Collective prenatal consultation: a new proposal for comprehensive health care

Penna, Lúcia Helena García; Carinhanha, Joana Iabrudi; Rodrigues, Raquel Fonseca

doi:10.1590/s0104-11692008000100024

Cited by 3 publications

(5 citation statements)

References 6 publications

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“…A clinical assessment piece, an education or skill-building activities piece, and a support group or counseling piece were included in all group ANC models (18/19) [ 26 – 33 , 36 – 45 ]; only the participatory group model described in one study [ 34 ] did not have a clinical assessment component. Of the models that included a clinical component, the majority conducted the women’s individual physical assessments within the group space, in a designated, private area [ 28 – 30 , 32 , 33 , 37 , 38 , 40 – 42 ]. One published study on group ANC and half (5/10) of the key informants reported that the health assessment did not occur in the group space [ 31 , 36 , 39 , 43 – 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most (16/19) models described involved women in self-care activities (ex. measuring blood pressure and weight) [ 28 , 29 , 31 – 33 , 36 , 37 , 40 – 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…Mechanisms to encourage peer support and relationship building within the group were described in most models. A majority reported use of mechanisms to support group equality: democratic conduct that reflects respect for all participants (11/19) [ 28 , 29 , 31 – 33 , 36 – 38 , 41 , 42 , 45 ], designated time for socializing within the group (9/11) [ 29 , 30 , 32 , 33 , 36 – 38 , 41 , 45 ], and group seating in a circle (10/19) [ 29 , 30 , 32 , 33 , 36 – 38 , 41 , 42 , 45 ]. While not all sources reported on this attribute, some group care models (8/19) also accommodated support persons (such as husbands, mothers, or mothers-in-law) if women desired their involvement [ 29 , 32 , 36 – 38 , 41 , 42 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

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Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis

2018

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In high-income countries, group antenatal care (ANC) offers an alternative to individual care and is associated with improved attendance, client satisfaction, and health outcomes for pregnant women and newborns. In low- and middle-income country (LMIC) settings, this model could be adapted to address low antenatal care uptake and improve quality. However, evidence on key attributes of a group care model for low-resource settings remains scant. We conducted a systematic review of the published literature on models of group antenatal care in LMICs to identify attributes that may increase the relevance, acceptability and effectiveness of group ANC in such settings. We systematically searched five databases and conducted hand and reference searches. We also conducted key informant interviews with researchers and program implementers who have introduced group antenatal care models in LMICs. Using a pre-defined evidence summary template, we extracted evidence on key attributes—like session content and frequency, and group composition and organization—of group care models introduced across LMIC settings. Our systematic literature review identified nine unique descriptions of group antenatal care models. We supplemented this information with evidence from 10 key informant interviews. We synthesized evidence from these 19 data sources to identify attributes of group care models for pregnant women that appeared consistently across all of them. We considered these components that are fundamental to the delivery of group antenatal care. We also identified attributes that need to be tailored to the context in which they are implemented to meet local standards for comprehensive ANC, for example, the number of sessions and the session content. We compiled these attributes to codify a composite “generic” model of group antenatal care for adaptation and implementation in LMIC settings. With this combination of standard and flexible components, group antenatal care, a service delivery alternative that has been successfully introduced and implemented in high-income country settings, can be adapted for improving provision and experiences of care for pregnant women in LMIC. Any conclusions about the benefits of this model for women, babies, and health systems in LMICs, however, must be based on robust evaluations of group antenatal care programs in those settings.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0476-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…Most (16/19) models described involved women in self-care activities (ex. measuring blood pressure and weight) [ 28 , 29 , 31 – 33 , 36 , 37 , 40 – 42 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis

2018

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“…Nesse estudo, observou-se que os profissionais ao conduzirem as consultas de pré-natal fazem uso das recomendações do protocolo do MS O grupo realizado antes das consultas de pré-natal mostrou-se como uma estratégia eficaz, visto que as gestantes participam e após são encaminhadas para a consulta individual, possibilitando às gestantes refletir e trocar experiências sobre o período gravídico e puerperal 4 . A consulta individual associada aos grupos, contribui para a expansão da cobertura pré-natal, garantindo uma assistência integral e humanizada às mulheres 27 . Foi referido pelos profissionais deste estudo que 7 ESFs realizam os grupos de gestantes como uma estratégia de educação em saúde e 6 ESFs não realizam, devido à pouca demanda de gestantes, ou ao não comparecimento de gestantes apenas para os grupos, ou até mesmo por não haver ACS em todo o território de abrangência.…”

Section: Estratégias De Intervenção Na Atenção à Gestante De Baixo Riscounclassified

A qualidade da assistência pré-natal sob olhar multiprofissional

et al. 2018

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“…However, the WHO was cautious, because premature adoption of a new model can have serious negative consequences, as exemplified by the reversal of the 4visit model [39]. A growing body of literature shows that group antenatal care is feasible and acceptable in many low and middle-income countries across the globe [40][41][42][43][44][45][46][47][48][49][50]. Additional work is underway in Mali, China, Ethiopia, Surinam, and elsewhere [51].…”

Section: Introductionmentioning

confidence: 99%

An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi

et al. 2020

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Background: Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO's call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes.Methods: Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices. Discussion: This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model. Trial registration: ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.

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Collective prenatal consultation: a new proposal for comprehensive health care

Cited by 3 publications

References 6 publications

Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis

Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis

A qualidade da assistência pré-natal sob olhar multiprofissional

An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi

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