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Lin H, Guo S, Zheng Q, Liu X, Hu A, Zeng J, Liu G. Couples' perceptions and experience of smartphone-assisted CenteringPregnancy model in southeast of China: a dyadic analysis of qualitative study. BMJ Open 2024; 14:e079121. [PMID: 39107027 DOI: 10.1136/bmjopen-2023-079121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES The objectives of this study are to describe couples' experiences and perceived barriers to participation in the CenteringPregnancy model in southeast of China and to understand whether smartphones could play a potential role in this model. DESIGN This study employed a descriptive phenomenological qualitative study using semistructured dyadic interviews with women and their partners. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis. SETTING This study was conducted in two pilot prenatal clinics in southern China. PARTICIPANTS A purposive sample of 13 couples who underwent smartphone-assisted CenteringPregnancy were recruited. Data were collected until saturation through semistructured dyadic interviews between December 2022 and March 2023. RESULTS The study yielded four primary themes: (1) motivation for participation, (2) acceptance of CenteringPregnancy, (3) barriers and suggestions and (4) support for smartphone use of CenteringPregnancy. CONCLUSIONS CenteringPregnancy was well received by couples. Couples can access additional medical care and engage in intensive social interactions assisted by smartphones. However, certain objective challenges need to be acknowledged, including inadequate activity space, high demand for knowledge by couples and inflexible time for employed partners. Moreover, the risk that smartphones can lead to false expectations among couples needs to be noted.
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Affiliation(s)
- Huimin Lin
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shengbin Guo
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | | | - Xiuwu Liu
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Anfen Hu
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jing Zeng
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Guihua Liu
- Fujian Maternity and Child Health Hospital, Fuzhou, China
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Yang X, Li L, Zhou R, Xia J, Li M, Zhang C, Guo H. Effects of the online and offline hybrid continuous group care on maternal and infant health: a randomized controlled trial. BMC Pregnancy Childbirth 2023; 23:629. [PMID: 37658338 PMCID: PMC10472587 DOI: 10.1186/s12884-023-05882-1] [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: 11/09/2022] [Accepted: 07/29/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The group care is a well-established maternal care model that has been widely used in many developed countries, but in China, it is confined to prenatal care services. In addition, affected by traditional birth culture, Chinese women tend to focus more on their fetuses and newborns but lack attention to their own intrapartum and postpartum care. The aim of this study was to construct and implement a prenatal, intrapartum, and the postpartum continuous group care model that combines online and offline service in Hainan Province, China, and to evaluate the effect on maternal women and newborns. METHODS This study was a randomized controlled trial involving 144 pregnant women in a first-class tertiary general hospital in Hainan Province, China. Women were divided into an intervention group and a control group using the random number table, with 72 women in each group. The control group received routine maternal care services, and the intervention group received the continuous group care based on the routine maternal care services. Count data such as rate of cesarean section and incidence rate of fetal macrosomia were analyzed with the chi-square test or Fisher's exact test, and the General Self-efficacy Scale scores were analyzed by repeated measures ANOVA. P < 0.05 was considered statistically significant, with two-sided probability values. RESULTS Compared with the control group, the rate of excessive prenatal weight gain, cesarean section, and 42-day postpartum depression were significantly lower in the intervention group (P < 0.05), and higher General Self-efficacy Scale scores (in the expectant period and 42 days postpartum) and exclusive breastfeeding rate (42 days postpartum) (P < 0.05). The incidence of fetal macrosomia was significantly lower in the intervention group (P < 0.05). But there was no significant difference in birth weight, preterm birth, the incidence of low-birth-weight infants and 1-min Apgar score (P > 0.05). CONCLUSION The continuous group care with online and offline service can effectively control the gestational weight gain, reduce the rate of cesarean section, macrosomia, and postpartum depression. It can improve the self-efficacy of women and the rate of exclusive breastfeeding effectively. TRIAL REGISTRATION Chinese Clinical Trial Regestry (ChiCTR2200065765, 04/11/2022, Retrospectively registered).
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Affiliation(s)
- Xiaoli Yang
- International Nursing school, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou, China
| | - Linwei Li
- International Nursing school, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou, China
- Jiangsu Health Vocational College, Nanjing, China
| | - Rong Zhou
- International Nursing school, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou, China
| | - Jieqiong Xia
- International Nursing school, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou, China
| | - Minxiang Li
- The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Caihong Zhang
- International Nursing school, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou, China.
| | - Honghua Guo
- International Nursing school, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou, China.
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Aloe CF, Hall KL, Pérez-Escamilla R, Rosenthal MS, Fenick AM, Sharifi M. Multilevel Factors Associated With Participation in Group Well-Child Care. Acad Pediatr 2023; 23:1376-1384. [PMID: 36933616 DOI: 10.1016/j.acap.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE To identify factors associated with participation in group well-child care (GWCC), wherein families share preventive health care visits. METHODS We extracted electronic health record data of mother-infant dyads with infants born 2013-18 at Yale New Haven Hospital and followed at the primary care center. Using chi-square analysis and multivariate logistic regression, we examined the extent to which 1) maternal/infant characteristics and recruitment timing were associated with GWCC initiation and continued engagement and 2) initiation was associated with primary care visits. RESULTS Of 2046 eligible mother-infant dyads, 11.6% initiated GWCC. The odds of initiation were higher among mothers with Spanish versus English primary language (odds ratio: 2.36 [95% confidence interval: 1.52-3.66]), with 1 child versus ≥ 3 children (1.58 [1.13-2.22]), and of non-Hispanic Black versus non-Hispanic White infants (2.72 [1.39-5.32]). Initiation was lower among infants born in 2016 (0.53 [0.32-0.88]) and 2018 (0.29 [0.17-0.52]) versus 2013. Among GWCC initiators with follow-up data (n = 217), continued engagement (n = 132, 60.8%) was positively associated with maternal age of 20-29 years (2.85 [1.10-7.34]) and > 30 years (3.46 [1.15-10.43]) compared with< 20 years, and mothers with 1 child versus ≥ 3 (2.28 [1.04-4.98]). GWCC initiators, versus non-initiators, had 5.06 times higher adjusted odds of attending > 9 primary care appointments in the first 18 months (95% confidence interval: 3.74-6.85). CONCLUSIONS As evidence builds on health and social benefits of GWCC, recruitment efforts may gain from considering multi-level socio-economic, demographic, and cultural factors associated with GWCC participation. Higher participation among systemically marginalized groups may present unique opportunities for family-based health promotion to mitigate health inequities.
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Affiliation(s)
- Carlin F Aloe
- Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn.
| | - Kelly L Hall
- Yale School of Public Health (KL Hall, R Pérez-Escamilla, and M Sharifi), New Haven, Conn.
| | - Rafael Pérez-Escamilla
- Yale School of Public Health (KL Hall, R Pérez-Escamilla, and M Sharifi), New Haven, Conn.
| | - Marjorie S Rosenthal
- Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn.
| | - Ada M Fenick
- Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn.
| | - Mona Sharifi
- Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn; Yale School of Public Health (KL Hall, R Pérez-Escamilla, and M Sharifi), New Haven, Conn.
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Martens N, Hindori-Mohangoo AD, Hindori MP, Damme AV, Beeckman K, Reis R, Crone MR, van der Kleij RR. Anticipated benefits and challenges of implementing group care in Suriname's maternity and child care sector: a contextual analysis. BMC Pregnancy Childbirth 2023; 23:592. [PMID: 37596532 PMCID: PMC10436662 DOI: 10.1186/s12884-023-05904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Nele Martens
- Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Manodj P Hindori
- Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname
| | - Astrid Van Damme
- Department of Public Health, Vrije Universiteit Brussel (VUB), Jette, Belgium
- Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium
| | - Katrien Beeckman
- Department of Public Health, Vrije Universiteit Brussel (VUB), Jette, Belgium
- Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium
- Centre for Research and Innovation in Care, Universiteit Antwerpen, Antwerp, Belgium
| | - Ria Reis
- Leiden University Medical Centre, Leiden, Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands
- University of Cape Town, Cape Town, South Africa
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Moyett JM, Ramey-Collier K, Zambrano Guevara LM, MacDonald A, Kuller JA, Wheeler SM, Dotters-Katz SK. CenteringPregnancy: A Review of Implementation and Outcomes. Obstet Gynecol Surv 2023; 78:490-499. [PMID: 37594439 DOI: 10.1097/ogx.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Importance CenteringPregnancy (CP) is a model for group prenatal care associated with improved perinatal outcomes for preterm birth and low birthweight, increased rates of breastfeeding, and higher rates of patient and clinician satisfaction. Objective The study aims to review the literature related to perinatal outcomes associated with CP, benefits and barriers to implementation, and utility of the model. Evidence An electronic-based search was performed in PubMed using the search terms "CenteringPregnancy" OR "Centering Pregnancy," revealing 221 articles. Results The CP model improves patient centeredness, efficiency, and equality in prenatal care. Challenges include administrative buy-in, limited resources, and financial support. Multisite retrospective studies of CP demonstrate improved maternal, neonatal, postpartum, and well-being outcomes, especially for participants from minority backgrounds; however, prospective studies had mixed results. CenteringPregnancy is feasibly implemented with high tenet fidelity in several low- and middle-income settings with improved perinatal outcomes compared with traditional care. Conclusions CenteringPregnancy is feasible to implement, largely accepted by communities, and shows positive qualitative and quantitative health outcomes. This body of literature supports CP as a potential tool for decreasing racial inequalities in prenatal access, quality of care, and maternal mortality. Further investigation is necessary to inform obstetric clinicians about the potential outcome differences that exist between group and traditional prenatal care.
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Affiliation(s)
- Julia M Moyett
- Medical Student, Duke University School of Medicine, Durham, NC
| | | | | | - Amy MacDonald
- Director, Group Care, Pomelo Care Affiliation, Bethesda, MD
| | | | | | - Sarah K Dotters-Katz
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, NC
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Talrich F, Van Damme A, Bastiaens H, Rijnders M, Bergs J, Beeckman K. It takes two to tango: the recruiter's role in accepting or refusing to participate in group antenatal care among pregnant women-an exploration through in-depth interviews. Fam Med Community Health 2023; 11:e002167. [PMID: 37474133 PMCID: PMC10357721 DOI: 10.1136/fmch-2023-002167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE The purpose of this study was to explore how women are recruited for group antenatal care (GANC) in primary care organisations (PCOs), what elements influence the behaviour of the recruiter, and what strategies recruiters use to encourage women to participate. METHOD Using a qualitative research design, we conducted 10 in-depth interviews with GANC facilitators working in PCOs. Selected constructs of the domains of the Consolidated Framework for Implementation Research and the Theoretical Domains Framework helped to develop interview questions and raise awareness of important elements during interviews and thematic analyses. GANC facilitators working in multidisciplinary PCOs located in Brussels and Flanders (Belgium) were invited to participate in an interview. We purposively selected participants because of their role as GANC facilitators and recruiters. We recruited GANC facilitators up until data saturation and no new elements emerged. RESULT We identified that the recruitment process consists of four phases or actions: identification of needs and potential obstacles for participation; selection of potential participants; recruitment for GANC and reaction to response. Depending on the phase, determinants at the level of the woman, recruiter, organisation or environment have an influence on the recruitment behaviour. CONCLUSION Our study concludes that it takes two to tango for successful recruitment for GANC. Potential participants' needs and wishes are of importance, but the care providers' behaviour should not be underestimated. Therefore, successful recruitment may be improved when introducing a multidisciplinary recruitment plan consisting of specific strategies, as we suggest.
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Affiliation(s)
- Florence Talrich
- Department of Public Health, Nursing and Midwifery Research Group (NUMID), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Astrid Van Damme
- Department of Public Health, Nursing and Midwifery Research Group (NUMID), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, Universiteit Antwerpen, Antwerp, Belgium
| | | | - Jochen Bergs
- Research Group of Healthcare and Ethics, Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | - Katrien Beeckman
- Department of Public Health, Nursing and Midwifery Research Group (NUMID), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Centre for Research and Innovation in Care (CRIC), Universiteit Antwerpen, Antwerp, Belgium
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Gresh A, Wilson D, Fenick A, Patil CL, Coker T, Rising SS, Glass N, Platt R. A Conceptual Framework for Group Well-Child Care: A Tool to Guide Implementation, Evaluation, and Research. Matern Child Health J 2023; 27:991-1008. [PMID: 37014564 PMCID: PMC10071241 DOI: 10.1007/s10995-023-03641-4] [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] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To use scoping review methods to construct a conceptual framework based on current evidence of group well-child care to guide future practice and research. METHODS We conducted a scoping review using Arksey and O'Malley's (2005) six stages. We used constructs from the Consolidated Framework for Implementation Research and the quadruple aim of health care improvement to guide the construction of the conceptual framework. RESULTS The resulting conceptual framework is a synthesis of the key concepts of group well-child care, beginning with a call for a system redesign of well-child care to improve outcomes while acknowledging the theoretical antecedents structuring the rationale that supports the model. Inputs of group well-child care include health systems contexts; administration/logistics; clinical setting; group care clinic team; community/patient population; and curriculum development and training. The core components of group well-child care included structure (e.g., group size, facilitators), content (e.g., health assessments, service linkages). and process (e.g., interactive learning and community building). We found clinical outcomes in all four dimensions of the quadruple aim of healthcare. CONCLUSION Our conceptual framework can guide model implementation and identifies several outcomes that can be used to harmonize model evaluation and research. Future research and practice can use the conceptual framework as a tool to standardize model implementation and evaluation and generate evidence to inform future healthcare policy and practice.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA.
| | - Deborah Wilson
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Ada Fenick
- Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL, 60612, USA
| | - Tumaini Coker
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, USA
| | | | - Nancy Glass
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Rheanna Platt
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
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Malchi F, Abedi P, Iravani M, Mohammadi E, Saadati N, Maraghi E. Perception of group prenatal care among pregnant adolescents: A qualitative study in Iran. J Pediatr Adolesc Gynecol 2023:S1083-3188(23)00276-0. [PMID: 36889456 DOI: 10.1016/j.jpag.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 02/10/2023] [Accepted: 02/25/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Understanding the pregnant adolescent's perception of group prenatal care is necessary for introducing and implementing this model of care. This qualitative study aims to explore adolescent pregnant women's perception of group prenatal care in Iran. METHODS This qualitative study was conducted in Iran to explore adolescents' perception of group prenatal care during pregnancy, from November 2021 to May 2022. Fifteen adolescent pregnant women (from low-income population) who received group prenatal care were recruited and interviewed individually in public health care center through an intentional sampling method. Interviews were digitally recorded and transcribed verbatim in Persian and analyzed using conventional content analysis. RESULTS From the data analysis, two themes, six main categories, and 21 subcategories emerged. The themes were "Maternal empowerment" and "Pleasant prenatal care". The first theme included four categories of knowledge enhancement, improving self-efficacy, perceived support, and feeling of security. The second theme is composed of two categories of motivation and effective interaction with peers. CONCLUSION The findings of this study showed the effectiveness of group prenatal care in promoting feelings of empowerment and satisfaction of adolescent pregnant women. Further research is needed to assess the benefits of group prenatal care for adolescents in Iran and other populations.
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Affiliation(s)
- Fatemeh Malchi
- Ph.D Student of midwifery, Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Parvin Abedi
- Professor in Midwifery Department, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mina Iravani
- Assistance Professor in midwifery Department, Reproductive Health Promotion Research Center, Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Eesa Mohammadi
- BScN., MScN., Ph.D., Professor, Nursing Department, Faculty of Medical Sciences Tarbiat Modares University, Tehran, Iran.
| | - Najmieh Saadati
- Associate Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Elham Maraghi
- PhD of Biostatistics, Assistant Professor, Department of biostatics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Crockett AH, Chen L, Heberlein EC, Britt JL, Covington-Kolb S, Witrick B, Doherty E, Zhang L, Borders A, Keenan-Devlin L, Smart B, Heo M. Group vs traditional prenatal care for improving racial equity in preterm birth and low birthweight: the Centering and Racial Disparities randomized clinical trial study. Am J Obstet Gynecol 2022; 227:893.e1-893.e15. [PMID: 36113576 PMCID: PMC9729420 DOI: 10.1016/j.ajog.2022.06.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/01/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The United States has persistently high rates of preterm birth and low birthweight and is characterized by significant racial disparities in these rates. Innovative group prenatal care models, such as CenteringPregnancy, have been proposed as a potential approach to improve the rates of preterm birth and low birthweight and to reduce disparities in these pregnancy outcomes. OBJECTIVE This study aimed to test whether participation in group prenatal care would reduce the rates of preterm birth and low birthweight compared with individual prenatal care and whether group prenatal care would reduce the racial disparity in these rates between Black and White patients. STUDY DESIGN This was a randomized controlled trial among medically low-risk pregnant patients at a single study site. Eligible patients were stratified by self-identified race and ethnicity and randomly allocated 1:1 between group and individual prenatal care. The primary outcomes were preterm birth at <37 weeks of gestation and low birthweight of <2500 g. The primary analysis was performed according to the intent-to-treat principle. The secondary analyses were performed according to the as-treated principle using modified intent-to-treat and per-compliance approaches. The analysis of effect modification by race and ethnicity was planned. RESULTS A total of 2350 participants were enrolled, with 1176 assigned to group prenatal care and 1174 assigned to individual prenatal care. The study population included 952 Black (40.5%), 502 Hispanic (21.4%), 863 White (36.8%), and 31 "other races or ethnicity" (1.3%) participants. Group prenatal care did not reduce the rate of preterm birth (10.4% vs 8.7%; odds ratio, 1.22; 95% confidence interval, 0.92-1.63; P=.17) or low birthweight (9.6% vs 8.9%; odds ratio, 1.08; 95% confidence interval, 0.80-1.45; P=.62) compared with individual prenatal care. In subgroup analysis, greater attendance in prenatal care was associated with lower rates of preterm birth and low birthweight. This effect was most noticeable for the rates of low birthweight for Black participants in group care: intent to treat (51/409 [12.5%]), modified intent to treat (36/313 [11.5%]), and per compliance (20/240 [8.3%]). Although the rates of low birthweight were significantly higher for Black participants than White participants seen in individual care (adjusted odds ratio, 2.00; 95% confidence interval, 1.14-3.50), the difference was not significant for Black participants in group care compared with their White counterparts (adjusted odds ratio, 1.58; 95% confidence interval, 0.74-3.34). CONCLUSION There was no difference in the overall rates of preterm birth or low birthweight between group and individual prenatal care. With increased participation in group prenatal care, lower rates of preterm birth and low birthweight for Black participants were observed. The role of group care models in reducing racial disparities in these birth outcomes requires further study.
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Affiliation(s)
- Amy H Crockett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health and the University of South Carolina School of Medicine, Greenville, SC.
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Emily C Heberlein
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA
| | - Jessica L Britt
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, SC
| | - Sarah Covington-Kolb
- Center for Community Health Alignment, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Brian Witrick
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Emily Doherty
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Lu Zhang
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Ann Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Britney Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Moonseong Heo
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
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Hopkins K, Remington C, Eilers MA, Rivas SD, Wallace Huff C, Moore LD, Hampton RM, Ogburn T. Obtaining buy-in for immediate postpartum long-acting reversible contraception programs in Texas hospitals: A qualitative study. Contraception 2022; 108:32-36. [PMID: 34748748 PMCID: PMC9098369 DOI: 10.1016/j.contraception.2021.10.016] [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: 03/09/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To understand the specific ways in which champions lead efforts to obtain and sustain buy-in for immediate postpartum long-acting reversible contraception (LARC) programs. METHODS We conducted a qualitative study with 60 semistructured interviews at 3 teaching hospitals in Texas with physicians, nurses, administrators and other staff who participated in the implementation of immediate postpartum LARC. Physicians self-identified as champions and identified other champion physicians and administrators. Two researchers analyzed and coded interview transcripts for content and themes. RESULTS We found that champions draw on institutional knowledge and relationships to build awareness and support for immediate postpartum LARC implementation. To obtain buy-in, champions needed to demonstrate financial sustainability, engage key stakeholders from multiple departments, and obtain nurse buy-in. Champions also created buy-in by communicating goals for the service that focused on expanding reproductive autonomy, improving maternal health, and improving access to postpartum contraception. Some staff, especially nurses, identified reasons for the program that run counter to reproductive justice principles: reducing birth rates, poverty, and/or unplanned pregnancy among young women and high-parity women. Respondents at 2 hospitals noted that not all women had equitable access to immediate postpartum LARC. CONCLUSION Physician and non-physician champions must secure long-term support across multiple hospital departments to successfully implement an immediate postpartum LARC program. For programs to equitably serve all women in need of postpartum contraceptive care, champions and other program leaders need to implement strategies to address access issues. They should also explicitly focus on reproductive justice principles during program introduction and training. IMPLICATIONS Successfully implementing immediate postpartum long-acting reversible contraception programs requires champions with institutional networking connections, administrative and nursing support, and clearly communicated goals. Champions need to address access issues and focus on reproductive justice principles during program introduction and training to equitably serve all women in need of postpartum contraceptive care.
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Affiliation(s)
- Kristine Hopkins
- Texas Policy Evaluation Project, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States.
| | - Courtney Remington
- Dell Seton Medical Center, The University of Texas at Austin, Austin, TX, United States
| | - Michelle A Eilers
- Texas Policy Evaluation Project, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States
| | - Saul D Rivas
- School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Cristina Wallace Huff
- The University of Texas Health Science Center at San Antonio, Department of Obstetrics, Gynecology and Reproductive Sciences, San Antonio, TX, United States
| | - Lee David Moore
- HSC School of Medicine at the Permian Basin, Texas Tech University, Odessa, TX, United States
| | - Raymond Moss Hampton
- HSC School of Medicine at the Permian Basin, Texas Tech University, Odessa, TX, United States
| | - Tony Ogburn
- School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
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Lazar J, Boned-Rico L, Olander EK, McCourt C. A systematic review of providers' experiences of facilitating group antenatal care. Reprod Health 2021; 18:180. [PMID: 34493314 PMCID: PMC8425020 DOI: 10.1186/s12978-021-01200-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Group antenatal care is a rapidly expanding alternative antenatal care delivery model. Research has shown it to be a safe and effective care model for women, but less is known about the perspectives of the providers leading this care. This systematic review examined published literature that considered health care professionals’ experiences of facilitating group antenatal care. Methods Systematic searches were conducted in seven databases (Cinahl, Medline, Psychinfo, Embase, Ovid Emcare, Global Health and MIDRS) in April 2020. Qualitative or mixed methods studies with a significant qualitative component were eligible for inclusion if they included a focus on the experiences of health care providers who had facilitated group antenatal care. Prisma screening guidelines were followed and study quality was critically appraised by three independent reviewers. The findings were synthesised thematically. Results Nineteen papers from nine countries were included. Three main themes emerged within provider experiences of group antenatal care. The first theme, ‘Giving women the care providers feel they want and need’, addresses richer use of time, more personal care, more support, and continuity of care. The second theme, ‘Building skills and relationships’, highlights autonomy, role development and hierarchy dissolution. The final theme, ‘Value proposition of group antenatal care’, discusses provider investment and workload. Conclusions Health care providers’ experience of delivering group antenatal care was positive overall. Opportunities to deliver high-quality care that benefits women and allows providers to develop their professional role were appreciated. Questions about the providers’ perspectives on workload, task shifting, and the structural changes needed to support the sustainability of group antenatal care warrant further exploration. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01200-0. Receiving antenatal care in a group setting has been found to be safe and satisfying for women and is supported by international public health guidelines. However, questions remain about the experience of health care professionals tasked with providing this model, such as whether they like working in this model and whether they support its expansion. To answer these questions, the team searched for studies about the experiences of health care providers with group antenatal care, and only included those studies where providers themselves spoke about their own experiences of providing this kind of care. Our review demonstrated that midwives, doctors, nurses and community health workers mostly enjoyed facilitating group antenatal care. They particularly appreciated the ability to give women the kind of care they felt women want and need. Health care providers also experienced some changes in their professional roles, in relation to both the women they serve and their colleagues and organizations. In order to determine if group antenatal care models are a satisfying and sustainable option for health care professionals in the long term, more research is needed.
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