-1951-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maira Quintanilha
- Agricultural, Food & Nutritional Science, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Maria J Mayan
- Faculty of Extension, University of Alberta, Community-University Partnership, 2-281 Enterprise Square, 10230 Jasper Avenue, Edmonton, AB, T5J 4P6, Canada.
| | - Kim D Raine
- School of Public Health, University of Alberta, 4-077 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada
| | - Rhonda C Bell
- Agricultural, Food & Nutritional Science, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| |
Collapse
|
13
|
|