Anticipated benefits and challenges of implementing group care in Suriname’s maternity and child care sector: a contextual analysis

Martens, Nele; Hindori-Mohangoo, Ashna D.; Hindori, Manodj P.; Damme, Astrid Van; Beeckman, Katrien; Reis, Ria; Crone, Mathilde R.; van der Kleij, Rianne RMJJ

doi:10.1186/s12884-023-05904-y

Enablers and barriers associated with successful implementation of group antenatal care in primary care facilities in Suriname: a qualitative evaluation study

Veenstra-Kwakkel,

Hindori,

Grunberg

et al. 2024

Discov Health Systems

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Background In 2019, group antenatal care (GANC) was introduced in four primary care facilities in Suriname, aiming to improve health and psychosocial wellbeing of pregnant women in vulnerable circumstances. This study aims to evaluate the implementation of GANC in primary care and provides insights into enablers and barriers of successful implementation. Methods This qualitative evaluation study is part of the ‘Group Care in the first 1000 days: GC_1000’ project. Data were collected through semi-structured (group-)interviews with relevant stakeholders: midwives from the four facilities who were trained for GANC (n = 10), healthcare management (n = 2), other health professionals (n = 3), and parents participating in GANC (n = 7). A thematic analysis was conducted, in which five moderating factors that influence adherence to an implementation served as an analytical framework. Results Enablers for successful implementation of GANC mentioned by interviewees were the organisation of antenatal care close to home, motivated midwives, support from colleagues and higher-level management, and the opportunity for parents to gain more knowledge compared to regular one-on-one care. Barriers mentioned were a lack of financial compensation for midwives, practical barriers related to finding adequate space and suitable time for group sessions, a perceived lack of communication between different stakeholders and contextual factors such as the current economic situation in Suriname and the position of midwives within the Surinamese healthcare system. Conclusion Successful implementation of GANC in primary care facilities in Suriname depends on several enablers and barriers. Motivated facilitators are a key enabler in successful implementation of GANC. Some form of financial compensation could increase such motivation.

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Implementing group care in Dutch and Surinamese maternity and child care services: the vital importance of addressing outer context barriers

Martens,

Haverkate,

Hindori-Mohangoo

et al. 2024

BMC Pregnancy Childbirth

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Background By addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation. Methods Contextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree. Results Outer setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname. Innovation: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners. Process: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs. Conclusions While the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.

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Implementing group care in Dutch and Surinamese maternity and child care services: The vital importance of addressing outer context barriers

Martens,

Haverkate,

Hindori-Mohangoo

et al. 2023

Preprint

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Background By addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation. Methods Contextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree. Results Outer setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname. Innovation: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners. Process: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs. Conclusions While the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.

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Anticipated benefits and challenges of implementing group care in Suriname’s maternity and child care sector: a contextual analysis

Cited by 3 publications

References 40 publications

Enablers and barriers associated with successful implementation of group antenatal care in primary care facilities in Suriname: a qualitative evaluation study

Enablers and barriers associated with successful implementation of group antenatal care in primary care facilities in Suriname: a qualitative evaluation study

Implementing group care in Dutch and Surinamese maternity and child care services: the vital importance of addressing outer context barriers

Implementing group care in Dutch and Surinamese maternity and child care services: The vital importance of addressing outer context barriers

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