Core strategies, social processes, and contextual influences of early phases of implementation and statewide scale-up of group prenatal care in South Carolina

Griend, Kristin Van De; Billings, Deborah L.; Frongillo, Edward A.; Messias, DeAnne K. Hilfinger; Crockett, Amy; Covington-Kolb, Sarah

doi:10.1016/j.evalprogplan.2019.101760

Cited by 9 publications

(9 citation statements)

References 28 publications

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“…The training and start‐up of CP was part of this study, and thus, health care professionals were inexperienced in facilitating CP groups at the start of our work. A previous study identified three phases in scaling‐up Centering in a health care facility: start‐up, expansion, and institutionalization 34 . Although midwives received intensive training, additional supervision, and consultation, the study period might have been too short to move beyond the start‐up phase in some practices.…”

Section: Discussionmentioning

confidence: 99%

“…Though we excluded sites that did not follow study protocols, nonetheless, among the remaining midwifery practices, there were still significant differences in participation rates, suggesting that a wide variety of conditions at the organizational and professional level play a role in recruitment. Attitudes and perceptions of the professionals themselves may have hampered recruitment; for example, prior assumptions about whether a woman will participate or not, being unsure about the concept of CP, or mis‐informing women about the advantages of CP are mechanisms known to influence woman's participation 33,34 . Furthermore, different styles of facilitation by care providers are known to be an important reason for women not continuing with CP once starting, for example, a very didactic style leaving little space for interactive learning and not responding to women's needs 6 …”

Section: Discussionmentioning

confidence: 99%

“…Implementing and sustaining CP appears to be challenging because of new demands on health care facilities as they shift from traditional, individual prenatal care visits to group prenatal care 6,29 . Challenges reported in previous studies include difficulties with finding appropriate spaces for group sessions, scheduling, recruitment, and staffing 29,34 …”

Section: Discussionmentioning

confidence: 99%

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CenteringPregnancy in the Netherlands: Who engages, who doesn’t, and why

Wagijo¹,

Crone²,

Zwicht

et al. 2022

Birth

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Background CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved pregnancy outcomes. However, motivating women to participate in CP can be difficult. As such, we explored the characteristics associated with CP uptake and attendance and then investigated whether participation differs between health care facilities. In addition, we examined the reasons why women may decline participation and the reasons for higher or lower attendance rates. Methods Data from a stepped‐wedge cluster randomized controlled trial were used. Univariate and multivariate logistic regression models were used to determine associations among women's health behavior, sociodemographic and psychosocial characteristics, health care facilities, and participation and attendance in CP. Results A total of 2562 women were included in the study, and the average participation rate was 31.6% per health care facility (range of 10%‐53%). Nulliparous women, women <26 years old or >30 years old, and women reporting average or high levels of stress were more likely to participate in CP. Participation was less likely for women who had stopped smoking before prenatal intake, or who scored below average on lifestyle/pregnancy knowledge. For those participating in CP, 87% attended seven or more out of the 10 sessions, and no significant differences were found in women's characteristics when compared for higher or lower attendance rates. After the initial uptake, group attendance rates remained high. Conclusion A more comprehensive understanding of the variation in participation rate between health care facilities is required, in order to develop effective strategies to improve the recruitment of women, especially those with less knowledge and understanding of health issues and smoking habits.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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CenteringPregnancy in the Netherlands: Who engages, who doesn’t, and why

Wagijo¹,

Crone²,

Zwicht

et al. 2022

Birth

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“…For instance, Van deGriend and colleagues conducted an analysis of influences on scaling-up group prenatal care. They used outsider (etic) codes that drew on researchers’ concepts and the literature to complement the insider (emic) codes that reflected participants’ concepts and views [ 19 ]. Balancing insider and outsider orientations is useful for pragmatic, qualitative IS studies increase the potential for the study to highlight practice- and community-based expertise, build the literature, and ultimately support the integration of evidence into practice.…”

Section: Section 1: Ensuring Fit Between Research Goals Practical Constraints and Analytic Approachesmentioning

confidence: 99%

Pragmatic approaches to analyzing qualitative data for implementation science: an introduction

Ramanadhan

Revette

Lee

et al. 2021

Implement Sci Commun

113

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Qualitative methods are critical for implementation science as they generate opportunities to examine complexity and include a diversity of perspectives. However, it can be a challenge to identify the approach that will provide the best fit for achieving a given set of practice-driven research needs. After all, implementation scientists must find a balance between speed and rigor, reliance on existing frameworks and new discoveries, and inclusion of insider and outsider perspectives. This paper offers guidance on taking a pragmatic approach to analysis, which entails strategically combining and borrowing from established qualitative approaches to meet a study’s needs, typically with guidance from an existing framework and with explicit research and practice change goals.Section 1 offers a series of practical questions to guide the development of a pragmatic analytic approach. These include examining the balance of inductive and deductive procedures, the extent to which insider or outsider perspectives are privileged, study requirements related to data and products that support scientific advancement and practice change, and strategic resource allocation. This is followed by an introduction to three approaches commonly considered for implementation science projects: grounded theory, framework analysis, and interpretive phenomenological analysis, highlighting core analytic procedures that may be borrowed for a pragmatic approach. Section 2 addresses opportunities to ensure and communicate rigor of pragmatic analytic approaches. Section 3 provides an illustrative example from the team’s work, highlighting how a pragmatic analytic approach was designed and executed and the diversity of research and practice products generated.As qualitative inquiry gains prominence in implementation science, it is critical to take advantage of qualitative methods’ diversity and flexibility. This paper furthers the conversation regarding how to strategically mix and match components of established qualitative approaches to meet the analytic needs of implementation science projects, thereby supporting high-impact research and improved opportunities to create practice change.

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“…Each visit includes health assessments, interactive learning for health promotion, and opportunities to socialize and build a sense of community [ 23 ]. Centering-based group ANC is associated with positive outcomes including declines in prematurity rates and improved attendance, satisfaction, breastfeeding practices, and feasibility of bringing it to scale [ 22 – 26 ]. When HIV and STI prevention content were integrated with CenteringPregnancy (CP+), there were improvements in safer sex behaviors and family planning uptake [ 21 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania

Jeremiah

Patel

Chirwa

et al. 2021

BMC Pregnancy Childbirth

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Background HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. Methods A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. Results Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. Conclusions HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.

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Core strategies, social processes, and contextual influences of early phases of implementation and statewide scale-up of group prenatal care in South Carolina

Cited by 9 publications

References 28 publications

CenteringPregnancy in the Netherlands: Who engages, who doesn’t, and why

CenteringPregnancy in the Netherlands: Who engages, who doesn’t, and why

Pragmatic approaches to analyzing qualitative data for implementation science: an introduction

A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania

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