`It makes sense and it works': Maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles)

Hunter, Louise; Motta, Giordana de Cássia Pinheiro da; McCourt, Christine; Wiseman, Octavia; Rayment, Juliet; Haora, Penny; Wiggins, Meg; Harden, Angela

doi:10.1016/j.midw.2018.07.016

Cited by 17 publications

(20 citation statements)

References 35 publications

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“…10,30,31,41 Complex health interventions require coordination of multiple types of staff and training, 42 highlighting the deleterious impact of inadequate resources on sustainability. 29,30,43 In this study, group care was integrated within a residency program, enhancing administrative buyin. In contrast, Pekkala et al found that sites with graduate medical education programs reported barriers to administrative buy-in, owing to the need to ensure adequate resident clinical experience; they proposed creative programming to enable residency programs to incorporate group care, as reported here.…”

Section: Discussionmentioning

confidence: 99%

Beyond Implementation: Sustaining Group Prenatal Care and Group Well‐Child Care

Novick

Womack

Sadler

2020

J Midwife Womens Health

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Introduction Group prenatal care and group well‐child care (collectively called group care) provide health care in groups. Group care is being introduced in many settings, and the model's benefits are increasingly recognized. Yet, little attention has been paid to understanding model sustainability. This study examined barriers to sustainability and offers suggestions for sustaining group care programs. Methods This qualitative research was guided by interpretive description. Semistructured interviews with 17 professionals were conducted in 4 sites in one community to explore barriers to sustaining group care and key ingredients for sustainability. Sites were 2 clinics that had provided group prenatal care, a clinic currently providing group prenatal care, and a clinic currently providing group well‐child care. Two clinics have continued providing group care and 2 have discontinued it. Participants included midwives, physicians, nurses, and nurse practitioners. Interviews were audio recorded, transcribed, and entered in ATLAS.ti. A priori and inductive coding schemes were developed; code content was compared across individuals, participant types, and settings. Results Five themes were identified: administrative buy‐in, robust recruitment, clinician and staff buy‐in, owning it, and sustainability mindset. Group care needs to be sold to many different constituencies: administrators, staff and clinicians, and patients. Furthermore, sustainability requires having a conscious awareness of the importance of sustainability from the outset, taking ownership by adapting group care to needs of settings, creating venues for expressing divergent viewpoints and problem‐solving, and recognizing that these processes are ongoing with change occurring incrementally. It also includes addressing the need for long‐term financing. Discussion Those implementing group care must be prepared to go beyond managing the logistics of introducing a complex new program; they must also be prepared to develop sustainability mindsets, sell the model to everyone on all levels within their institutions, and advocate for enhanced reimbursement for group care and value‐driven payment systems.

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Section: Discussionmentioning

confidence: 99%

Beyond Implementation: Sustaining Group Prenatal Care and Group Well‐Child Care

Novick

Womack

Sadler

2020

J Midwife Womens Health

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“…Collectively, these findings demonstrate the challenges of implementation science in maternity care within nations that are less than affluent. To manage sociocultural barriers, it can be helpful to adapt an intervention to a given context [113,140,159,161]-this might Mixed-methods 27 Case study 12 [139][140][141][142][143][144][145][146][147][148][149][150] Pre-post study 8 [151][152][153][154][155][156][157][158] Ethnography 6 [159][160][161][162][163][164] Cohort study 4 [165][166][167][168] Pilot-test 8 [169][170][171][172][173][174][175][176] Longitudinal survey 2 [177,178] Quasi-experimental 1 [179] Randomised controlled trial 2 [180,…”

Section: Theories Models and Framework: Absentmentioning

confidence: 99%

Implementation science in maternity care: a scoping review

Piper

Coates

2021

Implementation Sci

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Background Despite wide recognition that clinical care should be informed by the best available evidence, this does not always occur. Despite a myriad of theories, models and frameworks to promote evidence-based population health, there is still a long way to go, particularly in maternity care. The aim of this study is to appraise the scientific study of methods to promote the systematic uptake of evidence-based interventions in maternity care. This is achieved by clarifying if and how implementation science theories, models, and frameworks are used. Methods To map relevant literature, a scoping review was conducted of articles published between January 2005 and December 2019, guided by Peters and colleagues’ (2015) approach. Specifically, the following academic databases were systematically searched to identify publications that presented findings on implementation science or the implementation process (rather than just the intervention effect): Business Source Complete; CINAHL Plus with Full Text; Health Business Elite; Health Source: Nursing/Academic Edition; Medline; PsycARTICLES; PsycINFO; and PubMed. Information about each study was extracted using a purposely designed data extraction form. Results Of the 1181 publications identified, 158 were included in this review. Most of these reported on factors that enabled implementation, including knowledge, training, service provider motivation, effective multilevel coordination, leadership and effective communication—yet there was limited expressed use of a theory, model or framework to guide implementation. Of the 158 publications, 144 solely reported on factors that helped and/or hindered implementation, while only 14 reported the use of a theory, model and/or framework. When a theory, model or framework was used, it typically guided data analysis or, to a lesser extent, the development of data collection tools—rather than for instance, the design of the study. Conclusion Given that models and frameworks can help to describe phenomenon, and theories can help to both describe and explain it, evidence-based maternity care might be promoted via the greater expressed use of these to ultimately inform implementation science. Specifically, advancing evidence-based maternity care, worldwide, will require the academic community to make greater explicit and judicious use of theories, models, and frameworks. Registration Registered with the Joanna Briggs Institute (registration number not provided).

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“…This study is part of a NIHR-funded Programme Grant for Applied Research, the REACH Pregnancy Programme (Reference RP-DG-1108-10,049), which aims to improve women's access to, engagement with, and experience of antenatal care. The Programme comprises four main components including this trial and a two-stage feasibility/pilot study preceding it [4,21,23].…”

Section: Why Might Group Antenatal Care Be Beneficial?mentioning

confidence: 99%

“…Better birth experiences have the potential to impact on the wellbeing of women and their children [ 17 – 20 ]. Additionally, recent evidence has shown that midwives trained to deliver group antenatal care report satisfaction with working in this way [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…This study is part of a NIHR-funded Programme Grant for Applied Research, the REACH Pregnancy Programme (Reference RP-DG-1108-10,049), which aims to improve women’s access to, engagement with, and experience of antenatal care. The Programme comprises four main components including this trial and a two-stage feasibility/pilot study preceding it [ 4 , 21 , 23 ]. This preparatory work, in line with best practice recommendations [ 24 ], has enabled the research team to understand and address the local and UK national challenges that any group-based model of antenatal care needs to be tailored to meet, as well as to develop and test the methods for the full trial.…”

Section: Introductionmentioning

confidence: 99%

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Group antenatal care (Pregnancy Circles) for diverse and disadvantaged women: study protocol for a randomised controlled trial with integral process and economic evaluations

Wiggins

Sawtell

Wiseman

et al. 2020

BMC Health Serv Res

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Background Group antenatal care has been successfully implemented around the world with suggestions of improved outcomes, including for disadvantaged groups, but it has not been formally tested in the UK in the context of the NHS. To address this the REACH Pregnancy Circles intervention was developed and a randomised controlled trial (RCT), based on a pilot study, is in progress. Methods The RCT is a pragmatic, two-arm, individually randomised, parallel group RCT designed to test clinical and cost-effectiveness of REACH Pregnancy Circles compared with standard care. Recruitment will be through NHS services. The sample size is 1732 (866 randomised to the intervention and 866 to standard care). The primary outcome measure is a ‘healthy baby’ composite measured at 1 month postnatal using routine maternity data. Secondary outcome measures will be assessed using participant questionnaires completed at recruitment (baseline), 35 weeks gestation (follow-up 1) and 3 months postnatal (follow-up 2). An integrated process evaluation, to include exploration of fidelity, will be conducted using mixed methods. Analyses will be on an intention to treat as allocated basis. The primary analysis will compare the number of babies born “healthy” in the control and intervention arms and provide an odds ratio. A cost-effectiveness analysis will compare the incremental cost per Quality Adjusted Life Years and per additional ‘healthy and positive birth’ of the intervention with standard care. Qualitative data will be analysed thematically. Discussion This multi-site randomised trial in England is planned to be the largest trial of group antenatal care in the world to date; as well as the first rigorous test within the NHS of this maternity service change. It has a recruitment focus on ethnically, culturally and linguistically diverse and disadvantaged participants, including non-English speakers. Trial registration Trial registration; ISRCTN, ISRCTN91977441. Registered 11 February 2019 - retrospectively registered. The current protocol is Version 4; 28/01/2020.

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`It makes sense and it works': Maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles)

Abstract: Pre-registration education inadequately prepared midwives for group care. Addressing sticking points and securing management support for Pregnancy Circles is vital to sustain participation in this model of care.

Cited by 17 publications

References 35 publications

Beyond Implementation: Sustaining Group Prenatal Care and Group Well‐Child Care

Beyond Implementation: Sustaining Group Prenatal Care and Group Well‐Child Care

Implementation science in maternity care: a scoping review

Group antenatal care (Pregnancy Circles) for diverse and disadvantaged women: study protocol for a randomised controlled trial with integral process and economic evaluations

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