Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence

Abstract

Background High-quality antenatal care (ANC) provides a lifesaving opportunity for women and their newborns through providing health promotion, disease prevention, and early diagnosis and treatment of pregnancy-related health issues. However, systematically synthesised evidence on factors influencing the quality of ANC services is lacking. This scoping review aims to systematically synthesize the factors influencing in provision and utilisation of quality ANC services. Methods We conducted a scoping review of published evidence on the quality of ANC services. We searched records on four databases (PubMed, Scopus, Embase, and Google scholar) and grey literature from 1 to 2011 to 30 August 2021. We analysed data using Braun and Clarke’s thematic analysis approach. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline for the review. We explained themes using the Donabedian healthcare quality assessment model (input-process-output). Results Several inputs- and process-related factors contributed to suboptimal quality of ANC in many low and lower- or middle-income countries. Input factors included facility readiness (e.g., lack of infrastructure, provision of commodities and supplies, health workforce, structural and intermediary characteristics of pregnant women, and service delivery approaches). Processes-related factors included technical quality of care (e.g., lack of skilled adequate and timely care, and poor adherence to the guidelines) and social quality (lack of effective communication and poor client satisfaction). These input and process factors have also contributed to equity gaps in utilisation of quality ANC services. Conclusion Several input and process factors influenced the provision and utilization of optimum quality ANC services. Better health system inputs (e.g., availability of trained workforces, commodities, guidelines, context-specific programs) are essential to creating enabling facility environment for quality ANC services. Care processes can be improved by ensuring capacity-building activities for workforces (training, technical support visits), and mentoring staff working at peripheral facilities. Identifying coverage of quality ANC services among disadvantaged groups could be the initial step in designing and implementing targeted program approaches.

Conceptual framework for establishing twins prevention and continuous health promotion programme: a qualitative study

“…Experts recommended setting up the HPPP cohort as a suitable solution for monitoring the twin health with low government visit costs. The conceptual model presented in figure 1 illustrates the characteristics of the desired programme based on the input-process-output (IPO) model which is commonly used in health studies to present a comprehensive process and causal model of the programme 36–39. Our model combines experts’ opinions and themes extracted from FGDs.…”

“…Our model combines experts’ opinions and themes extracted from FGDs. The IPO model is commonly used in health studies to present a more comprehensive process and causal model of the programme 36–38. It explains the features, structure, prerequisites and infrastructure of such systems.…”

“…The conceptual model presented in figure 1 illustrates the characteristics of the desired programme based on the input-process-output (IPO) model which is commonly used in health studies to present a comprehensive process and causal model of the programme. [36][37][38][39] Our model combines experts' opinions and themes extracted from FGDs. The IPO model is commonly used in health studies to present a more comprehensive process and causal model of the programme.…”

“…The IPO model is commonly used in health studies to present a more comprehensive process and causal model of the programme. [36][37][38] It explains the features, structure, prerequisites and infrastructure of such systems. Our proposed framework is planned based on a concept that describes the inter-professional nature of our programme.…”

Pregnant Women’s Experiences with Midwifery-Led Antenatal Care Services in Peri-Urban Communities in Karachi, Pakistan

“… 4 Low satisfaction rates with the quality of care offered at the ANC facilities can discourage women from attending ANC visits, leading to missed opportunities for preventive measures and timely management of high risk pregnancies. 5 Negative perceptions and experiences are often attributed to poor interactions with health professionals, inadequate provision of health information, delayed care, limited involvement in decision-making, and suboptimal conditions of the health facilities, including lack of privacy and cleanliness. 6 These factors have been associated with negative ANC experiences, leading to ANC dropouts during pregnancy.…”