The influence of community factors in the implementation of community-based interventions to improve antenatal care: a qualitative study based on the IMCHA programme in Tanzania

Abstract

Background Efforts to improve antenatal care have been heightened to reduce global maternal deaths. In resource-limited settings, community-based interventions play a pivotal role in improving antenatal care services. However, effective implementation of community-based interventions is influenced by prevailing community-related factors. Drawing from the community-based interventions implemented in Iringa Region in Tanzania, this paper underscores how community factors influence implementation and ultimate improvement of antenatal care services. Methods A qualitative case study design was employed using in-depth interviews, focus group discussions and document reviews. Data was collected in Kilolo and Mufindi districts in Iringa Region where community-based interventions were implemented. A total of one hundred and forty-six (146) participants were involved in the study. Eighty-six (86) participants were interviewed and sixty (n = 60) participated in focus group discussions. Data were analysed thematically and manually by categorizing and coding emerging issues to facilitate analysis and interpretation. Results Key factors that influenced the implementation of the community-based interventions were the community readiness to adopt the interventions and effective local administrative systems. Stakeholders’ engagement and local health system support were also pivotal for improving antenatal care services. However, the physical environment, bullying of implementers of interventions and family-related challenges constrained the implementation of the interventions. Conclusion This study has shown that the performance of community-based interventions is highly influenced by community-related factors. More specifically, inadequate community engagement may lead to community members’ reluctance to adopt implemented interventions. Therefore, in-depth understanding and adequate management of community engagement are important during the planning, development and implementation of community-based interventions.

Community-Based Knowledge Translation Strategies for Maternal, Neonatal, and Perinatal Outcomes: A Systematic Review of Quantitative and Qualitative Data

“…The full text of ninety-six registries could not be retrieved even after contacting their authors. A total of twelve reports (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) of the 405 reviewed in full text met our inclusion criteria. We identified two additional studies while reviewing the referent list of two SRs captured for our search strategy (39,40).…”

“…Overall, we included seven quantitative studies (28,(33)(34)(35)(36)(37)39), five randomized studies (28,(34)(35)(36)(37) and two non-randomized studies (33,39); and seven qualitative studies (18,27,29,31,32,38,40). Qualitative studies included a variety of methodologies such as participatory action research (n = 5, 71.4%) (27,29,31,38,40), qualitative case study (n = 1, 14.3%) (39) grounded theory (n = 1, 14.3%) (32), and a mixedapproach study (n = 1, 14.3%) (30) that conducted a content analysis. We included the qualitative approach of the mixed study because of its relevance to our systematic review.…”

“…The quantitative studies involved 52,579 participants, and 942 patients were included in the qualitative studies. Thirteen of the studies (27)(28)(29)(30)(31)(33)(34)(35)(36)(37)(38)(39)(40) were developed in rural districts and/or locations with low socioeconomic conditions, and the remaining study was conducted in an urban area (32). We identified eight KTS in the fourteen studies included in our review: 1) community mobilization (28); 2) configuration of women's groups (31,33,34); 3) participatory action and learning cycles (35)(36)(37)40); 4) participatory intervention packages (38,39); 5) configuration of Action-Participation groups (29); 6) participatory action cycles (27); 7) quality circles (30); and 8) emancipation processes (32).…”

“…Study conducted in Tanzania. The districts exhibited low antenatal care uptake (31). Participatory Action Research was implemented through two phases: 1) covered identification of antenatal care problems, and 2) involved developing strategies to address the prioritized antenatal care problems.…”

“…The idea was to transform the limited knowledge on various health issues. These strategies were characterized by the empirical knowledge of people from the community, such as community healthcare workers, traditional midwives, women of childbearing age, older women, and community leaders (27,(29)(30)(31)(32). These studies emphasized that techniques such as reinterpretation of knowledge about the causes of maternal mortality together with reinforcement of non-detrimental cultural practices were particularly useful for optimizing healthcare (30,38,40).…”