Adapting group care to the postpartum period using a human-centered design approach in Malawi.
Adapting group care to the postpartum period using a human-centered design approach in Malawi.
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DOI：
10.1186/s12913-023-10036-2
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发表时间：
2023-10-14
影响因子：
2.8
通讯作者：
Patil, Crystal L.
中科院分区：
文献类型：
--
作者：
Gresh, Ashley;Batchelder, Anne;Glass, Nancy;Mambulasa, Janet;Kapito, Esnath;Macdonald, Amy;Ngutwa, Nellie;Plesko, Cori;Chirwa, Ellen;Patil, Crystal L.
低收入和中等收入国家需要采取应对和有弹性的战略，以降低孕产妇和婴儿死亡率高企以及临床医生短缺的问题。马拉维是全球孕产妇和婴儿死亡率最高的国家。团体医疗保健是一种整合了这些战略的服务提供模式。虽然主要在产前实施，但其改善产后母婴健康结果的潜力尚未实现。本研究的目的是适应和共同设计的原型，以证据为基础的群体护理模式的产后期间使用以人为本的设计方法与马拉维的主要利益相关者。我们完成了指导使用以人为本的设计的框架的步骤：1）定义问题并组建团队; 2）通过证据和灵感收集信息; 3）综合; 4）干预设计：指导原则和构思。使用定性方法完成步骤2-4。深入访谈（n = 24），孵化器会议（n = 6），采用自由上市，桩排序和排名完成与关键利益相关者。资料分析包括访谈内容分析与孵化器会议架构分析，以产生整合团体产后及幼儿照护模式原型。第五步将在另一份文件中详细说明。所有利益攸关方都报告说，希望参与并提供产后集体护理。利益攸关方合作共同创建原型，其中包括健康促进主题和互动活动的课程以及服务提供结构。健康促进专题的优先事项是卫生、母乳喂养、计划生育、营养和心理健康。建议的时间表包括6个疗程，与产后12个月期间的儿童疫苗接种时间表相对应。使用以人为本的设计方法，以适应基于证据的群体护理模式在LMIC，特别是马拉维，是可行的，并接受关键利益相关者，并导致在原型课程和诊所实施的实用策略。
Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi. We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2–4. In-depth interviews (n = 24), and incubator sessions (n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper. All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period. Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation.
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