Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania
Objective To identify implementation challenges associated with conducting a randomized controlled trial (RCT) of group prenatal care (PNC) and report outcomes of the pilot. Methods A multi‐site randomized pilot was conducted in Malawi and Tanzania between July 31, 2014, and June 30, 2015. Women age...
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| Veröffentlicht in: | International journal of gynecology and obstetrics 2017-12, Vol.139 (3), p.290-296 |
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| container_title | International journal of gynecology and obstetrics |
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| creator | Patil, Crystal L. Klima, Carrie S. Steffen, Alana D. Leshabari, Sebalda C. Pauls, Heather Norr, Kathleen F. |
| description | Objective
To identify implementation challenges associated with conducting a randomized controlled trial (RCT) of group prenatal care (PNC) and report outcomes of the pilot.
Methods
A multi‐site randomized pilot was conducted in Malawi and Tanzania between July 31, 2014, and June 30, 2015. Women aged at least 16 years with a pregnancy of 20–24 weeks were randomly assigned using sealed envelopes (1:1) to individual or group PNC. Structured interviews were conducted at baseline, in the third trimester and 6–8 weeks after delivery. The primary outcomes were attendance at four PNC visits and attendance at the 6‐week postnatal visit.
Results
The pilot showed that an RCT with individual randomization can be conducted in these two low‐resource settings. Significantly more women in group PNC than in individual PNC completed at least four PNC visits (96/102 [94.1%] vs 53/91 [58.2%]) and attended the postnatal visit (76/102 [74.5%] vs 45/90 [50.0%]; both P |
| doi_str_mv | 10.1002/ijgo.12324 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5673548</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1938851554</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4864-4a20e11c7835f5e64a1cdee58b8c8a094c010a54c9cd17e210e9da9289c9495f3</originalsourceid><addsrcrecordid>eNp9kUFPFTEQxxsjkSd68QOYHo3JYrvbvm0vJoYIPgPhAudm6M4-Srrt2u5KHle_OIVFohdOzXR--c1M_oR84OyQM1Z_cTfbeMjrphavyIqrVleNaPVrsipNVrW1rvfJ25xvGGO85fwN2a-VZrJp2xX5sxlGjwOGCSYXA7XX4D2GLWYKoaNxnmwcShF7CjSVrzi4O-yojWFKsaAdHZ2PE83T3O0WbJviPNIxYYAJPLWQkA6xQ09doGfg4dY9yi8g3EFw8I7s9eAzvn96D8jl8feLox_V6fnJ5ujbaWWFWotKQM2Qc9uqRvYS1wK47RClulJWAdPCMs5ACqttx1usOUPdgS63Wi207JsD8nXxjvPVgJ0tRyfwZkxugLQzEZz5vxPctdnG30au20YKVQSfngQp_poxT2Zw2aL3EDDO2XDdKCW5lKKgnxfUpphzwv55DGfmITXzkJp5TK3AH_9d7Bn9G1MB-ALcOo-7F1Rm8_PkfJHeA2ukpdE</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1938851554</pqid></control><display><type>article</type><title>Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Patil, Crystal L. ; Klima, Carrie S. ; Steffen, Alana D. ; Leshabari, Sebalda C. ; Pauls, Heather ; Norr, Kathleen F.</creator><creatorcontrib>Patil, Crystal L. ; Klima, Carrie S. ; Steffen, Alana D. ; Leshabari, Sebalda C. ; Pauls, Heather ; Norr, Kathleen F.</creatorcontrib><description>Objective
To identify implementation challenges associated with conducting a randomized controlled trial (RCT) of group prenatal care (PNC) and report outcomes of the pilot.
Methods
A multi‐site randomized pilot was conducted in Malawi and Tanzania between July 31, 2014, and June 30, 2015. Women aged at least 16 years with a pregnancy of 20–24 weeks were randomly assigned using sealed envelopes (1:1) to individual or group PNC. Structured interviews were conducted at baseline, in the third trimester and 6–8 weeks after delivery. The primary outcomes were attendance at four PNC visits and attendance at the 6‐week postnatal visit.
Results
The pilot showed that an RCT with individual randomization can be conducted in these two low‐resource settings. Significantly more women in group PNC than in individual PNC completed at least four PNC visits (96/102 [94.1%] vs 53/91 [58.2%]) and attended the postnatal visit (76/102 [74.5%] vs 45/90 [50.0%]; both P<0.001).
Conclusion
Group PNC was feasible and associated with an increase in healthcare utilization and improved outcomes in Malawi and Tanzania. Lessons learned should be considered when designing large RCTs to determine efficacy.
ClinicalTrials.gov: NCT02999334
Pilot results from Malawi and Tanzania show that group prenatal care is associated with increased healthcare utilization and that a randomized controlled trial is feasible.</description><identifier>ISSN: 0020-7292</identifier><identifier>EISSN: 1879-3479</identifier><identifier>DOI: 10.1002/ijgo.12324</identifier><identifier>PMID: 28905377</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Adult ; CenteringPregnancy ; Feasibility Studies ; Female ; Group healthcare models ; Group prenatal care ; Health Plan Implementation ; Humans ; Malawi ; Patient Acceptance of Health Care - statistics & numerical data ; Pilot Projects ; Postnatal Care - methods ; Pregnancy ; Prenatal care ; Prenatal Care - methods ; Psychotherapy, Group - methods ; Quality of care ; Randomized Controlled Trials as Topic - methods ; Respectful care ; Sub‐Saharan Africa ; Tanzania ; Young Adult</subject><ispartof>International journal of gynecology and obstetrics, 2017-12, Vol.139 (3), p.290-296</ispartof><rights>2017 International Federation of Gynecology and Obstetrics</rights><rights>2017 International Federation of Gynecology and Obstetrics.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4864-4a20e11c7835f5e64a1cdee58b8c8a094c010a54c9cd17e210e9da9289c9495f3</citedby><cites>FETCH-LOGICAL-c4864-4a20e11c7835f5e64a1cdee58b8c8a094c010a54c9cd17e210e9da9289c9495f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fijgo.12324$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fijgo.12324$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,777,781,882,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28905377$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patil, Crystal L.</creatorcontrib><creatorcontrib>Klima, Carrie S.</creatorcontrib><creatorcontrib>Steffen, Alana D.</creatorcontrib><creatorcontrib>Leshabari, Sebalda C.</creatorcontrib><creatorcontrib>Pauls, Heather</creatorcontrib><creatorcontrib>Norr, Kathleen F.</creatorcontrib><title>Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania</title><title>International journal of gynecology and obstetrics</title><addtitle>Int J Gynaecol Obstet</addtitle><description>Objective
To identify implementation challenges associated with conducting a randomized controlled trial (RCT) of group prenatal care (PNC) and report outcomes of the pilot.
Methods
A multi‐site randomized pilot was conducted in Malawi and Tanzania between July 31, 2014, and June 30, 2015. Women aged at least 16 years with a pregnancy of 20–24 weeks were randomly assigned using sealed envelopes (1:1) to individual or group PNC. Structured interviews were conducted at baseline, in the third trimester and 6–8 weeks after delivery. The primary outcomes were attendance at four PNC visits and attendance at the 6‐week postnatal visit.
Results
The pilot showed that an RCT with individual randomization can be conducted in these two low‐resource settings. Significantly more women in group PNC than in individual PNC completed at least four PNC visits (96/102 [94.1%] vs 53/91 [58.2%]) and attended the postnatal visit (76/102 [74.5%] vs 45/90 [50.0%]; both P<0.001).
Conclusion
Group PNC was feasible and associated with an increase in healthcare utilization and improved outcomes in Malawi and Tanzania. Lessons learned should be considered when designing large RCTs to determine efficacy.
ClinicalTrials.gov: NCT02999334
Pilot results from Malawi and Tanzania show that group prenatal care is associated with increased healthcare utilization and that a randomized controlled trial is feasible.</description><subject>Adolescent</subject><subject>Adult</subject><subject>CenteringPregnancy</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Group healthcare models</subject><subject>Group prenatal care</subject><subject>Health Plan Implementation</subject><subject>Humans</subject><subject>Malawi</subject><subject>Patient Acceptance of Health Care - statistics & numerical data</subject><subject>Pilot Projects</subject><subject>Postnatal Care - methods</subject><subject>Pregnancy</subject><subject>Prenatal care</subject><subject>Prenatal Care - methods</subject><subject>Psychotherapy, Group - methods</subject><subject>Quality of care</subject><subject>Randomized Controlled Trials as Topic - methods</subject><subject>Respectful care</subject><subject>Sub‐Saharan Africa</subject><subject>Tanzania</subject><subject>Young Adult</subject><issn>0020-7292</issn><issn>1879-3479</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFPFTEQxxsjkSd68QOYHo3JYrvbvm0vJoYIPgPhAudm6M4-Srrt2u5KHle_OIVFohdOzXR--c1M_oR84OyQM1Z_cTfbeMjrphavyIqrVleNaPVrsipNVrW1rvfJ25xvGGO85fwN2a-VZrJp2xX5sxlGjwOGCSYXA7XX4D2GLWYKoaNxnmwcShF7CjSVrzi4O-yojWFKsaAdHZ2PE83T3O0WbJviPNIxYYAJPLWQkA6xQ09doGfg4dY9yi8g3EFw8I7s9eAzvn96D8jl8feLox_V6fnJ5ujbaWWFWotKQM2Qc9uqRvYS1wK47RClulJWAdPCMs5ACqttx1usOUPdgS63Wi207JsD8nXxjvPVgJ0tRyfwZkxugLQzEZz5vxPctdnG30au20YKVQSfngQp_poxT2Zw2aL3EDDO2XDdKCW5lKKgnxfUpphzwv55DGfmITXzkJp5TK3AH_9d7Bn9G1MB-ALcOo-7F1Rm8_PkfJHeA2ukpdE</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Patil, Crystal L.</creator><creator>Klima, Carrie S.</creator><creator>Steffen, Alana D.</creator><creator>Leshabari, Sebalda C.</creator><creator>Pauls, Heather</creator><creator>Norr, Kathleen F.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201712</creationdate><title>Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania</title><author>Patil, Crystal L. ; Klima, Carrie S. ; Steffen, Alana D. ; Leshabari, Sebalda C. ; Pauls, Heather ; Norr, Kathleen F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4864-4a20e11c7835f5e64a1cdee58b8c8a094c010a54c9cd17e210e9da9289c9495f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>CenteringPregnancy</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Group healthcare models</topic><topic>Group prenatal care</topic><topic>Health Plan Implementation</topic><topic>Humans</topic><topic>Malawi</topic><topic>Patient Acceptance of Health Care - statistics & numerical data</topic><topic>Pilot Projects</topic><topic>Postnatal Care - methods</topic><topic>Pregnancy</topic><topic>Prenatal care</topic><topic>Prenatal Care - methods</topic><topic>Psychotherapy, Group - methods</topic><topic>Quality of care</topic><topic>Randomized Controlled Trials as Topic - methods</topic><topic>Respectful care</topic><topic>Sub‐Saharan Africa</topic><topic>Tanzania</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patil, Crystal L.</creatorcontrib><creatorcontrib>Klima, Carrie S.</creatorcontrib><creatorcontrib>Steffen, Alana D.</creatorcontrib><creatorcontrib>Leshabari, Sebalda C.</creatorcontrib><creatorcontrib>Pauls, Heather</creatorcontrib><creatorcontrib>Norr, Kathleen F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of gynecology and obstetrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patil, Crystal L.</au><au>Klima, Carrie S.</au><au>Steffen, Alana D.</au><au>Leshabari, Sebalda C.</au><au>Pauls, Heather</au><au>Norr, Kathleen F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania</atitle><jtitle>International journal of gynecology and obstetrics</jtitle><addtitle>Int J Gynaecol Obstet</addtitle><date>2017-12</date><risdate>2017</risdate><volume>139</volume><issue>3</issue><spage>290</spage><epage>296</epage><pages>290-296</pages><issn>0020-7292</issn><eissn>1879-3479</eissn><abstract>Objective
To identify implementation challenges associated with conducting a randomized controlled trial (RCT) of group prenatal care (PNC) and report outcomes of the pilot.
Methods
A multi‐site randomized pilot was conducted in Malawi and Tanzania between July 31, 2014, and June 30, 2015. Women aged at least 16 years with a pregnancy of 20–24 weeks were randomly assigned using sealed envelopes (1:1) to individual or group PNC. Structured interviews were conducted at baseline, in the third trimester and 6–8 weeks after delivery. The primary outcomes were attendance at four PNC visits and attendance at the 6‐week postnatal visit.
Results
The pilot showed that an RCT with individual randomization can be conducted in these two low‐resource settings. Significantly more women in group PNC than in individual PNC completed at least four PNC visits (96/102 [94.1%] vs 53/91 [58.2%]) and attended the postnatal visit (76/102 [74.5%] vs 45/90 [50.0%]; both P<0.001).
Conclusion
Group PNC was feasible and associated with an increase in healthcare utilization and improved outcomes in Malawi and Tanzania. Lessons learned should be considered when designing large RCTs to determine efficacy.
ClinicalTrials.gov: NCT02999334
Pilot results from Malawi and Tanzania show that group prenatal care is associated with increased healthcare utilization and that a randomized controlled trial is feasible.</abstract><cop>United States</cop><pmid>28905377</pmid><doi>10.1002/ijgo.12324</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Adult CenteringPregnancy Feasibility Studies Female Group healthcare models Group prenatal care Health Plan Implementation Humans Malawi Patient Acceptance of Health Care - statistics & numerical data Pilot Projects Postnatal Care - methods Pregnancy Prenatal care Prenatal Care - methods Psychotherapy, Group - methods Quality of care Randomized Controlled Trials as Topic - methods Respectful care Sub‐Saharan Africa Tanzania Young Adult |
| title | Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania |
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