Feasibility and preliminary effectiveness of group antenatal care in Senegalese health posts: a pilot implementation trial

McKinnon, Britt; Sall, Mohamadou; Vandermorris, Ashley; Traoré, Mahamadou; Lamesse-Diedhiou, Fatma; McLaughlin, Katie A.; Bassani, Diego G.

doi:10.1093/heapol/czz178

Cited by 14 publications

(21 citation statements)

References 28 publications

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“…Group ANC is consistent with the World Health Organization's (WHO's) ANC guidelines, in which women of similar gestational ages actively participate in their ANC together, facilitated by a nurse or midwife 40,41 . Several models of group ANC have been implemented in multiple low‐ and middle‐income countries including, Kenya, Nigeria, Senegal, Malawi, Tanzania, and Nepal 42–45 . Importantly, the structure of group ANC, which encourages group discussion and social support, is particularly conducive to the integration of mental health components, which together may further bolster the positive psychosocial effects inherent to the group ANC model.…”

Section: Discussionmentioning

confidence: 86%

Integrating Mental Health into Maternal Health Care in Rural Mali: A Qualitative Study

Lasater

Murray

Keita

et al. 2020

J Midwife Womens Health

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Introduction Common perinatal mental disorders are prevalent in low‐ and middle‐income countries. The gap between the need for and availability of mental health services, also known as the mental health treatment gap, is particularly acute for women during the perinatal period in rural Mali. This qualitative study aimed to identify a feasible and acceptable integrated care approach for the provision of maternal mental health care in rural Mali to help narrow the treatment gap and increase access to care. Methods From April to June 2016, qualitative data were collected in the Sélingué health district and Bamako, Mali. In‐depth interviews were conducted among women, community health workers, midwives, and mental health specialists. Focus group participants included community health workers, midwives, and an obstetric nurse. All data were inductively coded and analyzed using a thematic analysis approach. Results Women described several coping strategies to manage their distress, including visiting their parents; confiding in a friend, relative, or community health worker; and participating in women's association groups. Mental health‐related stigma was described as being widespread in the community and among health providers. In response to the lack of mental health services, midwives and community health workers supported the feasibility and acceptability of the integration of mental health services into maternal health services. Midwives were discussed as being key providers to conduct mental health screenings and provide initial psychosocial care for women. Discussion Integrated maternal and mental health interventions are needed to narrow the gap between the need for and availability of mental health services in rural Mali. Findings from this study underscore the great need for mental health services for women in the perinatal period who reside in rural Mali and that it is both feasible and acceptable to integrate mental health screening and low‐level psychosocial care into antenatal care, delivered by midwives.

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Section: Discussionmentioning

confidence: 86%

Integrating Mental Health into Maternal Health Care in Rural Mali: A Qualitative Study

Lasater

Murray

Keita

et al. 2020

J Midwife Womens Health

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“…These results are largely consistent with other published qualitative reports on G-ANC. In particular, themes of improved relationships with increased support and open communication are universally reported across studies from both LMICs and high-income countries [ 16 , 18 , 30 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…For pregnant women, studies of G-ANC in LMICs provide evidence for increased satisfaction [ 16 – 20 ] service utilization, [ 16 , 19 , 20 – 24 ] health literacy, [ 16 , 17 – 19 , 23 ] pregnancy related empowerment, [ 16 , 25 ] uptake of healthy behaviors, [ 16 , 21 – 24 ] and improved quality of care [ 16 , 20 , 21 , 23 , 24 , 26 , 27 ] compared to individual ANC. Qualitative research related to the experience of women has universally highlighted a preference for G-ANC over individual care and an appreciation for perceived gains in health literacy and meaningful relationships with providers and other women [ 16 , 18 , 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Transforming women’s and providers’ experience of care for improved outcomes: A theory of change for group antenatal care in Kenya and Nigeria

Grenier¹,

Onguti²,

Whiting-Collins

et al. 2022

PLoS ONE

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Background Group antenatal care (G-ANC) is a promising model for improving quality of maternal care and outcomes in low- and middle-income countries (LMICs) but little has been published examining the mechanisms by which it may contribute to those improvements. Substantial interplay can be expected between pregnant women and providers’ respective experiences of care, but most studies report findings separately. This study explores the experience and effects of G-ANC on both women and providers to inform an integrated theory of change for G-ANC in LMICs. Methods This paper reports on multiple secondary outcomes from a pragmatic cluster randomized controlled trial of group antenatal care in Kenya and Nigeria conducted from October 2016—November 2018 including 20 clusters per country. We collected qualitative data from providers and women providing or receiving group antenatal care via focus group discussions (19 with women; 4 with providers) and semi-structured interviews (42 with women; 4 with providers). Quantitative data were collected via surveys administered to 1) providers in the intervention arm at enrollment and after facilitating 4 cohorts and 2) women in both study arms at enrollment; 3–6 weeks postpartum; and 1 year postpartum. Through an iterative approach with framework analysis, we explored the interactions of voiced experience and perceived effects of care and placed them relationally within a theory of change. Selected variables from baseline and final surveys were analyzed to examine applicability of the theory to all study participants. Results Findings support seven inter-related themes. Three themes relate to the shared experience of care of women and providers: forming supportive relationships and open communication; becoming empowered partners in learning and care; and providing and receiving meaningful clinical services and information. Four themes relate to effects of that experience, which are not universally shared: self-reinforcing cycles of more and better care; linked improvements in health knowledge, confidence, and healthy behaviors; improved communication, support, and care beyond G-ANC meetings; and motivation to continue providing G-ANC. Together these themes map to a theory of change which centers the shared experience of care for women and providers among multiple pathways to improved outcomes. Discussion The reported experience and effects of G-ANC on women and providers are consistent with other studies in LMICs. This study is novel because it uses the themes to present a theory of change for G-ANC in low-resource settings. It is useful for G-ANC implementation to inform model development, test adaptations, and continue exploring mechanisms of action in future research.

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“…The context and methods of the pilot study from which this study is derived are presented in detail in a previous publication [22]. A summary of the methods for this convergent parallel mixed-methods substudy is provided here.…”

Section: Et Hodsmentioning

confidence: 99%

“…The objective of this study was to examine the experiences of Senegalese adolescents engaged in a G-ANC. The study draws from a larger pilot study of G-ANC in the Kaolack district of Senegal [22]. Senegal is a West African country that has made substantial recent progress in the domain of reproductive, maternal, newborn and child health (RMNCH) through initiatives targeting health system design and social determinants of health [23].…”

mentioning

confidence: 99%

Adolescents’ experiences with group antenatal care: Insights from a mixed‐methods study in Senegal

Vandermorris

McKinnon

Sall

et al. 2021

Tropical Med Int Health

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ObjectivesGroup antenatal care (G‐ANC) is an innovative model in which antenatal care is delivered to a group of 8–12 women of similar gestational age. Evidence from high‐income countries suggests G‐ANC is particularly effective for women from marginalised populations, including adolescents. The objective of this study was to examine the experiences of Senegalese adolescents engaged in group antenatal care.MethodsThis convergent parallel mixed‐methods study is derived from a larger effectiveness–implementation hybrid pilot study conducted in Kaolack district, Senegal. Quantitative data for adolescent participants were collected through baseline and postnatal surveys and descriptively analysed. One‐on‐one interviews and focus‐group discussions were conducted with adolescent participants, and qualitative data were analysed using qualitative descriptive analysis.ResultsForty‐five adolescents aged 15–19 participated in G‐ANC, with a median age of 18 years. The majority (93.3%) were married, and 64.4% were nulliparous. Findings indicated similar levels of G‐ANC participation for adolescent and adult women. The majority (93.1%) of participants who had previously attended individual ANC indicated they would prefer G‐ANC to individual care for a future pregnancy. Qualitative findings indicated key facets of consideration relevant to G‐ANC for adolescents include social connectedness, the influence of social norms and the opportunity for engagement in healthcare.ConclusionsThis study suggests that G‐ANC has the potential to be an adolescent‐responsive and culturally appropriate method of delivering antenatal care in Senegal.

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Feasibility and preliminary effectiveness of group antenatal care in Senegalese health posts: a pilot implementation trial

Cited by 14 publications

References 28 publications

Integrating Mental Health into Maternal Health Care in Rural Mali: A Qualitative Study

Integrating Mental Health into Maternal Health Care in Rural Mali: A Qualitative Study

Transforming women’s and providers’ experience of care for improved outcomes: A theory of change for group antenatal care in Kenya and Nigeria

Adolescents’ experiences with group antenatal care: Insights from a mixed‐methods study in Senegal

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