“Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya

Abstract Background Traditional antenatal care (ANC) models often do not meet women’s needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet wit...

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Main Authors: Aleefia Somji, Kate Ramsey, Sean Dryer, Fredrick Makokha, Constance Ambasa, Brittany Aryeh, Kathleen Booth, Serge Xueref, Seneca Moore, Ralpher Mwenesi, Shafia Rashid
Format: Article
Language:English
Published: BMC 2022-07-01
Series:BMC Health Services Research
Subjects:
Online Access:https://doi.org/10.1186/s12913-022-08200-1
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author Aleefia Somji
Kate Ramsey
Sean Dryer
Fredrick Makokha
Constance Ambasa
Brittany Aryeh
Kathleen Booth
Serge Xueref
Seneca Moore
Ralpher Mwenesi
Shafia Rashid
author_facet Aleefia Somji
Kate Ramsey
Sean Dryer
Fredrick Makokha
Constance Ambasa
Brittany Aryeh
Kathleen Booth
Serge Xueref
Seneca Moore
Ralpher Mwenesi
Shafia Rashid
author_sort Aleefia Somji
collection DOAJ
description Abstract Background Traditional antenatal care (ANC) models often do not meet women’s needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet with the same health provider for facilitated discussion. F studies show associations between GANC and various outcomes. Methods We employed a pre-post quasi-experimental design using mixed methods to assess a GANC model (Lea Mimba Pregnancy Clubs) at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1652 women assigned to 162 GANC cohorts. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes including experience of care, empowerment and self-efficacy, knowledge of healthy practices and danger signs, and practice of healthy behaviors, including ANC retention. At endline, we conducted 29 in-depth interviews (IDIs) and three focus group discussions with women who were currently and previously participating in GANC, and 15 IDIs with stakeholders. Results The proportion of survey respondents with knowledge of three or more danger signs during pregnancy more than tripled, from 7.1% at baseline to 26.4% at endline (OR: 4.58; 95% CI: 2.26–10.61). We also found improvements in women’s reports about their experience of care between baseline and endline, particularly in their assessment of knowledge and competence of health workers (OR: 2.52 95% CI: 1.57–4.02), respect shown by ANC providers (OR: 1.82, 95% CI: 1.16–2.85), and women’s satisfaction with overall quality of care (OR: 1.62, 95% CI: 1.03–2.53). We saw an increase from 58.9% at baseline to 71.7% at endline of women who strongly agreed that they shared their feelings and experiences with other women (OR: 1.73, 95% CI: 1.1–2.7). The mean number of ANC visits increased by 0.89 visits (95% CI: 0.47–1.42) between baseline (4.21) and endline (5.08). No changes were seen in knowledge of positive behaviors, empowerment, self-efficacy, and several aspects related to women’s experience of care and adoption of healthy behavior constructs. Qualitatively, women and stakeholders noted improved interactions between health providers and women, improved counseling, increased feelings of empowerment to ask questions and speak freely and strengthened social networks and enhanced social cohesion among women. Conclusions GANC offers promise for enhancing women’s experience of care by providing improved counseling and social support. Additional research is needed to develop and test measures for empowerment, self-efficacy, and experience of care, and to understand the pathways whereby GANC effects changes in specific outcomes.
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spelling doaj.art-2ae8143597e54d379bcc3a95884399d92022-12-22T00:58:16ZengBMCBMC Health Services Research1472-69632022-07-0122111510.1186/s12913-022-08200-1“Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, KenyaAleefia Somji0Kate Ramsey1Sean Dryer2Fredrick Makokha3Constance Ambasa4Brittany Aryeh5Kathleen Booth6Serge Xueref7Seneca Moore8Ralpher Mwenesi9Shafia Rashid10Management Sciences for Health (MSH)ScopeGlobally Minded FoundationMinistry of HealthIndependent ConsultantPartners in Health (PIH)Columbia University Mailman School of Public HealthMSHIndependent ConsultantMinistry of HealthMSHAbstract Background Traditional antenatal care (ANC) models often do not meet women’s needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet with the same health provider for facilitated discussion. F studies show associations between GANC and various outcomes. Methods We employed a pre-post quasi-experimental design using mixed methods to assess a GANC model (Lea Mimba Pregnancy Clubs) at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1652 women assigned to 162 GANC cohorts. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes including experience of care, empowerment and self-efficacy, knowledge of healthy practices and danger signs, and practice of healthy behaviors, including ANC retention. At endline, we conducted 29 in-depth interviews (IDIs) and three focus group discussions with women who were currently and previously participating in GANC, and 15 IDIs with stakeholders. Results The proportion of survey respondents with knowledge of three or more danger signs during pregnancy more than tripled, from 7.1% at baseline to 26.4% at endline (OR: 4.58; 95% CI: 2.26–10.61). We also found improvements in women’s reports about their experience of care between baseline and endline, particularly in their assessment of knowledge and competence of health workers (OR: 2.52 95% CI: 1.57–4.02), respect shown by ANC providers (OR: 1.82, 95% CI: 1.16–2.85), and women’s satisfaction with overall quality of care (OR: 1.62, 95% CI: 1.03–2.53). We saw an increase from 58.9% at baseline to 71.7% at endline of women who strongly agreed that they shared their feelings and experiences with other women (OR: 1.73, 95% CI: 1.1–2.7). The mean number of ANC visits increased by 0.89 visits (95% CI: 0.47–1.42) between baseline (4.21) and endline (5.08). No changes were seen in knowledge of positive behaviors, empowerment, self-efficacy, and several aspects related to women’s experience of care and adoption of healthy behavior constructs. Qualitatively, women and stakeholders noted improved interactions between health providers and women, improved counseling, increased feelings of empowerment to ask questions and speak freely and strengthened social networks and enhanced social cohesion among women. Conclusions GANC offers promise for enhancing women’s experience of care by providing improved counseling and social support. Additional research is needed to develop and test measures for empowerment, self-efficacy, and experience of care, and to understand the pathways whereby GANC effects changes in specific outcomes.https://doi.org/10.1186/s12913-022-08200-1KenyaPregnancy clubsQuality of careExperience of careEmpowermentSocial support
spellingShingle Aleefia Somji
Kate Ramsey
Sean Dryer
Fredrick Makokha
Constance Ambasa
Brittany Aryeh
Kathleen Booth
Serge Xueref
Seneca Moore
Ralpher Mwenesi
Shafia Rashid
“Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya
BMC Health Services Research
Kenya
Pregnancy clubs
Quality of care
Experience of care
Empowerment
Social support
title “Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya
title_full “Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya
title_fullStr “Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya
title_full_unstemmed “Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya
title_short “Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya
title_sort taking care of your pregnancy a mixed methods study of group antenatal care in kakamega county kenya
topic Kenya
Pregnancy clubs
Quality of care
Experience of care
Empowerment
Social support
url https://doi.org/10.1186/s12913-022-08200-1
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