Improving respectful maternity care through group antenatal care: Findings from a cluster randomized controlled trial

IF 2.6 3区医学 Q1 NURSING

Midwifery Pub Date : 2025-05-10 DOI:10.1016/j.midw.2025.104457

Theresa Norpeli Lanyo , Ruth Zielinski , Vida A. Kukula , Veronica E․A Apetorgbor , Bidisha Ghosh , Nancy A. Lockhart , Jody R. Lori

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引用次数: 0

Abstract

Background

Disrespect and patient mistreatment have been cited as barriers to adherence and healthcare utilization, contributing to the slow progress in meeting maternal and child health targets, particularly in Ghana. Group antenatal care, an alternative to routine individualized care, is recommended by the World Health Organization as an effective service delivery model for low- and middle-income countries. This study examined the impact of group antenatal care on respectful maternity care compared to individual-based antenatal care, including mothers' perceptions of respectful care.

Methods

We conducted a cluster randomized controlled trial (RCT: NCT04033003) across 14 health facilities in the Eastern Region of Ghana from September 2018 to August 2024. Facilities were randomized using a matched-pairs design. Pregnant women were recruited using predetermined inclusion criteria with a total sample size of 1761. Written and verbal consent were obtained. Data on respectful maternity care-related outcomes were collected at time 2 (6 weeks postpartum). Data were analyzed on an intent-to-treat basis. Chi-square test was used to compare the outcome between the group antenatal (intervention) (n = 877) and individual (control) groups (n = 884). Results are reported individually as percentages with significance set at a p-value less than 0.05. Focus group discussions were conducted with women as part of a process evaluation. Content analysis was employed for the qualitative data.

Results

Women in the group antenatal care reported greater respectful maternity outcomes than those in the control group (93.5 % vs. 83 %). A greater proportion (84 %) of midwives introduced themselves in the intervention group compared to 53 % in the control group. Waiting times were reduced (92 % vs. 81 %, p < 0.0001) in the intervention groups. Informed consent was also higher (95 % vs. 81 %). Women reported receiving information on nutrition (99.7 % vs. 94 %), what to expect during delivery (95 % vs. 87 %), delivery plans (99 % vs. 87 %), where to go to when complications arise (97 % vs. 94 %); breastfeeding (97 % vs. 81 %). Qualitative results indicated that group care ensured privacy and confidentiality, upheld dignity, was free from abuse and mistreatment, and generally contributed to satisfaction with group antenatal care.

Conclusion

Group antenatal care is an innovative strategy that promotes respectful maternity care, which is crucial for enhancing care quality and adherence among pregnant women. By improving respect in care through group antenatal care, we can address inequities, promote maternal health, and contribute to the achievement of Sustainable Development Goal 3 globally and in Ghana. These insights underscore the potential of group antenatal care as an impactful intervention to enhance respectful maternity care.

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通过群体产前护理改善尊重产妇护理：来自一项聚类随机对照试验的结果

背景不尊重和虐待病人被认为是坚持治疗和利用保健服务的障碍，导致在实现妇幼保健目标方面进展缓慢，特别是在加纳。小组产前护理是常规个体化护理的一种替代方案，世界卫生组织建议将其作为低收入和中等收入国家的一种有效服务提供模式。本研究考察了群体产前护理对尊重性产妇护理的影响，并与个体产前护理进行了比较，包括母亲对尊重性护理的看法。方法我们于2018年9月至2024年8月在加纳东部地区的14家卫生机构进行了一项聚类随机对照试验（RCT: NCT04033003）。设施采用配对设计随机化。采用预先确定的纳入标准招募孕妇，总样本量为1761例。获得书面和口头同意。在第2期（产后6周）收集尊重产妇护理相关结果的数据。数据以意向治疗为基础进行分析。采用卡方检验比较产前组（干预组）（n = 877）与个体组（对照组）（n = 884）的结局。结果以百分比单独报告，显著性设置为p值小于0.05。作为进程评价的一部分，与妇女进行了焦点小组讨论。定性资料采用内容分析。结果产前护理组的妇女比对照组的妇女更尊重分娩结果（93.5%比83%）。干预组的助产士自我介绍比例（84%）高于对照组的53%。等待时间减少了(92%对81%，p <；0.0001)。知情同意率也更高（95%对81%）。妇女报告说，她们获得了关于营养（99.7%对94%）、分娩期间会发生什么（95%对87%）、分娩计划（99%对87%）、出现并发症时去哪里（97%对94%）的信息；母乳喂养（97%对81%）。定性结果表明，集体护理确保了隐私和保密，维护了尊严，不受虐待和虐待，总体上有助于提高对集体产前护理的满意度。结论小组产前护理是一种促进尊重孕产妇护理的创新策略，对提高孕产妇护理质量和依从性至关重要。通过群体产前护理改善护理中的尊重，我们可以解决不平等问题，促进孕产妇健康，并为在全球和加纳实现可持续发展目标3做出贡献。这些见解强调了群体产前护理作为一种有效干预措施的潜力，以加强尊重产妇护理。

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来源期刊

Midwifery 医学-护理

CiteScore

4.50

自引率

7.40%

发文量

221

审稿时长

13.4 weeks

期刊介绍： Midwifery publishes the latest peer reviewed international research to inform the safety, quality, outcomes and experiences of pregnancy, birth and maternity care for childbearing women, their babies and families. The journal’s publications support midwives and maternity care providers to explore and develop their knowledge, skills and attitudes informed by best available evidence. Midwifery provides an international, interdisciplinary forum for the publication, dissemination and discussion of advances in evidence, controversies and current research, and promotes continuing education through publication of systematic and other scholarly reviews and updates. Midwifery articles cover the cultural, clinical, psycho-social, sociological, epidemiological, education, managerial, workforce, organizational and technological areas of practice in preconception, maternal and infant care. The journal welcomes the highest quality scholarly research that employs rigorous methodology. Midwifery is a leading international journal in midwifery and maternal health with a current impact factor of 1.861 (© Thomson Reuters Journal Citation Reports 2016) and employs a double-blind peer review process.