Preterm Birth Initiative-Rwanda antenatal care and postnatal care providers survey

Background: The East Africa Preterm Birth Initiative-Rwanda began a cluster randomized controlled trial of group antenatal care (ANC) and postnatal care (PNC) in Rwanda in 2017. That trial will report its primary outcome, gestational length at birth, after data collection concludes in 2019. This nested study includes providers of ANC and/or PNC at the 18 health centers randomized to provide the group model of ANC/PNC and the 18 health centers randomized to continue providing ANC/PNC in the traditional, individual visit model. The objective of this study is to understand the experiences of providers of group ANC/PNC and compare their job satisfaction and perceived stress with individual ANC/PNC providers.

Methods: We collected both quantitative and qualitative data from providers (nurses and midwives) who were recruited by health center directors to participate as group ANC and PNC facilitators at intervention sites and from a similar number of providers of standard ANC and PNC at control sites. Quantitative data was collected with questionnaires administered at baseline and approximately 9 months later (follow up). Qualitative data was collected in 3 focus groups of group ANC/PNC providers conducted one year after group care began.

Results: Eighty-six percent of nurses and midwives surveyed who implemented group ANC and PNC reported that they prefer group care to the traditional individual model of ANC and PNC. Perceived stress levels and job satisfaction results were similar between groups. Mixed focus group discussions among both nurses and midwives experienced in group ANC and PNC suggest that the group model of care has advantages for both service beneficiaries and providers. When providers described implementation challenges, their peers in the focus groups offered them suggestions to cope and improve service delivery.

Discussion: These results are consistent with studies of providers of group ANC and PNC in other LMIC contexts with respect to the perceived benefits of group care. This study adds new insights into the ways peer providers can help one another solve implementation problems. When given the opportunity to meet as a group, these study participants offered one another peer support and shared knowledge about best practices for successful implementation of group ANC/PNC.

This trial is registered at clinicaltrials.gov as NCT03154177.

研究背景：东非早产倡议-卢旺达项目于2017年在卢旺达启动了一项集体产前保健（Antenatal Care，ANC）与产后保健（Postnatal Care，PNC）的整群随机对照试验。该试验的主要结局指标为分娩时的孕周，其研究结果将于2019年数据收集工作结束后正式公布。本嵌套研究纳入了两类卫生中心的医护人员：一类是被随机分配采用集体式ANC/PNC服务模式的18所卫生中心，另一类是被随机分配继续采用传统个体就诊模式提供ANC/PNC服务的18所卫生中心。本研究旨在了解集体式ANC/PNC服务提供者的从业体验，并对比其与传统个体ANC/PNC服务提供者的工作满意度与感知压力水平。

研究方法：本研究从干预点卫生中心主任招募的集体ANC与PNC服务协调员，以及对照站点的同等数量的标准ANC/PNC服务提供者处，同步收集定量与定性数据。定量数据通过基线与约9个月后（随访阶段）发放的问卷采集完成。定性数据则在集体保健模式启动一年后，通过对集体ANC/PNC服务提供者开展的3次焦点小组讨论完成采集。

研究结果：参与调查的实施集体ANC与PNC服务的护士与助产士中，86%表示相较于传统个体式ANC/PNC服务模式，他们更偏好集体服务模式。两组医护人员的感知压力水平与工作满意度结果相近。针对具备集体ANC/PNC服务经验的护士与助产士开展的混合焦点小组讨论显示，集体服务模式对服务受众与提供者均存在显著优势。当提供者提及实施过程中的挑战时，焦点小组内的同行会为其提供应对策略与优化服务提供的建议。

讨论：本研究结果与其他低收入和中等收入国家（Low- and Middle-Income Countries，LMIC）背景下针对集体ANC/PNC服务提供者的相关研究结论一致，均认可集体服务模式的感知收益。本研究为同行医护人员如何互助解决实施难题提供了新的学术见解。当获得集体参会的机会时，本研究参与者互相提供了同伴支持，并共享了成功推行集体ANC/PNC服务的最佳实践相关知识。

本试验已在clinicaltrials.gov注册，注册号为NCT03154177。