Group prenatal care: model fidelity and outcomes

Abstract

Objective CenteringPregnancy group prenatal care has been demonstrated to improve pregnancy outcomes. However, there is likely variation in how the model is implemented in clinical practice, which may be associated with efficacy, and therefore variation, in outcomes. We examined the association of fidelity to process and content of the CenteringPregnancy group prenatal care model with outcomes previously shown to be affected in a clinical trial: preterm birth, adequacy of prenatal care and breastfeeding initiation. Study Design Participants were 519 women who received CenteringPregnancy group prenatal care. Process fidelity reflected how facilitative leaders were and how involved participants were in each session. Content fidelity reflected whether recommended content was discussed in each session. Fidelity was rated at each session by a trained researcher. Preterm birth and adequacy of care were abstracted from medical records. Participants self-reported breastfeeding initiation at 6-months postpartum. Results Controlling for important clinical predictors, greater process fidelity was associated with significantly lower odds of both preterm birth (B=−0.43, Wald χ2=8.65, P=.001) and intensive utilization of care (B=−0.29, Wald χ2=3.91, P=.05). Greater content fidelity was associated with lower odds of intensive utilization of care (B=−0.03, Wald χ2=9.31, P=.001). Conclusion Maintaining fidelity to facilitative group processes in CenteringPregnancy was associated with significant reductions in preterm birth and intensive care utilization of care. Content fidelity also was associated with reductions in intensive utilization of care. Clinicians learning to facilitate group care should receive training in facilitative leadership, emphasizing the critical role that creating a participatory atmosphere can play in improving outcomes.

Use of a Facilitated Group Process to Design and Implement a Group Antenatal and Postnatal Care Program in Rwanda

“…We relied on the fundamental principle of group ANC, the group process in which all members participate fully as peers and equals while 1 to 2 members act as facilitators 28. Descriptions of group ANC published over the past 20 years describe the role of a facilitative leader who understands that pregnant women in the group are the experts on their own needs 19.…”

A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression

“…Twelve studies reported qualitative data on the perspectives and attitudes of those who had received universal preventive interventions for PND [277][278][279][280][281][282][283][284][285][286][287][288][289] (of these, two also reported perspectives and attitudes of service providers on universal preventive interventions 287,288 and two studies reported only on the perspectives and attitudes of service providers to preventive interventions). 290,291 l Four studies presented data from those who had received a selective preventive intervention [292][293][294][295][296][297][298] (with one study additionally presenting data relating to an indicated population). [296][297][298] Of these, one study also reported perspectives and attitudes of service providers on selective preventive interventions.…”

“…Ethnicity was reported in 13 studies. 280,[282][283][284][285][286]290,[292][293][294][295][296][297][298]300 For further details of participant characteristics see Appendix 9.…”

“…Service provider data came from four clinicians, [296][297][298] three nurses, 288 two certified nurse-midwives and two medical assistants, [293][294][295] three physicians, 290 four certified nurse midwives, five health centre staff and five administrators, 284 from support workers, midwives and health visitors 287 and from peer volunteers. 301 The age range of the women was reported in eight studies.…”

“…psychological (n = 3; six reports) 253,254,282,[296][297][298] 2. educational (n = 0) 3. social support (n = 3; four reports) 281,287,299,301 4. pharmacological agents or supplements (n = 0) 5. midwifery-led interventions (n = 8; 11 reports) 277,[283][284][285][289][290][291][292][293][294][295] 6. organisation of maternity care (n = 2) 288,300 7. CAM and other (n = 3; four reports).…”