Group prenatal care: effectiveness and challenges to implementation

Andrade-Romo, Zafiro; Heredia-Pi, Ileana; Fuentes-Rivera, Evelyn; Alcalde‐Rabanal, Jacqueline Elizabeth; Cacho, Lourdes Bravo Bolaños; Jurkiewicz, Laurie; Darney, Blair G.

doi:10.11606/s1518-8787.2019053001303

Cited by 13 publications

(8 citation statements)

References 26 publications

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“…The evidence for improvements in knowledge of healthy behaviors was inconclusive: while knowledge of danger signs tripled among GANC participants, no statistical difference was found in knowledge of positive health behaviors between baseline and endline. This contradicts what is generally found in the literature [17,23,34,35], which has reported improvements in all aspects of knowledge. A recent study in Nepal [31] also found that knowledge of danger signs signi cantly improved, but knowledge of birth preparation decreased, from baseline to endline.…”

Section: Discussioncontrasting

confidence: 95%

“…We found few studies describing implementation experience; one study in India [15] reported similar challenges, including inadequate sta ng, issues with scheduling, and long wait times. One systematic review [35] also underscored demand-and supply-related challenges, including those related to personnel, participant retention, and physical resources, that occurred as part of GANC implementation.…”

Section: Discussionmentioning

confidence: 99%

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“Taking Care of Your Pregnancy”: A Mixed-Methods Study of Group Antenatal Care in Kakamega County, Kenya

Somji¹,

Ramsey²,

Dryer³

et al. 2020

Preprint

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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. There are few studies that show associations between GANC and various outcomes. Methods: We used mixed methods to evaluate a contextualized GANC model (Lea Mimba Pregnancy Clubs) and to understand implementation experiences at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1,652 women who were assigned to 162 GANC cohorts to assess ANC retention. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes and used time diaries to assess wait times. 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: GANC was associated with enhanced social support, with some evidence for improved knowledge, adoption of healthy behaviors, enhanced self-efficacy, and improved experience of care. Quantitatively, we found strong associations with knowledge of danger signs, women who shared their feelings with other women, knowledge and competence of health workers, respect shown by ANC providers, overall quality of care, and birth preparations. No changes were seen in knowledge of positive behaviors, empowerment, several aspects of the experience of care, ANC retention, early ANC, and other healthy behaviors. Qualitatively, women and stakeholders noted improvements in 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. Both wait times and counseling times increased in GANC compared to traditional ANC.Conclusions: This is one of the few mixed-methods studies evaluating GANC and offers new measures for experience of care, empowerment, and adoption of healthy behaviors. While more research is required, GANC holds promise for enhancing women’s experiences during pregnancy. Modifications are needed for sustainability and scalability.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

“Taking Care of Your Pregnancy”: A Mixed-Methods Study of Group Antenatal Care in Kakamega County, Kenya

Somji¹,

Ramsey²,

Dryer³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The evidence for improvements in knowledge was inconclusive: while knowledge of danger signs tripled among GANC participants, no statistical difference was found in knowledge of positive health behaviors between baseline and endline. This contradicts what is generally found in the literature (17,21,36,37), which has reported improvements in all aspects of knowledge. A recent study in Nepal (38) also found that knowledge of danger signs improved, but knowledge of birth preparation decreased, from baseline to endline.…”

Section: Discussioncontrasting

confidence: 85%

“Taking Care of Your Pregnancy”: A mixed-methods study of group antenatal care in Kakamega County, Kenya

Somji

Ramsey²,

Dryer

et al. 2021

Preprint

View full text Add to dashboard Cite

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. There are few studies that show associations between GANC and various outcomes. Methods We used mixed methods to evaluate a contextualized GANC model (Lea Mimba Pregnancy Clubs) and to understand implementation experiences at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1,652 women who were assigned to 162 GANC cohorts to assess ANC retention. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes and used time diaries to assess wait times. 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 GANC was associated with enhanced social support, with some evidence for improved knowledge, adoption of healthy behaviors, enhanced self-efficacy, and improved experience of care. Quantitatively, we found strong associations between GANC and knowledge of danger signs, women who shared their feelings with other women, knowledge and competence of health workers, respect shown by ANC providers, overall quality of care, and birth preparations; as well as an improvement in ANC retention. No changes were seen in knowledge of positive behaviors, empowerment, several aspects related to women’s experience of care, ANC retention, early initiation of ANC, and other healthy behaviors. 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. Both wait times and counseling times increased in GANC compared to traditional ANC. Conclusions This is one of the few mixed-methods studies evaluating GANC and offers new measures for experience of care, empowerment, and adoption of healthy behaviors. While more research is required, GANC holds promise for enhancing women’s experiences during pregnancy. Modifications are needed for sustainability and scalability.

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“…The G-ANC model is being implemented and has been reported in more than 22 countries including India, but there are some challenges. Problems include additional resource allocation in terms of logistical support, as well as organizational issues, privacy concerns, and adaptation of materials for beneficiaries [ 4 ].…”

Section: Challenges To Providing Group Antenatal Care In Low- and Midmentioning

confidence: 99%

Group Antenatal Care: A Paradigm Shift to Explore for Positive Impacts in Resource-poor Settings

Gaur

Vasudevan

Pegu

2021

J Prev Med Public Health

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The delivery of high-quality antenatal care is a perennial global concern for improving maternal and neonatal outcomes. Antenatal care is currently provided mainly on a one-to-one basis, but growing evidence has emerged to support the effectiveness of group antenatal care. Providing care in a small group gives expectant mothers the opportunity to have discussions with their peers about certain issues and concerns that are unique to them and to form a support system that will improve the quality and utilization of antenatal care services. The aim of this article is to promote group antenatal care as a means to increase utilization of healthcare.

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Group prenatal care: effectiveness and challenges to implementation

Cited by 13 publications

References 26 publications

“Taking Care of Your Pregnancy”: A Mixed-Methods Study of Group Antenatal Care in Kakamega County, Kenya

“Taking Care of Your Pregnancy”: A Mixed-Methods Study of Group Antenatal Care in Kakamega County, Kenya

“Taking Care of Your Pregnancy”: A mixed-methods study of group antenatal care in Kakamega County, Kenya

Group Antenatal Care: A Paradigm Shift to Explore for Positive Impacts in Resource-poor Settings

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