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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.
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Short VL, Hand DJ, Mancuso F, Raju A, Sinnott J, Caldarone L, Rosenthall E, Liveright E, Abatemarco DJ. Group prenatal care for pregnant women with opioid use disorder: Preliminary evidence for acceptability and benefits compared with individual prenatal care. Birth 2024; 51:144-151. [PMID: 37800365 DOI: 10.1111/birt.12775] [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] [Received: 12/01/2022] [Revised: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION The effectiveness of group prenatal care (G-PNC) compared with individual prenatal care (I-PNC) for women with opioid use disorder (OUD) is unknown. The objectives of this study were to (1) assess the acceptability of co-locating G-PNC at an opioid treatment program and (2) describe the maternal and infant characteristics and outcomes of pregnant women in treatment for OUD who participated in G-PNC and those who did not. METHODS This was a retrospective cohort study of 71 women (G-PNC n = 15; I-PNC n = 56) who were receiving treatment for OUD from one center and who delivered in 2019. Acceptability was determined by assessing the representativeness of the G-PNC cohorts, examining attendance at sessions, and using responses to a survey completed by G-PNC participants. The receipt of health services and healthcare use, behaviors, and infant health between those who participated in G-PNC and those who received I-PNC were described. RESULTS G-PNC was successfully implemented among women with varying backgrounds (e.g., racial, ethnic, marital status) who self-selected into the group. All G-PNC participants reported that they were satisfied to very satisfied with the program. Increased rates of breastfeeding initiation, breastfeeding at hospital discharge, receipt of the Tdap vaccine, and postpartum visit attendance at 1-2 weeks and 4-8 weeks were observed in the G-PNC group compared with the I-PNC group. Fewer G-PNC reported postpartum depression symptomatology. CONCLUSION Findings suggest that co-located G-PNC at an opioid treatment program is an acceptable model for pregnant women in treatment for OUD and may result in improved outcomes.
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Affiliation(s)
- Vanessa L Short
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dennis J Hand
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Amulya Raju
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jacqueline Sinnott
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Elizabeth Liveright
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Diane J Abatemarco
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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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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Durosini I, Pravettoni G. Patients' representation of oncological disease: psychological aspects in the cancer journey. Front Psychol 2023; 14:1087083. [PMID: 37502747 PMCID: PMC10371254 DOI: 10.3389/fpsyg.2023.1087083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/15/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Ilaria Durosini
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Modde Epstein C, Houfek JF, Jones LP. Deep health: A qualitative, woman-centered perspective of health during pregnancy. Midwifery 2023; 120:103628. [PMID: 36870255 PMCID: PMC10111285 DOI: 10.1016/j.midw.2023.103628] [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: 06/06/2022] [Revised: 12/09/2022] [Accepted: 02/05/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To explore and define a woman-centered perspective on health during pregnancy. DESIGN Qualitative study using abductive thematic analysis of semi-structured interview data. SETTING & PARTICIPANTS Twenty pregnant participants, primarily single and low-income, were recruited from an urban women's health clinic in the Midwestern United States and interviewed during mid-to-late pregnancy. FINDINGS Women experienced health as "deeper than physical health" to include emotional well-being, financial stability, and support. We defined the central theme of Deep Health to be an embodied sense of happiness, energy, stability, and purpose (Being) supported through positive health practices (Doing) and adequate financial and social resources (Having). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE While the Doing aspects of health are often a focal point for health promotion efforts in prenatal care, a restricted focus on lifestyle behaviors may contribute to a lack of shared understanding about health between women and their healthcare providers. Greater attention to the Being and Having aspects of health may work to bolster shared priorities for health between pregnant women and their providers.
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Affiliation(s)
- Crystal Modde Epstein
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, United States; School of Nursing, University of North Carolina Greensboro, 1007 Walker Avenue, Greensboro, NC 27412, United States.
| | - Julia F Houfek
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, United States
| | - Lawrency P Jones
- School of Nursing, University of North Carolina Greensboro, 1007 Walker Avenue, Greensboro, NC 27412, United States
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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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Cutajar L, Dahlen HG, Leechburch Auwers A, Vir S, Berberovic B, Jedrzejewski T, Burns ES. Model of care matters: An integrative review. Women Birth 2023:S1871-5192(22)00367-5. [PMID: 36642558 DOI: 10.1016/j.wombi.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pregnant women are entitled to quality care during pregnancy. Some health districts offer a variety of maternity care models but, not all women are aware of what is available and there is limited research on the experiences of women within their chosen or allocated model of care. AIM The aim of this integrative review is to explore the available literature on women's experiences of the model of care accessed during pregnancy. METHOD A database search of CINAHL, MEDLINE, SCOPUS, OVID, JBI and Cochrane Database was conducted to identify original research articles published in English between 2011 and 2021. In total, 20 articles met the inclusion criteria. FINDINGS The included papers came from nine different countries and reported on eight different models of care. Following analysis of the articles one overarching theme 'Model of care matters', and six sub themes were identified: 1.'Choosing a model', 2.'Learning about pregnancy and birth', 3.'Being known', 4.'Making social and emotional connections', 5.'Receiving enabling or disabling care' and 6.'Integrated care is best'. Some women disclosed that they had no choice in the model they were allocated, while others stated they were not provided with information about all available models of care. CONCLUSION A lack of integrated care between medical and midwifery models led to feelings of dissatisfaction and distress during pregnancy. Positive experiences were reported when women developed a connection with the care provider. The development of a well-informed decision aid could alleviate deficits of information, and clarify the subtle differences that occur within various models.
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Affiliation(s)
- Lisa Cutajar
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia.
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia.
| | | | - Swati Vir
- South Western Sydney Primary Health Network, Australia.
| | | | | | - Elaine S Burns
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia.
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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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Somji A, Ramsey K, Dryer S, Makokha F, Ambasa C, Aryeh B, Booth K, Xueref S, Moore S, Mwenesi R, Rashid S. "Taking care of your pregnancy": a mixed-methods study of group antenatal care in Kakamega County, Kenya. BMC Health Serv Res 2022; 22:969. [PMID: 35906642 PMCID: PMC9336107 DOI: 10.1186/s12913-022-08200-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/15/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Traditional antenatal care (ANC) models often do not meet women's needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet with the same health provider for facilitated discussion. F studies show associations between GANC and various outcomes. METHODS We employed a pre-post quasi-experimental design using mixed methods to assess a GANC model (Lea Mimba Pregnancy Clubs) at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1652 women assigned to 162 GANC cohorts. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes including experience of care, empowerment and self-efficacy, knowledge of healthy practices and danger signs, and practice of healthy behaviors, including ANC retention. At endline, we conducted 29 in-depth interviews (IDIs) and three focus group discussions with women who were currently and previously participating in GANC, and 15 IDIs with stakeholders. RESULTS The proportion of survey respondents with knowledge of three or more danger signs during pregnancy more than tripled, from 7.1% at baseline to 26.4% at endline (OR: 4.58; 95% CI: 2.26-10.61). We also found improvements in women's reports about their experience of care between baseline and endline, particularly in their assessment of knowledge and competence of health workers (OR: 2.52 95% CI: 1.57-4.02), respect shown by ANC providers (OR: 1.82, 95% CI: 1.16-2.85), and women's satisfaction with overall quality of care (OR: 1.62, 95% CI: 1.03-2.53). We saw an increase from 58.9% at baseline to 71.7% at endline of women who strongly agreed that they shared their feelings and experiences with other women (OR: 1.73, 95% CI: 1.1-2.7). The mean number of ANC visits increased by 0.89 visits (95% CI: 0.47-1.42) between baseline (4.21) and endline (5.08). No changes were seen in knowledge of positive behaviors, empowerment, self-efficacy, and several aspects related to women's experience of care and adoption of healthy behavior constructs. Qualitatively, women and stakeholders noted improved interactions between health providers and women, improved counseling, increased feelings of empowerment to ask questions and speak freely and strengthened social networks and enhanced social cohesion among women. CONCLUSIONS GANC offers promise for enhancing women's experience of care by providing improved counseling and social support. Additional research is needed to develop and test measures for empowerment, self-efficacy, and experience of care, and to understand the pathways whereby GANC effects changes in specific outcomes.
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Affiliation(s)
- Aleefia Somji
- Management Sciences for Health (MSH), Alexandria, USA
| | | | - Sean Dryer
- Globally Minded Foundation, Burgas, Bulgaria
| | | | | | | | - Kathleen Booth
- Columbia University Mailman School of Public Health, New York, USA
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Durosini I, Triberti S, Sebri V, Giudice AV, Guiddi P, Pravettoni G. Psychological Benefits of a Sport-Based Program for Female Cancer Survivors: The Role of Social Connections. Front Psychol 2021; 12:751077. [PMID: 34899491 PMCID: PMC8664561 DOI: 10.3389/fpsyg.2021.751077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
In the context of sports-based interventions for improving health and quality of life in chronic patients, participants could develop meaningful social relationships that affect their well-being as much as intervention activities. In this study, 80 female cancer survivors participated in a running-based group intervention (2 sessions/week; 1.5 h), while 51 acted as controls. The intervention lasted approximately 5 months. Unfortunately, the length of the intervention was reduced and sport activities were altered by the COVID-19 pandemic and lockdown mid-intervention, while the shared therapy sessions continued online. This possibly altered the results, as anxiety, depression, and physical aspects did not show significant differences between the experimental and control groups after the intervention. Participants reported positive comments on the experience as a whole, especially regarding the positive influence of the newly developed social connections. This was corroborated by significant correlations between group perceived cohesion and anxiety, depression, self-efficacy, and positive experience with the group psychological support. Overall, it is possible to suggest that in the program an important role was played by social connections and support, peer influence and the group experience, preserving positive experiential qualities of the intervention even if it was altered by external circumstances.
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Affiliation(s)
- Ilaria Durosini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Triberti
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Valeria Sebri
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alice Viola Giudice
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Guiddi
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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11
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Vandermorris A, McKinnon B, Sall M, Witol A, Traoré M, Lamesse-Diedhiou F, Bassani DG. Adolescents' experiences with group antenatal care: Insights from a mixed-methods study in Senegal. Trop Med Int Health 2021; 26:1700-1708. [PMID: 34669987 DOI: 10.1111/tmi.13692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Group antenatal care (G-ANC) is an innovative model in which antenatal care is delivered to a group of 8-12 women of similar gestational age. Evidence from high-income countries suggests G-ANC is particularly effective for women from marginalised populations, including adolescents. The objective of this study was to examine the experiences of Senegalese adolescents engaged in group antenatal care. METHODS This convergent parallel mixed-methods study is derived from a larger effectiveness-implementation hybrid pilot study conducted in Kaolack district, Senegal. Quantitative data for adolescent participants were collected through baseline and postnatal surveys and descriptively analysed. One-on-one interviews and focus-group discussions were conducted with adolescent participants, and qualitative data were analysed using qualitative descriptive analysis. RESULTS Forty-five adolescents aged 15-19 participated in G-ANC, with a median age of 18 years. The majority (93.3%) were married, and 64.4% were nulliparous. Findings indicated similar levels of G-ANC participation for adolescent and adult women. The majority (93.1%) of participants who had previously attended individual ANC indicated they would prefer G-ANC to individual care for a future pregnancy. Qualitative findings indicated key facets of consideration relevant to G-ANC for adolescents include social connectedness, the influence of social norms and the opportunity for engagement in healthcare. CONCLUSIONS This study suggests that G-ANC has the potential to be an adolescent-responsive and culturally appropriate method of delivering antenatal care in Senegal.
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Affiliation(s)
- Ashley Vandermorris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Britt McKinnon
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohamadou Sall
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Adrian Witol
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mahamadou Traoré
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Fatma Lamesse-Diedhiou
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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12
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Todhunter L, Hogan-Roy M, Pressman EK. Complications of Pregnancy in Adolescents. Semin Reprod Med 2021; 40:98-106. [PMID: 34375993 DOI: 10.1055/s-0041-1734020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Teenage pregnancy is a complex issue that can have negative socioeconomic and health outcomes. About 11% of births worldwide are by adolescents aged between 15 and 19 years and middle- and low-income countries account for more than 90% of these births. Despite the downward trend in international adolescent pregnancy rates, 10 million unplanned adolescent pregnancies occur annually. Adolescents are also at increase risks of poor obstetric outcomes including preterm delivery, low birth weight, eclampsia, postpartum hemorrhage, anemia, and infant, as well as maternal morbidity. Important additional considerations include increased risk of depression, poor social support, and the need for a multidisciplinary approach to their obstetric care. We look to highlight both the unique socioeconomic and medical factors to consider when caring for these patients and demonstrate that these factors are intertwined.
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Affiliation(s)
- Logan Todhunter
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
| | - Megan Hogan-Roy
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
| | - Eva K Pressman
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
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13
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Renbarger KM, Place JM, Schreiner M. The Influence of Four Constructs of Social Support on Pregnancy Experiences in Group Prenatal Care. WOMEN'S HEALTH REPORTS 2021; 2:154-162. [PMID: 34235502 PMCID: PMC8243703 DOI: 10.1089/whr.2020.0113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/12/2022]
Abstract
Objective: This study aimed to identify the influence of the four constructs of social support on positive pregnancy experiences in CenteringPregnancy, a group prenatal care (GPNC) model. Methods: Using a qualitative descriptive design, semi-structured interviews were conducted with 11 women who had participated in at least 6 of 10 GPNC sessions at a family practice medicine residency. Participants were asked to describe their experiences in GPNC. Results: Using a standard content analysis, four constructs of social support (emotional, informational, instrumental, and appraisal) were identified through three major themes: (1) informational support, offered by peers in GPNC settings, promotes learning and prepares women for motherhood; (2) emotional and appraisal support, offered by peers in GPNC, improves emotional well-being and helps women build lasting, supportive connections with peers, and (3) emotional, informational, instrumental, and appraisal support work in tandem to create positive relationships between women and health care providers. Conclusion: Social support provided a means to a positive prenatal health care experience that facilitated the attainment of new knowledge and the formation of positive relationships with health care providers and peers. The findings of this study can provide health care providers with a framework to examine and enhance their practice and care of women in the perinatal period.
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Affiliation(s)
| | - Jean Marie Place
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, USA
| | - Melanie Schreiner
- IU Health Ball Memorial Family Medicine Residency Center, Muncie, Indiana, USA
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14
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Durosini I, Savioni L, Triberti S, Guiddi P, Pravettoni G. The Motivation Journey: A Grounded Theory Study on Female Cancer Survivors' Experience of a Psychological Intervention for Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:950. [PMID: 33499109 PMCID: PMC7908434 DOI: 10.3390/ijerph18030950] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/25/2022]
Abstract
Psychological interventions are proposed to cancer survivors to support their quality of life against the emotional trauma of cancer and the side effects of treatment. Psychological interventions often require patient engagement and commitment to activities that could be more or less demanding in terms of lifestyle change (e.g., psychotherapy, sports). Analyzing participant motivations (personal aims, expectations, needs) prior to participation is useful to predict their adherence to the intervention as well as final outcomes. Yet, participant motivations may evolve during the intervention because the intervention experience turns out to be meaningful and positively challenging. The present study aimed to obtain a preliminary understanding of the process of motivation change in female cancer survivors who participated in a sport-based intervention to promote quality of life by employing a grounded theory approach. Data analysis took place alongside data collection and according to the procedure of grounded theory ("open coding", "axial coding", and "selective coding") in order to describe the process of motivation change during women's participation in psychological intervention for quality of life. On 14 women interviewed, 13 reported changing their motivation to participate during the first months of involvement, mostly changing from individualistic to group-related motivations (i.e., from self-care to friendship with other participants and enriching group membership), and from physical to psychological growth (i.e., pursuing not only physical health but also self-fulfillment). The discussion explains the preliminary aspects of the motivation change process and highlights the importance to monitor motivation dynamics within psychological interventions.
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Affiliation(s)
- Ilaria Durosini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.S.); (S.T.); (P.G.); (G.P.)
| | - Lucrezia Savioni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.S.); (S.T.); (P.G.); (G.P.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Stefano Triberti
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.S.); (S.T.); (P.G.); (G.P.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Paolo Guiddi
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.S.); (S.T.); (P.G.); (G.P.)
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.S.); (S.T.); (P.G.); (G.P.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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15
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Bazrafshan S, Kheirkhah M, Inanlou M, Rasouli M. Controlling the anxiety in Iranian pregnant women at risk of preterm labor by undergoing the counseling group intervention. J Family Med Prim Care 2020; 9:4016-4025. [PMID: 33110804 PMCID: PMC7586580 DOI: 10.4103/jfmpc.jfmpc_1227_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/25/2020] [Accepted: 06/06/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The effect of a new, structured group training program on the anxiety reduction in Iranian pregnant women at risk of preterm labor (PTL) was assessed. Design A randomized controlled clinical trial. Setting The prenatal care center in the Gynecology Clinic of University Hospital. Population 72 Iranian pregnant women at risk of PTL with a gestational age of 24-28 weeks. Methods Several trained research nurses presented group educational counseling sessions for 6 weeks based on the integration of psychological instructions and interactive lectures for the intervened group (n = 36). Pregnant women in the control group (n = 36) only received routine pregnancy care. Main Outcome Measures The completion of pregnancy-related anxiety questionnaire (PRAQ) for Iranian pregnant women at risk of PTL in the intervention (before and after 6-week counseling, and 1-month post-counseling) and control (before, and on the 6th and 10th week after the study) groups. Results There was a significant difference in the mean anxiety score between the intervention (3.45 ± 0.75) and control (3.01 ± 0.34) groups before the group educational counseling sessions. After this intervention, a significant reduction in the mean anxiety scores of intervened pregnant women (2.48 ± 0.32) compared to the control (2.68 ± 0.81) was found. This decrease in mean anxiety score after the 1-month post-counseling was more pronounced than the 6th week after the study onset (P < 0.001). Low anxiety scores in the intervention group over time were also maintained. Conclusions Implementing the group educational counseling sessions is recommended as a complementary, effective, and noninvasive intervention to efficiently control the anxiety in pregnant women at risk of PTL.
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Affiliation(s)
- Somayeh Bazrafshan
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Kheirkhah
- Nursing Care Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Inanlou
- Nursing Care Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Rasouli
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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16
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Patberg E, Young M, Archer S, Duininck G, Li J, Blackwell C, Lathrop E, Haddad L. Postpartum Contraceptive Use and Other Reproductive Health Outcomes Among CenteringPregnancy Group Prenatal Care Participants. J Womens Health (Larchmt) 2020; 30:990-996. [PMID: 33052781 DOI: 10.1089/jwh.2019.8241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: CenteringPregnancy® is a model of group prenatal care (PNC) that reduces preterm birth and increases patient satisfaction. Less is known about postpartum outcomes. Methods: This study aimed to evaluate whether CenteringPregnancy participants have more favorable postpartum reproductive health outcomes compared with traditional PNC participants. Our primary outcome was utilization of long-acting reversible contraception (LARC). As secondary outcomes, we examined breastfeeding at the postpartum visit, follow-up at the postpartum visit, and rapid repeat pregnancy. We conducted a retrospective cohort study of 422 women who received PNC and delivered at tertiary care hospital in Atlanta, Georgia between 2011 and 2015. Participants were eligible to participate if they were enrolled in Medicaid and received at least three PNC visits with a Certified Nurse Midwife in either CenteringPregnancy (n = 248) or traditional PNC (n = 174). Demographic and clinical data were abstracted from the electronic medical record. Multivariable log binomial regression was used to compare CenteringPregnancy participants and women who received traditional PNC. Results: One quarter of women (26%) chose LARC for postpartum contraception. There was no difference in overall contraceptive uptake between CenteringPregnancy and traditional PNC groups. CenteringPregnancy participants were 70% more likely to use LARC postpartum compared with women receiving traditional PNC (adjusted relative risk [aRR] 1.76; p < 0.01). CenteringPregnancy participants were significantly more likely to initiate breastfeeding before hospital discharge (aRR 1.14, p = 0.01) and to report exclusive breastfeeding at the postpartum visit (relative risk [RR] 2.54; p < 0.01). Women in the CenteringPregnancy group were marginally more likely to report any breastfeeding at the postpartum visit and to attend the postpartum visit (RR 1.31, p = 0.05 and RR 1.17, p = 0.05 respectively), but were no less likely to have a rapid repeat pregnancy (RR 0.90, p = 0.57). Conclusion: Women in CenteringPregnancy groups had increased uptake of LARC compared with a similar cohort of women in traditional PNC. Other potential benefits of CenteringPregnancy, including breastfeeding and attendance at the postpartum visit require further study.
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Affiliation(s)
- Elizabeth Patberg
- Department of Obstetrics and Gynecology, NYU Winthrop Hospital, Mineola, New York, USA
| | - Marisa Young
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sydney Archer
- Department of Ob/Gyn, University of Colorado, Aurora, California, USA
| | - Grace Duininck
- Department of Ob/Gyn, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jessica Li
- Department of Ob/Gyn, Indiana University, Indianapolis, Indiana, USA
| | - Conner Blackwell
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lisa Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
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17
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Romano A, Kennedy HP, Avery MD. Improving US Maternity Care: A 2020 Call to Action to Scale Up Midwifery. J Midwifery Womens Health 2020; 65:595-604. [PMID: 32979000 DOI: 10.1111/jmwh.13158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Amy Romano
- Independent consultant, Milford, Connecticut
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18
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Maldonado LY, Fryer KE, Tucker CM, Stuebe AM. The Association between Travel Time and Prenatal Care Attendance. Am J Perinatol 2020; 37:1146-1154. [PMID: 31189187 DOI: 10.1055/s-0039-1692455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the association between a patient's travel time to clinic and her prenatal care attendance. STUDY DESIGN We conducted a retrospective cohort study of women (≥18 years) who received prenatal care and delivered at North Carolina Women's Hospital between July 1, 2014, and June 30, 2016 (n = 2,808 women, 24,021 appointments). We queried demographic data from the electronic medical record and calculated travel time with ArcGIS. Multinomial logistic regression models estimated the association between travel time and attendance, adjusted for sociodemographic covariates. RESULTS For every 10 minutes of additional travel time, women were 1.05 (95% confidence interval [CI]: 1.02-1.08, p < 0.001) times as likely to arrive late and 1.03 (95% CI: 1.01-1.04, p < 0.001) times as likely to cancel appointments than arrive on time. Travel time did not significantly affect a patient's likelihood of not showing for appointments. Non-Hispanic black patients were 71% more likely to arrive late and 51% more likely to not show for appointments than non-Hispanic white patients (p < 0.05). Publicly insured women were 28% more likely to arrive late to appointments and 82% more likely to not show for appointments than privately insured women (p < 0.05). CONCLUSION Changes to transportation availability alone may only modestly affect outcomes compared with strategically improving access for sociodemographically marginalized women.
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Affiliation(s)
- Lauren Y Maldonado
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kimberly E Fryer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christine M Tucker
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Alison M Stuebe
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina.,Divsion of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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19
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Beecher C, Devane D, White M, Greene R, Dowling M. Women’s experiences of their maternity care: A principle- based concept analysis. Women Birth 2020; 33:419-425. [DOI: 10.1016/j.wombi.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/03/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
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20
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Novick G, Womack JA, Sadler LS. Beyond Implementation: Sustaining Group Prenatal Care and Group Well-Child Care. J Midwifery Womens Health 2020; 65:512-519. [PMID: 32519425 DOI: 10.1111/jmwh.13114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Group prenatal care and group well-child care (collectively called group care) provide health care in groups. Group care is being introduced in many settings, and the model's benefits are increasingly recognized. Yet, little attention has been paid to understanding model sustainability. This study examined barriers to sustainability and offers suggestions for sustaining group care programs. METHODS This qualitative research was guided by interpretive description. Semistructured interviews with 17 professionals were conducted in 4 sites in one community to explore barriers to sustaining group care and key ingredients for sustainability. Sites were 2 clinics that had provided group prenatal care, a clinic currently providing group prenatal care, and a clinic currently providing group well-child care. Two clinics have continued providing group care and 2 have discontinued it. Participants included midwives, physicians, nurses, and nurse practitioners. Interviews were audio recorded, transcribed, and entered in ATLAS.ti. A priori and inductive coding schemes were developed; code content was compared across individuals, participant types, and settings. RESULTS Five themes were identified: administrative buy-in, robust recruitment, clinician and staff buy-in, owning it, and sustainability mindset. Group care needs to be sold to many different constituencies: administrators, staff and clinicians, and patients. Furthermore, sustainability requires having a conscious awareness of the importance of sustainability from the outset, taking ownership by adapting group care to needs of settings, creating venues for expressing divergent viewpoints and problem-solving, and recognizing that these processes are ongoing with change occurring incrementally. It also includes addressing the need for long-term financing. DISCUSSION Those implementing group care must be prepared to go beyond managing the logistics of introducing a complex new program; they must also be prepared to develop sustainability mindsets, sell the model to everyone on all levels within their institutions, and advocate for enhanced reimbursement for group care and value-driven payment systems.
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Affiliation(s)
- Gina Novick
- Yale University School of Nursing, West Haven, Connecticut
| | - Julie A Womack
- Yale University School of Nursing, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lois S Sadler
- Yale University School of Nursing, West Haven, Connecticut.,Yale Child Study Center, New Haven, Connecticut
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21
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Khatony A, Soroush A, Andayeshgar B, Saedpanah N, Abdi A. Attitude of primiparous women towards their preference for delivery method: a qualitative content analysis. ACTA ACUST UNITED AC 2019; 77:38. [PMID: 31452882 PMCID: PMC6700977 DOI: 10.1186/s13690-019-0364-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/06/2019] [Indexed: 11/15/2022]
Abstract
Background The delivery method is one of the primary concerns of primiparous women. Today, due to the fear of delivery, the number of cesarean sections has increased significantly. Considering the importance of choosing the type of delivery and the lack of study in this regard, the present study was conducted to explain the attitude of primiparous women towards their preference for delivery method. Method In this qualitative study, in-depth interview was conducted with 12 primiparous women. The transcripts of the interviews were read carefully by the researcher for several times. Finally, using the analytical method, the codes were extracted and subsequent subcategories and main categories were determined. To assess the credibility of the data, the Denzin & Lincoln’s criteria were used, which include Credibility, Transferability, Dependability, and Confirmability. Results Because of inexperience in delivery and ambiguity in process, most of the woman had a specific fear and they commonly affected by other advices and experiences. The majority of the participants had desire to vaginal delivery with announcing its advantages such as shortage of pain process, easy breast feeding, and mother ability to better carryout the newborn works. Other participants believed on adverse effects of normal vaginal delivery including bladder prolapse, uterus rupture, and probability of experience of both happenings (CS and NVD), frequent examination, pain and urine incontinence. Some stated cesarean section have benefits of less injury to neonate and preserving her/his beauty. Conclusion Results showed that, choosing a delivery method is difficult for primiparous women, and their attitude toward the type of delivery is influenced by subjective and internal factors. Giving awareness to primiparous women greatly enhances their tendency towards vaginal delivery.
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Affiliation(s)
- Alireza Khatony
- 1Health Institute, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Soroush
- 2Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahare Andayeshgar
- 2Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Neda Saedpanah
- 2Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- 3Students Research Committee, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Nursing Department, School of Nursing and Midwifery, Dowlat Abad, Kermanshah, Iran
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22
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Brookfield J. Group antenatal care for Aboriginal and Torres Strait Islander women: An acceptability study. Women Birth 2019; 32:437-448. [PMID: 31326383 DOI: 10.1016/j.wombi.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.
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Affiliation(s)
- Jo Brookfield
- P.O. Box 53, Earlville, Queensland, 4870, Australia.
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23
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Wadsworth KH, Archibald TG, Payne AE, Cleary AK, Haney BL, Hoverman AS. Shared medical appointments and patient-centered experience: a mixed-methods systematic review. BMC FAMILY PRACTICE 2019; 20:97. [PMID: 31286876 PMCID: PMC6615093 DOI: 10.1186/s12875-019-0972-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/31/2019] [Indexed: 12/25/2022]
Abstract
Background Shared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care. In this review, we sought to better understand opportunities, barriers, and limitations to SMAs based on patient experience in the primary care context. Methods An experienced biomedical librarian conducted literature searches of PubMed, Cochrane Library, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and SSRN for peer-reviewed publications published 1997 or after. We searched grey literature, nonempirical reports, social science publications, and citations from published systematic reviews. The search yielded 1359 papers, including qualitative, quantitative, and mixed method studies. Categorization of the extracted data informed a thematic synthesis. We did not perform a formal meta-analysis. Results Screening and quality assessment yielded 13 quantitative controlled trials, 11 qualitative papers, and two mixed methods studies that met inclusion criteria. We identified three consistent models of care: cooperative health care clinic (five articles), shared medical appointment / group visit (10 articles) and group prenatal care / CenteringPregnancy® (11 articles). Conclusions SMAs in a variety of formats are increasingly employed in primary care settings, with no singular gold standard. Accepting and implementing this nontraditional approach by both patients and clinicians can yield measurable improvements in patient trust, patient perception of quality of care and quality of life, and relevant biophysical measurements of clinical parameters. Further refinement of this healthcare delivery model will be best driven by standardizing measures of patient satisfaction and clinical outcomes. Electronic supplementary material The online version of this article (10.1186/s12875-019-0972-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim H Wadsworth
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA.
| | - Trevor G Archibald
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Allison E Payne
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Anita K Cleary
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Byron L Haney
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA.,Family Health Care of Ellensburg, Ellensburg, WA, USA
| | - Adam S Hoverman
- Multnomah County Health Department, Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
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Group Prenatal Care Attendance and Women’s Characteristics Associated with Low Attendance: Results from Centering and Racial Disparities (CRADLE Study). Matern Child Health J 2019; 23:1371-1381. [DOI: 10.1007/s10995-019-02784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Sultana M, Ali N, Akram R, Jahir T, Mahumud RA, Sarker AR, Islam Z. Group prenatal care experiences among pregnant women in a Bangladeshi community. PLoS One 2019; 14:e0218169. [PMID: 31188891 PMCID: PMC6561581 DOI: 10.1371/journal.pone.0218169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Complications during pregnancy, childbirth, and following delivery remain significant challenges that contribute to maternal morbidity and mortality, thus affecting health systems worldwide. Group prenatal care (GPC) is an integrated approach incorporating peer support and health education that provides prenatal care in a group setting. The GPC approach was piloted in a district of Bangladesh to measure the feasibility and effectiveness of GPC compared to individual care. Understanding the experiences of women of receiving this grouped care approach is crucial to understand the perspectives, perception, and acceptability of the programme among mothers, which are lack in Bangladesh. The objective of the present study was to understand the core experiences and perspectives of mothers who participated in GPC sessions during their pregnancy period. Methods A qualitative research approach was used to understand the experiences of women receiving GPC. A total of 21 in-depth interviews were conducted in this study targeting pregnant mothers who attended all recommended GPC sessions. Face-to-face interviews were conducted by trained and experienced interviewers using a specific interview guideline to achieve detailed responses. Thematic analysis was conducted to analyse the data. Results Mothers appreciated receiving pregnancy care in group setting and expressed their preferences towards GPC compared to individual care. Themes included the comprehensiveness of GPC, prescheduled appointments and reduced waiting time, social gathering, coping with common discomforts, relationship with service providers, birth preparedness, and recommendations from participating mothers. The themes conveyed overall positive experiences of the participating mothers, with suggestions for further betterment of the programme. Nevertheless, the reported experiences of women involved in the study suggests that the inclusion of a specialist in group care, post-partum care, and family planning advice will be more beneficial in the GPC model. Conclusions The overall experiences of the women in the present study suggest that GPC is helpful for them, and it is useful to reduce complications during pregnancy. The GPC model promises movement towards family-supported care, as explained by the participants.
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Affiliation(s)
- Marufa Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Health and Social Development, Deakin University, Melbourne, Australia
- * E-mail:
| | - Nausad Ali
- Health System and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Raisul Akram
- Health System and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tania Jahir
- Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Abdur Razzaque Sarker
- Health System and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Management Science, University of Strathclyde, Glasgow, United Kingdom
| | - Ziaul Islam
- School of Commerce, University of Southern Queensland, Toowoomba, Australia
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Downe S, Finlayson K, Tunçalp Ö, Gülmezoglu AM. Provision and uptake of routine antenatal services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 6:CD012392. [PMID: 31194903 PMCID: PMC6564082 DOI: 10.1002/14651858.cd012392.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Antenatal care (ANC) is a core component of maternity care. However, both quality of care provision and rates of attendance vary widely between and within countries. Qualitative research can assess factors underlying variation, including acceptability, feasibility, and the values and beliefs that frame provision and uptake of ANC programmes.This synthesis links to the Cochrane Reviews of the effectiveness of different antenatal models of care. It was designed to inform the World Health Organization guidelines for a positive pregnancy experience and to provide insights for the design and implementation of improved antenatal care in the future. OBJECTIVES To identify, appraise, and synthesise qualitative studies exploring:· Women's views and experiences of attending ANC; and factors influencing the uptake of ANC arising from women's accounts;· Healthcare providers' views and experiences of providing ANC; and factors influencing the provision of ANC arising from the accounts of healthcare providers. SEARCH METHODS To find primary studies we searched MEDLINE, Ovid; Embase, Ovid; CINAHL, EbscoHost; PsycINFO, EbscoHost; AMED, EbscoHost; LILACS, VHL; and African Journals Online (AJOL) from January 2000 to February 2019. We handsearched reference lists of included papers and checked the contents pages of 50 relevant journals through Zetoc alerts received during the searching phase. SELECTION CRITERIA We included studies that used qualitative methodology and that met our quality threshold; that explored the views and experiences of routine ANC among healthy, pregnant and postnatal women or among healthcare providers offering this care, including doctors, midwives, nurses, lay health workers and traditional birth attendants; and that took place in any setting where ANC was provided.We excluded studies of ANC programmes designed for women with specific complications. We also excluded studies of programmes that focused solely on antenatal education. DATA COLLECTION AND ANALYSIS Two authors undertook data extraction, logged study characteristics, and assessed study quality. We used meta-ethnographic and Framework techniques to code and categorise study data. We developed findings from the data and presented these in a 'Summary of Qualitative Findings' (SoQF) table. We assessed confidence in each finding using GRADE-CERQual. We used these findings to generate higher-level explanatory thematic domains. We then developed two lines of argument syntheses, one from service user data, and one from healthcare provider data. In addition, we mapped the findings to relevant Cochrane effectiveness reviews to assess how far review authors had taken account of behavioural and organisational factors in the design and implementation of the interventions they tested. We also translated the findings into logic models to explain full, partial and no uptake of ANC, using the theory of planned behaviour. MAIN RESULTS We include 85 studies in our synthesis. Forty-six studies explored the views and experiences of healthy pregnant or postnatal women, 17 studies explored the views and experiences of healthcare providers and 22 studies incorporated the views of both women and healthcare providers. The studies took place in 41 countries, including eight high-income countries, 18 middle-income countries and 15 low-income countries, in rural, urban and semi-urban locations. We developed 52 findings in total and organised these into three thematic domains: socio-cultural context (11 findings, five moderate- or high-confidence); service design and provision (24 findings, 15 moderate- or high-confidence); and what matters to women and staff (17 findings, 11 moderate- or high-confidence) The third domain was sub-divided into two conceptual areas; personalised supportive care, and information and safety. We also developed two lines of argument, using high- or moderate-confidence findings:For women, initial or continued use of ANC depends on a perception that doing so will be a positive experience. This is a result of the provision of good-quality local services that are not dependent on the payment of informal fees and that include continuity of care that is authentically personalised, kind, caring, supportive, culturally sensitive, flexible, and respectful of women's need for privacy, and that allow staff to take the time needed to provide relevant support, information and clinical safety for the woman and the baby, as and when they need it. Women's perceptions of the value of ANC depend on their general beliefs about pregnancy as a healthy or a risky state, and on their reaction to being pregnant, as well as on local socio-cultural norms relating to the advantages or otherwise of antenatal care for healthy pregnancies, and for those with complications. Whether they continue to use ANC or not depends on their experience of ANC design and provision when they access it for the first time.The capacity of healthcare providers to deliver the kind of high-quality, relationship-based, locally accessible ANC that is likely to facilitate access by women depends on the provision of sufficient resources and staffing as well as the time to provide flexible personalised, private appointments that are not overloaded with organisational tasks. Such provision also depends on organisational norms and values that overtly value kind, caring staff who make effective, culturally-appropriate links with local communities, who respect women's belief that pregnancy is usually a normal life event, but who can recognise and respond to complications when they arise. Healthcare providers also require sufficient training and education to do their job well, as well as an adequate salary, so that they do not need to demand extra informal funds from women and families, to supplement their income, or to fund essential supplies. AUTHORS' CONCLUSIONS This review has identified key barriers and facilitators to the uptake (or not) of ANC services by pregnant women, and in the provision (or not) of good-quality ANC by healthcare providers. It complements existing effectiveness reviews of models of ANC provision and adds essential insights into why a particular type of ANC provided in specific local contexts may or may not be acceptable, accessible, or valued by some pregnant women and their families/communities. Those providing and funding services should consider the three thematic domains identified by the review as a basis for service development and improvement. Such developments should include pregnant and postnatal women, community members and other relevant stakeholders.
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Affiliation(s)
- Soo Downe
- University of Central LancashireResearch in Childbirth and Health (ReaCH) unitPrestonUKPR1 2HE
| | - Kenneth Finlayson
- University of Central LancashireResearch in Childbirth and Health (ReaCH) unitPrestonUKPR1 2HE
| | - Özge Tunçalp
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
| | - Ahmet Metin Gülmezoglu
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
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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.
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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.
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Buultjens M, Murphy G, Ruddock-Hudson M, Milgrom J, Taket A. A qualitative study of women's experience of a perinatal group health-promoting programme. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/bjom.2019.27.2.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Melissa Buultjens
- Senior Lecturer, School of Psychology and Public Health, La Trobe University, Australia
| | - Gregory Murphy
- Professor, School of Psychology and Public Health, La Trobe University, Australia
| | - Mandy Ruddock-Hudson
- Lecturer, School of Psychology and Public Health, La Trobe University, Australia
| | - Jeannette Milgrom
- Director of Clinical and Health Psychology, Parent-Infant Research Institute, Austin Health; and Professor of Psychology, Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - Ann Taket
- Professor and Chair in Health and Social Exclusion Faculty of Health, School of Health and Social Development, Deakin University, Australia
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Womack JA, Novick G, Fried T. The beginning of the end: A qualitative study of falls among HIV+ individuals. PLoS One 2018; 13:e0207006. [PMID: 30408088 PMCID: PMC6224109 DOI: 10.1371/journal.pone.0207006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022] Open
Abstract
Falls are an important concern for individuals living with HIV (HIV+). The purpose of this study was to understand perceptions of HIV+ individuals who had fallen regarding what caused their falls, prevention strategies that they used, and the impact of falls on their lives. Qualitative Description was the approach best suited to our study. We conducted in-depth interviews with 21 HIV+ individuals aged 47 to 71 years who had fallen within the past two years and who received care in a primary care/HIV clinic. Participants identified causes of falls as intrinsic (HIV, opportunistic infections, antiretroviral therapy, substance use, polypharmacy) or extrinsic (icy sidewalks, wet floors). Among those who felt that their falls could be prevented, prevention strategies included physical therapy and avoiding extrinsic fall risk factors. Some participants, however, felt that their falls could not be prevented. While some participants responded adaptively to falls, for many, the experience of falling was connected with deep feelings of loss and suffering. For these individuals, falls were understood to be "the beginning of the end" and a source of social isolation, changing family roles, diminished sense of self, and stigma.
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Affiliation(s)
- Julie A. Womack
- VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Nursing, West Haven, CT, United States of America
| | - Gina Novick
- Yale School of Nursing, West Haven, CT, United States of America
| | - Terri Fried
- VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Internal Medicine, Division of Geriatrics, Yale School of Medicine, New Haven, CT, United States of America
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Sayinzoga F, Lundeen T, Gakwerere M, Manzi E, Nsaba YDU, Umuziga MP, Kalisa IR, Musange SF, Walker D. Use of a Facilitated Group Process to Design and Implement a Group Antenatal and Postnatal Care Program in Rwanda. J Midwifery Womens Health 2018; 63:593-601. [PMID: 30251304 PMCID: PMC6220997 DOI: 10.1111/jmwh.12871] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/28/2018] [Accepted: 04/07/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The government of Rwanda is exploring strategies that may reduce the incidence of prematurity and low birth weight. Large-scale implementation of group antenatal care (ANC) and postnatal care (PNC) within the context of the Rwanda national health care system is under consideration. To launch a cluster randomized controlled trial of group ANC and PNC in 5 districts in Rwanda, the implementation team needed a customized group care model for this context and trained health care workers to deliver the program. PROCESS Adapting the group ANC and group PNC model for the Rwandan context was accomplished through a group process identical to that which is fundamental to group care. A technical working group composed of 10 Rwandan maternal-child health stakeholders met 3 times over the course of 3 months, for 4 to 8 hours each time. Their objectives were to consider the evidence on group ANC, agree on the priorities and constraints of their ANC delivery system, and ultimately define the content and structure of a combined group ANC and PNC model for implementation in Rwanda. The same group process was employed to train health care workers to act as group ANC facilitators. OUTCOMES A customized group ANC and PNC model and guidelines for its introduction were developed in the context of a cluster randomized controlled trial in 36 health centers. Descriptions of this model and the implementation plan are included in this article. DISCUSSION Our experience suggests that the group process fundamental to successful group ANC and PNC is an effective method to customize and implement this innovative health services delivery model in a new context and is instrumental in achieving local ownership.
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Hunter LJ, Da Motta G, McCourt C, Wiseman O, Rayment JL, Haora P, Wiggins M, Harden A. Better together: A qualitative exploration of women's perceptions and experiences of group antenatal care. Women Birth 2018; 32:336-345. [PMID: 30253938 DOI: 10.1016/j.wombi.2018.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/09/2018] [Accepted: 09/09/2018] [Indexed: 11/18/2022]
Abstract
PROBLEM Childbearing women from socio-economically disadvantaged communities and minority ethnic groups are less likely to access antenatal care and experience more adverse pregnancy outcomes. BACKGROUND Group antenatal care aims to facilitate information sharing and social support. It is associated with higher rates of attendance and improved health outcomes. AIMS To assess the acceptability of a bespoke model of group antenatal care (Pregnancy Circles) in an inner city community in England, understand how the model affects women's experiences of pregnancy and antenatal care, and inform further development and testing of the model. METHODS A two-stage qualitative study comprising focus groups with twenty six local women, followed by the implementation of four Pregnancy Circles attended by twenty four women, which were evaluated using observations, focus groups and semi-structured interviews with participants. Data were analysed thematically. FINDINGS Pregnancy Circles offered an appealing alternative to standard antenatal care and functioned as an instrument of empowerment, mediated through increased learning and knowledge sharing, active participation in care and peer and professional relationship building. Multiparous women and women from diverse cultures sharing their experiences during Circle sessions was particularly valued. Participants had mixed views about including partners in the sessions. CONCLUSIONS Group antenatal care, in the form of Pregnancy Circles, is acceptable to women and appears to enhance their experiences of pregnancy. Further work needs to be done both to test the findings in larger, quantitative studies and to find a model of care that is acceptable to women and their partners.
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Affiliation(s)
- Louise J Hunter
- City, University of London, Centre for Maternal and Child Health Research, School of Health Sciences, UK.
| | - Giordana Da Motta
- City, University of London, Centre for Maternal and Child Health Research, School of Health Sciences, UK
| | - Christine McCourt
- City, University of London, Centre for Maternal and Child Health Research, School of Health Sciences, UK
| | - Octavia Wiseman
- City, University of London, Centre for Maternal and Child Health Research, School of Health Sciences, UK
| | - Juliet L Rayment
- City, University of London, Centre for Maternal and Child Health Research, School of Health Sciences, UK
| | - Penny Haora
- University of East London, Institute for Health & Human Development, London, UK
| | - Meg Wiggins
- University College London, Social Science Research Unit, Institute of Education, London, UK
| | - Angela Harden
- University of East London, Institute for Health & Human Development, London, UK; Barts Health NHS Trust, London, UK
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Thompson-Lastad A. Group Medical Visits as Participatory Care in Community Health Centers. QUALITATIVE HEALTH RESEARCH 2018; 28:1065-1076. [PMID: 29781398 PMCID: PMC6500445 DOI: 10.1177/1049732318759528] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In this article, I examine group medical visits, a clinic-based intervention that aims to improve patient health by combining clinical care, health education and peer support. Research shows that health care inequalities are reproduced through the interplay of interpersonal, institutional, and structural factors. I examine changing social relations made possible by group visits, including peer support and an expanded role for patient knowledge. The qualitative data presented here are part of a mixed-methods study of how group medical visits and integrative medicine are combined and implemented for low-income people with chronic conditions. I find that patients take active roles in each other's care, supporting, challenging, and advocating in ways that shift patient-provider relationships. Such shifts demand reflection about what kinds of knowledge matter for health. Health care encounters can reproduce inequality for marginalized patients; this study suggests group visits can restructure patient-provider encounters to interrupt healthcare inequalities.
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Cunningham SD, Grilo S, Lewis JB, Novick G, Rising SS, Tobin JN, Ickovics JR. Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction. Matern Child Health J 2018; 21:770-776. [PMID: 27485493 DOI: 10.1007/s10995-016-2161-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.
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Affiliation(s)
- Shayna D Cunningham
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Stephanie Grilo
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Jessica B Lewis
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Gina Novick
- Yale University School of Nursing, New Haven, CT, USA
| | | | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, USA.,Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
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Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M, Harvey R, Bessey A, Cantrell A, Dennis CL, Ren S, Ragonesi M, Barkham M, Churchill D, Henshaw C, Newstead J, Slade P, Spiby H, Stewart-Brown S. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess 2018; 20:1-414. [PMID: 27184772 DOI: 10.3310/hta20370] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. OBJECTIVES To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness. DATA SOURCES We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013. REVIEW METHODS Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values. RESULTS From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of -1.43 (95% credible interval -4.00 to 1.36)], person-centred approach (PCA)-based and cognitive-behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent-infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive-behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated) and IPT-based intervention in the sensitivity analysis (indicated), although there was considerable uncertainty. Expected value of partial perfect information (EVPPI) for efficacy data was in excess of £150M for each population. Given the EVPPI values, future trials assessing the relative efficacies of promising interventions appears to represent value for money. LIMITATIONS In the NMAs, some trials were omitted because they could not be connected to the main network of evidence or did not provide EPDS scores. This may have introduced reporting or selection bias. No adjustment was made for the lack of quality of some trials. Although we appraised a very large number of studies, much of the evidence was inconclusive. CONCLUSIONS Interventions warrant replication within randomised controlled trials (RCTs). Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. FUTURE WORK RECOMMENDATIONS Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future research conducting RCTs to establish which interventions are most clinically effective and cost-effective should be considered. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003273. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Jane Morrell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Sutcliffe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebecca Harvey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alice Bessey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy-Lee Dennis
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shijie Ren
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margherita Ragonesi
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Dick Churchill
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Henshaw
- Division of Psychiatry, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jo Newstead
- Nottingham Experts Patients Group, Clinical Reference Group for Perinatal Mental Health, Nottingham, UK
| | - Pauline Slade
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Slomian J, Emonts P, Vigneron L, Acconcia A, Glowacz F, Reginster JY, Oumourgh M, Bruyère O. Identifying maternal needs following childbirth: A qualitative study among mothers, fathers and professionals. BMC Pregnancy Childbirth 2017; 17:213. [PMID: 28673272 PMCID: PMC5496411 DOI: 10.1186/s12884-017-1398-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/28/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pregnancy and childbirth are two critical stages in a woman's life. Various studies have suggested that psychological distress is common during the year after childbirth. The objectives of this exploratory study were (1) to explore the needs of mothers in the year following childbirth; (2) to compare these needs between mothers who did not have the feeling of living a psychological disorder or a depression and mothers who lived a psychological disorder or had the impression of living a depression; and (3) to compare the needs expressed by mothers with the perception of professionals and fathers about the mothers' needs. METHODS First, we proceeded to 22 individual qualitative interviews followed by one focus group, with mothers, with and without experience of psychological distress. Then, we conducted 2 focus groups: one with professionals and one with fathers. RESULTS Needs of mothers after childbirth have been indexed in four categories: need of information, need of psychological support, need to share experience, and need of practical and material support. Women do not feel sufficiently informed about this difficult period of life. They do not feel sufficiently supported, not only from a psychological point of view but also from a more practical point of view, for example with household chores. They need to share their experience of life, they need to be reassured and they need to feel understood. It seems that some differences exist between mothers' and professionals' experiences but also between mothers' and fathers' experiences. CONCLUSION Young mothers apparently feel a lack of support at different levels in the year following childbirth. This study provides ways to meet women's needs and to try to prevent the risk of postpartum psychological distress during this period of time.
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Affiliation(s)
- J Slomian
- Department of Public Health, Epidemiology and Health Economics and Support Unit in Epidemiology and Biostatistics, University of Liège, Avenue Hippocrate 13, Bât. B23, 4000, Liège, Belgium.
| | - P Emonts
- Department of Obstetrics and Gynaecology, CHU Liège, Avenue Hippocrate 13, Bât. B23, 4000, Liège, Belgium
| | - L Vigneron
- Wallonia e-health Living Lab, The labs, Parc scientifique du Sart-Tilman, Rue Bois Saint Jean 15/1, 4102, Liège, Belgium
| | - A Acconcia
- Wallonia e-health Living Lab, The labs, Parc scientifique du Sart-Tilman, Rue Bois Saint Jean 15/1, 4102, Liège, Belgium
| | - F Glowacz
- Department of Psychology, University of Liège, Quartier Hôpital, Avenue Hippocrate 13, Bât. B23, 4000, Liège, Belgium
| | - J Y Reginster
- Department of Public Health, Epidemiology and Health Economics and Support Unit in Epidemiology and Biostatistics, University of Liège, Avenue Hippocrate 13, Bât. B23, 4000, Liège, Belgium.,Public Health Department, Bone and cartilage metabolism Department, CHU Liège, Quai Godefroid Kurth 45, 4000, Liège, Belgium
| | - M Oumourgh
- Department of Public Health, Epidemiology and Health Economics and Support Unit in Epidemiology and Biostatistics, University of Liège, Avenue Hippocrate 13, Bât. B23, 4000, Liège, Belgium
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics and Support Unit in Epidemiology and Biostatistics, University of Liège, Avenue Hippocrate 13, Bât. B23, 4000, Liège, Belgium.,Department of Motricity Science, University of Liège, Liège, Belgium.,Public Health Department, Bone and cartilage metabolism Department, CHU Liège, Quai Godefroid Kurth 45, 4000, Liège, Belgium
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Mazzoni SE, Carter EB. Group prenatal care. Am J Obstet Gynecol 2017; 216:552-556. [PMID: 28189608 DOI: 10.1016/j.ajog.2017.02.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/26/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
Patients participating in group prenatal care gather together with women of similar gestational ages and 2 providers who cofacilitate an educational session after a brief medical assessment. The model was first described in the 1990s by a midwife for low-risk patients and is now practiced by midwives and physicians for both low-risk patients and some high-risk patients, such as those with diabetes. The majority of literature on group prenatal care uses CenteringPregnancy, the most popular model. The first randomized controlled trial of CenteringPregnancy showed that it reduced the risk of preterm birth in low-risk women. However, recent meta-analyses have shown similar rates of preterm birth, low birthweight, and neonatal intensive care unit admission between women participating in group prenatal care and individual prenatal care. There may be subgroups, such as African Americans, who benefit from this type of prenatal care with significantly lower rates of preterm birth. Group prenatal care seems to result in increased patient satisfaction and knowledge and use of postpartum family planning as well as improved weight gain parameters. The literature is inconclusive regarding breast-feeding, stress, depression, and positive health behaviors, although it is theorized that group prenatal care positively affects these outcomes. It is unclear whether group prenatal care results in cost savings, although it may in large-volume practices if each group consists of approximately 8-10 women. Group prenatal care requires a significant paradigm shift. It can be difficult to implement and sustain. More randomized trials are needed to ascertain the true benefits of the model, best practices for implementation, and subgroups who may benefit most from this innovative way to provide prenatal care. In short, group prenatal care is an innovative and promising model with comparable pregnancy outcomes to individual prenatal care in the general population and improved outcomes in some demographic groups.
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Affiliation(s)
- Sara E Mazzoni
- Department of Obstetrics and Gynecology, Divisions of Women's Reproductive Healthcare and Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL.
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, MO
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Chen L, Crockett AH, Covington-Kolb S, Heberlein E, Zhang L, Sun X. Centering and Racial Disparities (CRADLE study): rationale and design of a randomized controlled trial of centeringpregnancy and birth outcomes. BMC Pregnancy Childbirth 2017; 17:118. [PMID: 28403832 PMCID: PMC5390374 DOI: 10.1186/s12884-017-1295-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/25/2017] [Indexed: 11/25/2022] Open
Abstract
Background In the United States, preterm birth (PTB) before 37 weeks gestational age occurs at an unacceptably high rate, and large racial disparities persist. To date, medical and public health interventions have achieved limited success in reducing rates of PTB. Innovative changes in healthcare delivery are needed to improve pregnancy outcomes. One such model is CenteringPregnancy group prenatal care (GPNC), in which individual physical assessments are combined with facilitated group education and social support. Most existing studies in the literature on GPNC are observational. Although the results are promising, they are not powered to detect differences in PTB, do not address the racial disparity in PTB, and do not include measures of hypothesized mediators that are theoretically based and validated. The aims of this randomized controlled trial (RCT) are to compare birth outcomes as well as maternal behavioral and psychosocial outcomes by race among pregnant women who participate in GPNC to their counterparts in individual prenatal care (IPNC) and to investigate whether improving women’s behavioral and psychosocial outcomes will explain the potential benefits of GPNC on birth outcomes and racial disparities. Methods/design This is a single site RCT study at Greenville Health System in South Carolina. Women are eligible if they are between 14–45 years old and enter prenatal care before 20 6/7 weeks of gestational age. Eligible, consenting women will be randomized 1:1 into GPNC group or IPNC group, stratified by race. Women allocated to GPNC will attend 2-h group prenatal care sessions according to the standard curriculum provided by the Centering Healthcare Institute, with other women due to deliver in the same month. Women allocated to IPNC will attend standard, traditional individual prenatal care according to standard clinical guidelines. Patients in both groups will be followed up until 12 weeks postpartum. Discussion Findings from this project will provide rigorous scientific evidence on the role of GPNC in reducing the rate of PTB, and specifically in reducing racial disparities in PTB. Establishing the improved effect of GPNC on pregnancy and birth outcomes can change the way healthcare is delivered, particularly with populations with higher rates of PTB. Trial registration NCT02640638 Date Registered: 12/20/2015.
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Affiliation(s)
- Liwei Chen
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA.
| | - Amy H Crockett
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, SC, 29605, USA
| | - Sarah Covington-Kolb
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, SC, 29605, USA
| | - Emily Heberlein
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, 30303, USA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Xiaoqian Sun
- Department of Mathematical Sciences, Clemson University, Clemson, SC, 29634, USA
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Kweekel L, Gerrits T, Rijnders M, Brown P. The Role of Trust in CenteringPregnancy: Building Interpersonal Trust Relationships in Group-Based Prenatal Care in The Netherlands. Birth 2017; 44:41-47. [PMID: 28198099 DOI: 10.1111/birt.12260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND CenteringPregnancy (CP) is a specific model of group-based prenatal care for women, implemented in 44 midwifery practices in The Netherlands since 2011. Women have evaluated CP positively, especially in terms of social support, and improvements have been made in birthweight and preterm-birth outcomes; however, there is limited understanding as to why. The purpose of this study was to examine the mechanisms that create trusting relationships within CP to better understand CP outcomes and effectiveness. METHODS A qualitative study was conducted using in-depth interviews with 26 (former) CP participants, alongside observations of CP sessions. All interviews were transcribed and analyzed following open, axial, and selective coding. RESULTS Most women characterized trust as a positive expectation about how others would respond to sensitive information that was shared within the group. Trust emerged within the data as a multidimensional concept and several preconditions seemed crucial in building trusting relations: vulnerability, communication, reciprocity, chemistry, and atmosphere. The facilitating of interpersonal trust among CP participants enhanced group processes, especially as a basis for social support by which women said they were more eager to share sensitive information in a trusting environment. CONCLUSIONS Processes of trust were interwoven within various CP group dynamics. Trust facilitated social support which in turn enabled reassurance and the building of women's self-confidence.
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Affiliation(s)
| | - Trudie Gerrits
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Patrick Brown
- Department of Sociology and Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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Promoting improved social support and quality of life with the CenteringPregnancy ® group model of prenatal care. Arch Womens Ment Health 2017; 20:209-220. [PMID: 27988822 DOI: 10.1007/s00737-016-0698-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/27/2016] [Indexed: 11/27/2022]
Abstract
This prospective cohort study compared women participating in CenteringPregnancy® group prenatal care (N = 120) with those in standard individual care (N = 221) to determine if participation in Centering was associated with improvements in perceived social support and quality of life, with concomitant decreases in screens of postpartum depression and improvements in breastfeeding rates. Participants completed surveys at the onset of prenatal care, in the late third trimester and in the postpartum period. Centering participants had higher scores of perceived social support from friends after participating in group care (p < 0.05) with associated improvements in quality of life in the psychological and relational domains (p < 0.05) compared to standard care participants who showed higher scores of perceived support from family (p < 0.05) but did not show concomitant improvements in quality of life. This did not translate to any significant difference in scores on postpartum depression screens but was associated with improvements in breastfeeding continuation rates among Centering participants in the postpartum period. This study indicates that Centering care is associated with improved perceptions of peer social support with associated improvements in quality of life and higher rates of continued breastfeeding.
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Kearney L, Kynn M, Craswell A, Reed R. The relationship between midwife-led group-based versus conventional antenatal care and mode of birth: a matched cohort study. BMC Pregnancy Childbirth 2017; 17:39. [PMID: 28103820 PMCID: PMC5244557 DOI: 10.1186/s12884-016-1216-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwife facilitated, group models of antenatal care have emerged as an alternative to conventional care both within Australia and internationally. Group antenatal care can be offered in a number of different ways, however usually constitutes a series of sessions co-ordinated by a midwife combining physical assessment, antenatal education and peer support in a group setting. Midwife-led group antenatal care is viewed positively by expectant mothers, with no associated adverse outcomes identified in the published literature for women or their babies when compared with conventional care. Evidence of an improvement in outcomes is limited. The aim of this study was to compare mode of birth (any vaginal birth with caesarean birth) between pregnant women accessing midwife-led group antenatal care and conventional individual antenatal care, in Queensland, Australia. METHODS This was a retrospective matched cohort study, set within a collaborative antenatal clinic between the local university and regional public health service in Queensland, Australia. Midwife-led group antenatal care (n = 110) participants were compared with controls enrolled in conventional antenatal care (n = 330). Groups were matched by parity, maternal age and gestation to form comparable groups, selecting a homogeneous sample with respect to confounding variables likely to affect outcomes. RESULTS There was no evidence that group care resulted in a greater number of caesarean births. The largest increase in the odds of caesarean birth was associated with a previous caesarean birth (p < 0.001), no previous birth (compared with previous vaginal birth) (p < 0.003), and conventional antenatal care (p < 0.073). The secondary outcomes (breastfeeding and infant birth weight) which were examined between the matched cohorts were comparable between groups. CONCLUSIONS There is no evidence arising from this study that there was a significant difference in mode of birth (caesarean or vaginal) between group and conventional care. Group care was associated with a lower risk of caesarean birth after controlling for previous births, with the highest chance for a vaginal birth being a woman who has had a previous vaginal birth and was in group care. Conversely, the highest risk of caesarean birth was for women who have had a previous caesarean birth and conventional care.
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Affiliation(s)
- Lauren Kearney
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
- Women and Families Service Group, Sunshine Coast Hospital and Health Service, Maroochydore DC, Queensland Australia
| | - Mary Kynn
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
| | - Alison Craswell
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
| | - Rachel Reed
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
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42
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Invested in Success: A Qualitative Study of the Experience of CenteringPregnancy Group Prenatal Care for Perinatal Educators. J Perinat Educ 2017; 26:125-135. [PMID: 30723376 DOI: 10.1891/1058-1243.26.3.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to understand the central meaning of the experience of providing CenteringPregnancy for perinatal educators who were facilitators for the group sessions. Four perinatal educators participated in one-on-one interviews and/or a validation focus group. Six themes emerged: (a) "stepping back and taking on a different role," (b) "supporting transformation," (c) "getting to knowing," (d) "working together to bridge the gap," (e) "creating the environment," and (f) "fostering community." These themes contributed to the core phenomenon of being "invested in success." Through bridging gaps and inconsistencies in information received from educators and physicians, this model of CenteringPregnancy provides an opportunity for women to act on relevant information more fully than more traditional didactic approaches to perinatal education.
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McDonald SD, Sword W, Eryuzlu LN, Neupane B, Beyene J, Biringer AB. Why Are Half of Women Interested in Participating in Group Prenatal Care? Matern Child Health J 2016; 20:97-105. [PMID: 26243139 DOI: 10.1007/s10995-015-1807-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the likelihood of participating in group prenatal care (GPC) and associated factors among low-risk women receiving traditional prenatal care from obstetricians, family physicians or midwives, and to determine factors associated with likelihood of participating. METHODS Prior to completing a self-administered questionnaire, a 2-min compiled video of GPC was shown to pregnant women receiving traditional prenatal care. Data were collected on opinions of current prenatal care, GPC, and demographics. Biologically plausible variables with a p value ≤0.20 were entered in the multivariable logistic regression model and those with a p value <0.05 were retained. RESULTS Of 477 respondents, 234 [49.2%, 95% confidence interval (CI) 44.6-53.6%] reported being "definitely" or "probably likely" to participate in GPC. Women were more likely to participate in GPC if they had at least postsecondary education [adjusted odds ratio (aOR) 1.84, 95% CI 1.05-3.24], had not discussed labour with their care provider (aOR 1.67, 95% CI 1.12-2.44), and valued woman-centeredness ("fairly important" aOR 2.81, 95% CI 1.77-4.49; "very important" aOR 4.10, 95% CI 2.45-6.88). Women placed high importance on learning components of GPC. The majority would prefer to be with similar women, especially in age. About two-thirds would prefer to have support persons attend GPC and over half would be comfortable with male partners. CONCLUSION Approximately half of women receiving traditional prenatal care were interested in participating in GPC. Our findings will hopefully assist providers interested in optimizing satisfaction with traditional prenatal care and GPC by identifying important elements of each, and thus help engage women to consider GPC.
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Affiliation(s)
- Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, HSC 3N52B, Hamilton, ON, L8S4K1, Canada.
| | - Wendy Sword
- Department of Clinical Epidemiology and Biostatistics, School of Nursing, McMaster University, 1280 Main St. West, Hamilton, ON, L8S4K1, Canada
| | - Leyla N Eryuzlu
- Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, ON, L8S4K1, Canada
| | - Binod Neupane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, HSC 3N52B, Hamilton, ON, L8S4K1, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, 1280 Main St. West, MDCL 3211, Hamilton, ON, L8S4K1, Canada
| | - Anne B Biringer
- Department of Family and Community Medicine, University of Toronto, 60 Murray Street, Fourth Floor, Toronto, ON, M5T 3L9, Canada
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Lathrop B, Pritham UA. A pilot study of prenatal care visits blended group and individual for women with low income. Nurs Womens Health 2016; 18:462-74. [PMID: 25495967 DOI: 10.1111/1751-486x.12159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Healthy Pregnancy, Healthy Childbirth, Healthy Parenting (HPCP) is a blended prenatal care model that integrates group visits with individual prenatal visits. While group prenatal care has been found to have a positive impact on pregnancy outcomes, current models may not be feasible or desirable in all clinical settings. HPCP offers one educational group visit each trimester to improve knowledge of self-care during pregnancy and of childbirth and infant care. The program was piloted among women with low income in a southern metropolitan area. This article presents the findings of a pilot study that examined maternal knowledge acquisition and subsequent changes in self-efficacy and satisfaction with care. Suggestions for future use of a blended model for the delivery of prenatal care are shared.
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Yang YO. Penetrating the Fog: The Experience of Being Pregnant in Taiwan. Nurs Sci Q 2016; 29:237-40. [PMID: 27271138 DOI: 10.1177/0894318416647779] [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: 11/17/2022]
Abstract
The purpose of this column is to explore the experience of being pregnant as talked about by women in Taiwan. In nursing and healthcare in general, there is a tendency to objectify the experience from a biomedical view, focusing on physiological changes and symptoms. A human science approach is here applied to help understand the themes that were evident in the comments of 23 pregnant Taiwanese women, about what being pregnant was like for them. The perspective used for the explanation was Parse's humanbecoming paradigm. Being pregnant is seen by the author as a chosen way of becoming visible-invisible becoming in the world which involves; being oneself, but not oneself, doubling up, and living with the mystery of the other.
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Affiliation(s)
- Yu-O Yang
- Associate Professor, Kaohsiung Medical University, Kaohsiung, Taiwan
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Heberlein EC, Picklesimer AH, Billings DL, Covington-Kolb S, Farber N, Frongillo EA. Qualitative Comparison of Women's Perspectives on the Functions and Benefits of Group and Individual Prenatal Care. J Midwifery Womens Health 2016; 61:224-34. [DOI: 10.1111/jmwh.12379] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Group prenatal care is an emerging trend in obstetrics, and for medically low-risk women has been shown to result in lower rates of preterm birth, higher rates of breastfeeding, and higher rates of participation in postpartum family planning. Significant cost savings to the health care system are seen when the lower rates of preterm birth and neonatal intensive care unit admissions are considered. More research is needed about patients' health outcomes as well as the economic and workforce implications to outpatient obstetric practices before widely transitioning prenatal care into group settings.
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Earnshaw VA, Rosenthal L, Cunningham SD, Kershaw T, Lewis J, Rising S, Stasko E, Tobin J, Ickovics JR. Exploring Group Composition among Young, Urban Women of Color in Prenatal Care: Implications for Satisfaction, Engagement, and Group Attendance. Womens Health Issues 2016; 26:110-5. [PMID: 26542382 PMCID: PMC4690784 DOI: 10.1016/j.whi.2015.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Group models of prenatal care continue to grow in popularity. However, little is known about how group composition (similarity or diversity between members of groups) relates to care-related outcomes. The current investigation aimed to explore associations between prenatal care group composition with patient satisfaction, engagement, and group attendance among young, urban women of color. METHODS Data were drawn from two studies conducted in New Haven and Atlanta (2001-2004; n = 557) and New York City (2008-2011; n = 375) designed to evaluate group prenatal care among young, urban women of color. Women aged 14 to 25 were assigned to group prenatal care and completed surveys during their second and third trimesters of pregnancy. Group attendance was recorded. Data were merged and analyzed guided by the Group Actor-Partner Interdependence Model using multilevel regression. Analyses explored composition in terms of age, race, ethnicity, and language. MAIN FINDINGS Women in groups with others more diverse in age reported greater patient engagement and, in turn, attended more group sessions, b(se) = -0.01(0.01); p = .04. CONCLUSION The composition of prenatal care groups seems to be associated with young women's engagement in care, ultimately relating to the number of group prenatal care sessions they attend. Creating groups diverse in age may be particularly beneficial for young, urban women of color, who have unique pregnancy needs and experiences. Future research is needed to test the generalizability of these exploratory findings.
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Affiliation(s)
- Valerie A. Earnshaw
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lisa Rosenthal
- Department of Psychology, Pace University, New York City, NY
| | | | - Trace Kershaw
- School of Public Health, Yale University, New Haven, CT
| | - Jessica Lewis
- School of Public Health, Yale University, New Haven, CT
| | | | - Emily Stasko
- Department of Psychology, Drexel University, Philadelphia, PA
| | - Jonathan Tobin
- Clinical Directors Network, New York, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
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Novick G, Womack JA, Lewis J, Stasko EC, Rising SS, Sadler LS, Cunningham SC, Tobin JN, Ickovics JR. Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites. Res Nurs Health 2015; 38:462-74. [PMID: 26340483 DOI: 10.1002/nur.21681] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/06/2022]
Abstract
Group prenatal care improves perinatal outcomes, but implementing this complex model places substantial demands on settings designed for individual care. To describe perceived barriers and facilitators to implementing and sustaining CenteringPregnancy Plus (CP+) group prenatal care, 24 in-depth interviews were conducted with 22 clinicians, staff, administrators, and study personnel in six of the 14 sites of a randomized trial of the model. All sites served low-income, minority women. Sites for the present evaluation were selected for variation in location, study arm, and initial implementation response. Implementing CP+ was challenging in all sites, requiring substantial adaptations of clinical systems. All sites had barriers to meeting the model's demands, but how sites responded to these barriers affected whether implementation thrived or struggled. Thriving sites had organizational cultures that supported innovation, champions who advocated for CP+, and staff who viewed logistical demands as manageable hurdles. Struggling sites had bureaucratic organizational structures and lacked buy-in and financial resources, and staff were overwhelmed by the model's challenges. Findings suggested that implementing and sustaining health care innovation requires new practices and different ways of thinking, and health systems may not fully recognize the magnitude of change required. Consequently, evidence-based practices are modified or discontinued, and outcomes may differ from those in the original controlled studies. Before implementing new models of care, clinical settings should anticipate model demands and assess capacity for adapting to the disruptions of innovation.
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Affiliation(s)
- Gina Novick
- Assistant Professor, School of Nursing, Yale University West Campus, P.O. Box 27399, West Haven, CT, 06516
| | - Julie A Womack
- Assistant Professor, Yale University School of Nursing, VA Connecticut Healthcare System, West Haven, CT
| | - Jessica Lewis
- Research Associate, Yale School of Public Health, New Haven, CT
| | - Emily C Stasko
- Doctoral Student, Department of Psychology, Drexel University, Philadelphia, PA
| | - Sharon S Rising
- Founder and President Emeritus, Centering Healthcare Institute, Silver Spring, MD
| | - Lois S Sadler
- Professor, Yale University School of Nursing, Yale Child Study Center, West Haven, CT
| | | | - Jonathan N Tobin
- President/CEO, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Clinical Directors Network, Bronx, NY
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Tucker Edmonds B, Mogul M, Shea JA. Understanding low-income African American women's expectations, preferences, and priorities in prenatal care. FAMILY & COMMUNITY HEALTH 2015; 38:149-157. [PMID: 25739062 DOI: 10.1097/fch.0000000000000066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We aimed to explore factors affecting prenatal care attendance and preferences for prenatal care experiences among low-income black women by conducting a focus group study using a community-based participatory research framework and nominal group technique. Discussions were audiorecorded, transcribed, and coded by trained reviewers. Friends/family and baby's health were the top attendance motivators. Greatest barriers were insurance, transportation, and ambivalence. Facilitators included transportation services, social support, and resource education. In a "perfect system," women wanted continuity of care, personal connection, and caring/respect from providers. Relationship-centered maternity care models may mitigate disparities. Group prenatal care may provide the continuity and support system desired.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Indiana University School of Medicine, Obstetrics & Gynecology, Indianapolis (Dr Tucker Edmonds); Maternity Care Coalition, Philadelphia, Pennsylvania (Dr Mogul); and University of Pennsylvania School of Medicine (Dr Shea)
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