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Title Before and after implementation of group antenatal care in Rwanda: a qualitative study of women's experiences.
Full text https://escholarship.org/uc/item/8w1185v5
Date 2019
Author(s) Musabyimana, Angele; Lundeen, Tiffany; Butrick, Elizabeth; Sayinzoga, Felix; Rwabufigiri, Bernard Ngabo; Walker, Dilys; Musange, Sabine F
Abstract BackgroundThe Preterm Birth Initiative-Rwanda is conducting a 36-cluster randomized controlled trial of group antenatal and postnatal care. In the context of this trial, we collected qualitative data before and after implementation. The purpose was two-fold. First, to inform the design of the group care program before implementation and second, to document women's experiences of group care at the mid-point of the trial to make ongoing programmatic adjustments and improvements.MethodsWe completed 8 focus group discussions among women of reproductive age before group care implementation and 6 focus group discussions among women who participated in group antenatal care and/or postnatal care at 18 health centers that introduced the model, approximately 9 months after implementation.ResultsBefore implementation, focus group participants reported both enthusiasm for the potential for support and insight from a group of peers and concern about the risk of sharing private information with peers who may judge, mock, or gossip. After implementation, group care participants reported benefits including increased knowledge, peer support, and more satisfying relationships with providers. When asked about barriers to group care participation, none of them cited concern about privacy but instead cited lack of financial resources, lack of cooperation from a male partner, and long distances to the health center. Finally, women stated that the group care experience would be improved if all participants and providers arrived on time and remained focused on the group care visit throughout.DiscussionThese results are consistent with other published reports of women's perceptions of group antenatal care, especially increased pregnancy- and parenting-related knowledge, peer support, and improved relationships with health care providers. Some results were unexpected, especially the consequences of staff allocation patterns that resulted in providers arriving late for group visits or having to leave during group visits to attend to other facility services, which diminished women's experiences of care.ConclusionGroup antenatal and postnatal care provide compelling benefits to women and families. If the model requires the addition of human resources at the health center, intensive reminder communications, and large-scale community outreach to benefit the largest number of pregnant and postnatal mothers, those additional resources required must be factored into any future decision to scale a group care model.Trial registrationThis trial is registered at clinicaltrials.gov as NCT03154177 .
Subject(s) Humans; Prenatal Care; Focus Groups; Health Knowledge; Attitudes; Practice; Pregnancy; Qualitative Research; Adolescent; Adult; Health Personnel; Women; Health Planning; Health Plan Implementation; Patient Acceptance of Health Care; Rwanda; Female; Young Adult; Antenatal care; Clients' perspectives; Group care; Postnatal care; Prenatal care; Qualitative study; Sub-Saharan Africa; Basic Behavioral and Social Science; Behavioral and Social Science; Pediatric; Clinical Research; Clinical Trials and Supportive Activities; Health Services; 8.1 Organisation and delivery of services; Reproductive health and childbirth; Paediatrics and Reproductive Medicine; Obstetrics & Reproductive Medicine
Coverage 90
Publisher eScholarship, University of California
Type of publication article
Format application/pdf
Source Reproductive health, vol 16, iss 1
Rights public
Identifier qt8w1185v5
Repository Berkeley - University of California
Added to C-A: 2022-08-31;09:39:52