Adapting group-based postpartum and well-child care using a human-centered design approach in Malawi

Abstract

Background. Responsive and resilient strategies to reduce the high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of highest maternal and infant mortality rates globally. Group-based healthcare is one such strategy to improve maternal and child health outcomes. Group-based care has been applied to the perinatal period, but less attention has been paid its potential benefits in postpartum care. The postpartum period is a period of opportunity for innovative approaches to engage mothers and children in care and contribute to the reduction of maternal and infant mortality and morbidity. We present the adaption of an evidence-based group-based perinatal care model to the postpartum period using human centered design with key stakeholders in Malawi. Methods. To adapt the perinatal group-based care model for the Malawian context, the team completed four steps of a five-step framework guiding the use of human centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Steps 2-4 relied on qualitative methods, in-depth interviews, and incubator sessions with key stakeholders to produce a prototype of the group-based postpartum care model. Results Once the stakeholders had defined the problem of limited postpartum care in the context and assembled local and global team members, we completed 20 interviews and 6 incubator sessions with stakeholders. All stakeholders reported a desire to participate in and offer group care in the postpartum period in their community. Health promotion priorities identified were hygiene (e.g., perineal care), breastfeeding, family planning, nutrition, and mental health. The recommended group-based care implementation schedule includes 6 sessions that corresponds with the child vaccination schedule over the 12-month postpartum period. A prototype for the curriculum and implementation structure for group postpartum and well-child care was created based on the findings. Conclusions A human centered design approach to adapt an evidence-based group-based care approach to an LMIC, Malawi is feasible and acceptable to key stakeholders and resulted in a prototype curriculum with practical strategies for implementation in the health care setting.