Group Antenatal Care to Promote a Healthy Pregnancy and Optimize Maternal and Newborn Outcomes: A Cluster Randomized Controlled Trial

团体产前护理促进健康妊娠并优化孕产妇和新生儿结局：整群随机对照试验

• 批准号: 10471877
• 负责人: Jody Rae Lori
• 金额: $ 44.34万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10471877
• 关键词: Address; Behavior; Behavioral; Birth; Birth Rate; Caring; Childbirth; Client; Clinic; Clinical; Communication; Community Health Planning; Complication; Country; Data Collection; Development; Educational process of instructing; Elements; Exhibits; Funding; Gestational Age; Ghana; Grouping; Health; Health care facility; Individual; Information Services; International; Intervention; Interview; Knowledge; Learning; Life; Literature; Location; Low Literacy Population; Maternal Health; Medical Records; Midwife; Modeling; Morbidity - disease rate; Mothers; Neighborhood Health Center; Neonatal Mortality; Newborn Infant; Nurses; Outcome; Participant; Patient Education; Patients; Pattern; Perinatal mortality demographics; Population; Postnatal Care; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnant Women; Primary Health Care; Process; Provider; Public Health; Randomized; Randomized Controlled Trials; Readiness; Research; Resource-limited setting; Resources; Rural; Savings; Self Care; Services; Site; Surveys; Testing; Theoretical model; Time; Transportation; United States National Institutes of Health; Visit; Vulnerable Populations; Woman; Women' s Group; antenatal care; base; behavioral outcome; care seeking; clinical care; clinical practice; comparison group; design; efficacy evaluation; experience; feasibility testing; health goals; health literacy; healthy pregnancy; improved; innovation; maternal morbidity; mortality; novel strategies; peer support; postpartum care; rural area; skills; stillbirth

Project Summary/Abstract This proposal, Group Antenatal Care to Promote a Healthy Pregnancy and Optimize Maternal and Newborn Outcomes: A Cluster Randomized Controlled Trial, responds to PAR-16-160, and builds on our recent Fogarty International/NIH funded study (1 K01 TW008763-01A1, Lori PI) in Ghana. Our study is guided by a theoretical model originally developed by Squiers et al. and modified in our preliminary research to assess maternal health literacy. The Modified Maternal Health Literacy Skills Framework uses an ecological perspective to help assist in the development and testing of potential interventions to impact health literacy. Our intervention, group antenatal care (ANC), consists of grouping women by similar gestational ages into small groups at the first ANC visit. They then meet with the same group and the same provider over the course of their pregnancy. The model used to conduct the group visits was developed and tested among low- and non-literate pregnant women in Ghana by the PI with funding from Fogarty, in a quasi-experimental, two-group comparison study that yielded favorable behavioral outcomes. In this study, we propose three aims: Aim 1: To quantify differences in Birth Preparedness and Complication Readiness (BPCR), including knowledge of danger signs and recommended action steps between women randomized to group-based ANC and routine, individual ANC. Aim 2: To assess behavioral differences in care-seeking patterns (e.g. facility birth rates, postnatal and postpartum care) between women randomized to group-based ANC and routine, individual ANC. Aim 3: To evaluate the clinical outcomes of mothers and their newborns (e.g. decrease in maternal morbidities and perinatal and neonatal mortality) between women randomized to group-based ANC and routine, individual ANC immediately postpartum and up to one year following birth. We hypothesize that pregnant women randomized into group ANC will exhibit increased health literacy through: 1) increased BPCR including recognition of danger signs and knowledge of how to respond to such signs; 2) higher rates of care-seeking behaviors, including seeking care for problems identified during pregnancy, higher facility delivery rates, and increased attendance at postnatal care; and 3) better clinical outcomes for themselves and their newborns than women who received the standard, individual ANC. To test our hypotheses, we propose to conduct a cluster randomized control trial stratified by site and gestational age in the East Mamprusi District of the Northern Region of Ghana, a predominantly rural area. We will follow women and their newborns for one-year post delivery. To examine clinical and behavioral outcomes, data collection will be conducted via cellphones, face-to-face interviews, and medical record review. This study is significant and timely because it is one of the first randomized control trials to be conducted to examine the effects of group ANC with low and non-literate participants. Our findings have the potential to impact how clinical care is delivered to low literacy populations both globally and domestically to improve maternal and newborn outcomes.

项目总结/摘要 这一建议，集团产前护理，以促进健康的怀孕和优化产妇和新生儿 结果：一项群集随机对照试验，响应PAR-16-160，并建立在我们最近的Fogarty基础上 国际/NIH资助的加纳研究（1 K 01 TW 008763 - 01 A1，洛里PI）。我们的研究是由一个 理论模型最初由Squiers等人开发，并在我们的初步研究中进行了修改以评估 产妇保健知识。《经修订的孕产妇保健知识技能框架》采用了一种生态 这一观点有助于制定和测试影响卫生知识普及的潜在干预措施。 我们的干预措施，小组产前护理（ANC），包括分组妇女按相似的胎龄， 在第一次ANC访问中的小团体。然后他们在课程中与同一组和同一提供者会面 他们的怀孕。制定了进行集体访问的模式，并在低收入和低收入群体中进行了测试。 在Fogarty的资助下，PI在加纳的文盲孕妇中进行了一项准实验性的两组研究， 比较研究产生了良好的行为结果。在本研究中，我们提出了三个目标：目标1： 量化分娩准备和并发症准备（BPCR）的差异，包括 随机分组至基于组的ANC和常规组的女性之间的危险体征和建议的行动步骤， 个体ANC目的2：评估寻求护理模式中的行为差异（例如设施出生率， 产后和产后护理）之间的妇女随机分组为基于组的ANC和常规，个人ANC。 目的3：评价母亲及其新生儿的临床结局（例如，降低孕产妇发病率 和围产期和新生儿死亡率）之间的妇女随机分组为基础的ANC和常规，个人 产后立即和产后一年内的ANC。我们假设孕妇 随机分组的ANC将通过以下方式表现出健康素养的提高：1）BPCR增加，包括 识别危险信号并了解如何应对这些信号; 2）更高的求医率 行为，包括在怀孕期间发现的问题寻求护理，更高的设施分娩率， 增加产后护理; 3）为自己和新生儿提供更好的临床结果 接受标准的个体ANC的女性。为了验证我们的假设，我们建议进行一项 在东曼普鲁西地区进行的一项按地点和胎龄分层的随机分组对照试验 加纳北方地区，主要是农村地区。我们将跟踪妇女和她们的新生儿一年 邮寄。为了检查临床和行为结果，将通过手机进行数据收集， 面谈和病历审查这项研究意义重大而且及时，因为它是 第一个随机对照试验将进行检查组ANC的影响，低和文盲， 参与者我们的研究结果有可能影响临床护理如何提供给低文化水平的人。 在全球和国内的人口，以改善孕产妇和新生儿的结果。

项目成果

Group Antenatal Care in Ghana: Protocol for a Cluster Randomized Controlled Trial.

• DOI: 10.2196/40828
• 发表时间: 2022-09-09
• 期刊: JMIR RESEARCH PROTOCOLS
• 影响因子: 1.7
• 作者: Lori, Jody R.;Williams, John E. O.;Kukula, Vida A.;Apetorgbor, Veronica E. A.;Awini, Elizabeth A.;Amankwah, Georgina;Zielinski, Ruth;Lockhart, Nancy;James, Katherine H.;Moyer, Cheryl A.
• 通讯作者: Moyer, Cheryl A.

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

通过团体产前护理改善尊重的产妇护理：整群随机对照试验的结果。

• DOI: 10.21203/rs.3.rs-3682833/v1
• 发表时间: 2023
• 期刊: Research square
• 作者: Lanyo,TheresaNorpeli;Zielinski,Ruth;Kukula,VidaA;Apetorgbor,VeronicaEA;Ghosh,Bidisha;Lockhart,NancyA;Lori,JodyR
• 通讯作者: Lori,JodyR

Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana.

• DOI: 10.1186/s12884-023-06224-x
• 发表时间: 2024-01-05
• 期刊: BMC pregnancy and childbirth
• 影响因子: 3.1

"With group antenatal care, pregnant women know they are not alone": The process evaluation of a group antenatal care intervention in Ghana.

• DOI: 10.1371/journal.pone.0291855
• 发表时间: 2023
• 期刊: PloS one
• 影响因子: 3.7