Adapting and Implementing Group-Based Postpartum/Well-Child Care at Clinics In Blantyre District, Malawi

马拉维布兰太尔区诊所调整和实施基于团体的产后/儿童保健

• 批准号: 10456474
• 负责人: Ashley Katrina Gresh
• 金额: $ 0.25万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-16 至 2022-06-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456474
• 关键词: Address; Affect; Africa; Africa South of the Sahara; Attention; Birth; Birth Intervals; Breast Feeding; Caring; Child; Child Care; Child Development; Child Rearing; Child Support; Childbirth; Clinic; Cognition; Collection; Community Outreach; Conflict (Psychology); Continuity of Patient Care; Contraceptive Agents; Discipline of Nursing; Disease; Economics; Effectiveness; Ensure; Ethnography; Exclusive Breastfeeding; Family; Foundations; Funding; Future; Guidelines; Health; Health Promotion; Health care facility; Healthcare; Hour; Husband; Immunization; Incubators; Individual; Infant; Infant Health; Infant Mortality; Kenya; Learning; Life Cycle Stages; Link; Live Birth; Malawi; Maternal Health; Maternal Mortality; Maternal and Child Health; Mental Depression; Mental Health; Methods; Mission; Modeling; Mothers; Nigeria; Nurses; Outcome; Parents; Personal Satisfaction; Phase; Postpartum Period; Prenatal care; Provider; Quality of Care; Recovery; Research; Research Infrastructure; Resources; Rwanda; Science; Self Efficacy; Service delivery model; Standardization; Stress; Structure; Tanzania; Testing; Thinking; Time; Training; Translating; Visit; Woman; Women' s Health; Work; World Health Organization; acceptability and feasibility; antenatal care; base; behavior change; child services; combat; community building; cost; critical period; design; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness trial; empowered; evidence base; expectation; experience; feasibility testing; feeding; global health; hands-on learning; health care model; health literacy; health management; implementation barriers; implementation facilitators; improved; improved outcome; infant death; infant morbidity; infant morbidity/mortality; infant nutrition; innovation; maternal comorbidity; maternal morbidity; nutrition; parental role; postpartum care; postpartum health; prenatal; programs; prototype; psychosocial; response; satisfaction; social; success

PROJECT SUMMARY Postpartum care, defined from the time of birth through the first year, sets the stage for long-term health and well-being for both the mother and her child; further it is a critical time to reduce maternal and infant morbidity and mortality. The World Health Organization (WHO) recommends that every mother and baby should have at least four postpartum visits within the first six weeks of giving birth. The first year after childbirth is a period of not only physical recovery but is an important time to identify and manage health and social challenges including psychosocial adaptations and transitions to a parental role, that make women and children vulnerable for poor health outcomes. Globally there is no standardized package of care for the first year postpartum. Further, there are low rates of postpartum care attendance, revealing women's unmet needs during this critical period in their life course. Sub-Saharan Africa and specifically Malawi have some of the highest rates of maternal and infant mortality (MMR 634 maternal deaths per 100,000 live births and 42 infant deaths per 1,000 live births) globally. High rates of maternal and infant morbidity and mortality and preventable illness and disease necessitate transformation in the delivery of postpartum and well-child care in this critical time in the maternal/infant life course. CenteringParenting is an innovative group healthcare model that can address gaps in both postpartum and well-child care with a growing evidence base yielding positive results. This group-care model aims to improve maternal and child health outcomes by addressing maternal co-morbidities, ensuring contraceptive plans to promote adequate birth-spacing, encouraging exclusive breastfeeding, infant nutrition, parenting self-efficacy, child development and quality of care. There is a need to develop through innovative strategies a postpartum/well-child group care model that is sensitive to maternal-infant dyads in low resource contexts where rates of maternal and infant morbidity and mortality are high. Therefore, the purpose of this mixed methods study is to adapt and implement CenteringParenting, a model of care that holds promise to advance guidelines for quality postpartum and well-child care, and evaluate its feasibility and acceptability in the Malawian context. This study will build on the research infrastructure and momentum of the ongoing NINR- funded (R01 NR018115) effectiveness trial for group based antenatal care in Blantyre district, Malawi. The proposed study will use the five-steps of design thinking approach to adapt CenteringParenting: 1) empathize; 2) define; 3) ideate; 4) prototype; and 5) test. This will be done through a rapid ethnographic assessment and incubator sessions with women, health surveillance workers and providers to create the Care Circles prototype. The Care Circles prototype will be tested to determine feasibility and acceptability in the Malawian context. The findings will inform the next step in the applicant's program of research, to determine the effectiveness of the CenteringParenting program model in Malawi and other low-resource settings, including in the US and beyond.

项目摘要 产后护理，从出生到第一年的定义，为长期健康奠定了基础， 此外，现在是降低孕产妇和婴儿发病率的关键时刻 and mortality.世界卫生组织（WHO）建议，每一位母亲和婴儿都应该在 在分娩后的前六周内至少进行四次产后访视。分娩后的第一年是一段时间， 不仅是身体恢复，而且是识别和管理健康和社会挑战的重要时间 包括心理社会适应和向父母角色的过渡，使妇女和儿童处于弱势地位 因为健康状况不佳。在全球范围内，产后第一年没有标准化的一揽子护理。 此外，产后护理就诊率较低，揭示了妇女在这一关键时期未得到满足的需求 在他们的生命历程中。撒哈拉以南非洲，特别是马拉维， 产妇和婴儿死亡率（产妇死亡率为每100 000例活产634例产妇死亡，每1 000例活产42例婴儿死亡 活产）。产妇和婴儿发病率和死亡率以及可预防疾病的发病率和死亡率高， 在这一关键时期， 母婴生命历程CenteringParenting是一种创新的团体医疗保健模式，可以解决差距 在产后和儿童健康护理方面，越来越多的证据基础产生了积极的结果。这种集体护理 该模式旨在通过解决孕产妇合并症，确保 避孕计划，以促进适当的生育间隔，鼓励纯母乳喂养，婴儿营养， 养育自我效能、儿童发展和照料质量。有必要通过创新发展 策略在资源匮乏的情况下，建立对母婴二元关系敏感的产后/健康儿童团体护理模式 在孕产妇和婴儿发病率和死亡率高的情况下，因此，这样做的目的 混合方法研究是适应和实施CenteringParenting，一种护理模式， 推进优质产后和良好儿童护理指南，并评估其可行性和可接受性 马拉维背景。这项研究将建立在正在进行的NINR的研究基础设施和势头的基础上， 在马拉维的布兰太尔地区进行的一项资助的（R 01 NR 018115）基于小组的产前保健有效性试验。的 本研究拟采用五步设计思维方法来适应以人为本的教养方式：1）移情; 2)定义; 3）构思; 4）原型; 5）测试。这将通过快速人种学评估来完成， 与妇女、健康监测工作者和提供者举行孵化器会议，以创建护理圈原型。 将对“护理圈”原型进行测试，以确定其在马拉维的可行性和可接受性。的 调查结果将告知申请人研究计划的下一步，以确定 在马拉维和其他低资源环境中，包括在美国和其他地区，以育儿计划为中心。