{"title":"“南印度产前妇女的护理途径——顺序解释性混合方法研究”。","authors":"Veneza Zareen Lyngdoh Jarain, Jayalakshmy Ramakrishnan, Vanessa Ravel, Punithakumary Purushothaman, T Susila, Zunatha Banu, Palanivel Chinnakali","doi":"10.4103/jfmpc.jfmpc_1641_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Poor access to effective antenatal care (ANC) is identified as one of the key challenges in reducing maternal mortality. Antenatal women seek ANC through different pathways, including primary health centers (PHCs), private clinics/hospitals, and tertiary care facilities, influenced by factors such as perceived quality of care, financial constraints, proximity, and cultural preferences. The study aimed to determine the pathways antenatal women choose to seek ANC, reasons for preferring such point of care or facilities, and the out-of-pocket expenditure (OOPE) incurred for an ANC visit.</p><p><strong>Methods: </strong>This tertiary hospital-based mixed-method study was conducted among 303 antenatal women in South India. The study was conducted in 2019. A pretested semistructured questionnaire was used to gather data on sociodemographic and obstetric characteristics, utilization of ANC services, reasons for choosing each facility, and the costs incurred during an ANC visit. Among some participants, in-depth interviews were conducted to explore the facilitators and barriers to using ANC services at primary healthcare centers, private healthcare facilities, and tertiary care facilities. Collected quantitative data were analyzed using SPSS version 20 (IBM Corp). In-depth interviews were transcribed and analyzed using an inductive content analysis approach. Codes were grouped to form similar categories which in turn were grouped to themes.</p><p><strong>Results: </strong>Out of 303, 279 pregnant women registered in their respective PHCs, the remaining 24 participants (7.9%) did not register or seek ANC from a PHC. Most of them mentioned the lack of facilities and unawareness about a PHC in their locality as the reasons for not using ANC services at PHC. The highest OOPE incurred was at a private facility, where the median cost per visit was INR 1400 (990-2115) compared with PHC, which was INR 100 (20-360).</p><p><strong>Conclusion: </strong>Appropriate action has to be implemented at PHCs to improve the utilization rate and to reduce OOPE incurred.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":"14 8","pages":"3279-3286"},"PeriodicalIF":1.0000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488147/pdf/","citationCount":"0","resultStr":"{\"title\":\"\\\"Pathways to care among antenatal women in South India - A sequential explanatory mixed-method study\\\".\",\"authors\":\"Veneza Zareen Lyngdoh Jarain, Jayalakshmy Ramakrishnan, Vanessa Ravel, Punithakumary Purushothaman, T Susila, Zunatha Banu, Palanivel Chinnakali\",\"doi\":\"10.4103/jfmpc.jfmpc_1641_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Poor access to effective antenatal care (ANC) is identified as one of the key challenges in reducing maternal mortality. Antenatal women seek ANC through different pathways, including primary health centers (PHCs), private clinics/hospitals, and tertiary care facilities, influenced by factors such as perceived quality of care, financial constraints, proximity, and cultural preferences. The study aimed to determine the pathways antenatal women choose to seek ANC, reasons for preferring such point of care or facilities, and the out-of-pocket expenditure (OOPE) incurred for an ANC visit.</p><p><strong>Methods: </strong>This tertiary hospital-based mixed-method study was conducted among 303 antenatal women in South India. The study was conducted in 2019. A pretested semistructured questionnaire was used to gather data on sociodemographic and obstetric characteristics, utilization of ANC services, reasons for choosing each facility, and the costs incurred during an ANC visit. Among some participants, in-depth interviews were conducted to explore the facilitators and barriers to using ANC services at primary healthcare centers, private healthcare facilities, and tertiary care facilities. Collected quantitative data were analyzed using SPSS version 20 (IBM Corp). In-depth interviews were transcribed and analyzed using an inductive content analysis approach. Codes were grouped to form similar categories which in turn were grouped to themes.</p><p><strong>Results: </strong>Out of 303, 279 pregnant women registered in their respective PHCs, the remaining 24 participants (7.9%) did not register or seek ANC from a PHC. Most of them mentioned the lack of facilities and unawareness about a PHC in their locality as the reasons for not using ANC services at PHC. The highest OOPE incurred was at a private facility, where the median cost per visit was INR 1400 (990-2115) compared with PHC, which was INR 100 (20-360).</p><p><strong>Conclusion: </strong>Appropriate action has to be implemented at PHCs to improve the utilization rate and to reduce OOPE incurred.</p>\",\"PeriodicalId\":15856,\"journal\":{\"name\":\"Journal of Family Medicine and Primary Care\",\"volume\":\"14 8\",\"pages\":\"3279-3286\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488147/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Family Medicine and Primary Care\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/jfmpc.jfmpc_1641_24\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"PRIMARY HEALTH CARE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Family Medicine and Primary Care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/jfmpc.jfmpc_1641_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/24 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"PRIMARY HEALTH CARE","Score":null,"Total":0}
引用次数: 0
摘要
导言：难以获得有效的产前保健（ANC）已被确定为降低孕产妇死亡率的主要挑战之一。产前妇女通过不同途径寻求产前护理，包括初级保健中心（phc）、私人诊所/医院和三级保健设施，受到护理质量、财政限制、邻近和文化偏好等因素的影响。这项研究的目的是确定产前妇女选择寻求产前护理的途径，选择这种护理点或设施的原因，以及产前护理就诊所产生的自付费用。方法：以三级医院为基础的混合方法研究在南印度的303名产前妇女中进行。该研究于2019年进行。使用预先测试的半结构化问卷收集有关社会人口统计学和产科特征、ANC服务的利用、选择每个设施的原因以及ANC访问期间产生的费用的数据。在一些参与者中，进行了深入访谈，以探讨在初级保健中心、私人保健设施和三级保健设施使用ANC服务的促进因素和障碍。收集的定量数据使用SPSS version 20 （IBM Corp .）进行分析。深度访谈记录和分析使用归纳内容分析方法。代码被分组以形成类似的类别，这些类别又被分组到主题。结果：303,279名孕妇在各自的初级保健中心登记，其余24名参与者（7.9%）没有在初级保健中心登记或寻求ANC。他们中的大多数人提到，他们所在地区缺乏设施和对初级保健不了解，这是他们没有在初级保健使用ANC服务的原因。最高的OOPE发生在私立医院，每次就诊的中位数费用为1400印度卢比（990-2115），而初级保健为100印度卢比（20-360）。结论：初级保健医院应采取适当措施，提高医院的使用率，减少医院发生的开放性手术。
"Pathways to care among antenatal women in South India - A sequential explanatory mixed-method study".
Introduction: Poor access to effective antenatal care (ANC) is identified as one of the key challenges in reducing maternal mortality. Antenatal women seek ANC through different pathways, including primary health centers (PHCs), private clinics/hospitals, and tertiary care facilities, influenced by factors such as perceived quality of care, financial constraints, proximity, and cultural preferences. The study aimed to determine the pathways antenatal women choose to seek ANC, reasons for preferring such point of care or facilities, and the out-of-pocket expenditure (OOPE) incurred for an ANC visit.
Methods: This tertiary hospital-based mixed-method study was conducted among 303 antenatal women in South India. The study was conducted in 2019. A pretested semistructured questionnaire was used to gather data on sociodemographic and obstetric characteristics, utilization of ANC services, reasons for choosing each facility, and the costs incurred during an ANC visit. Among some participants, in-depth interviews were conducted to explore the facilitators and barriers to using ANC services at primary healthcare centers, private healthcare facilities, and tertiary care facilities. Collected quantitative data were analyzed using SPSS version 20 (IBM Corp). In-depth interviews were transcribed and analyzed using an inductive content analysis approach. Codes were grouped to form similar categories which in turn were grouped to themes.
Results: Out of 303, 279 pregnant women registered in their respective PHCs, the remaining 24 participants (7.9%) did not register or seek ANC from a PHC. Most of them mentioned the lack of facilities and unawareness about a PHC in their locality as the reasons for not using ANC services at PHC. The highest OOPE incurred was at a private facility, where the median cost per visit was INR 1400 (990-2115) compared with PHC, which was INR 100 (20-360).
Conclusion: Appropriate action has to be implemented at PHCs to improve the utilization rate and to reduce OOPE incurred.
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