City Research Online

Abstract

Background: Antenatal and postnatal Group Care, based on the Centering Healthcare model, relies on three core components: health assessment, interactive learning and community building. The health assessment consists of self-assessments conducted by the participants and one-to-one medical check-ups conducted by the healthcare provider. Research shows that this component can be challenging within existing health care systems. This study aimed to investigate the modifications and corresponding strategies applied to adopt the health assessment during Group Care implementation.

Methods: A qualitative descriptive study explored modifications to the health assessment and the corresponding strategies in 24 Group Care implementation sites in seven countries. A structured qualitative survey was conducted based on the Expanded Framework for Adaptations and Modifications to Evidence-Based Interventions including views of different stakeholders (site-level and project-level implementers). This provided data on the ‘who’, ‘what’, and ‘where’ of modifications and corresponding strategies. Reflexive thematic analysis provided both structured and in-depth insights into the adaptation process.

Results: Three cross-country strategies were identified: (1) creative solutions to find appropriate spaces for Group Care to accommodate the health assessment, (2) providing assistance with self-assessment, (3) and extending the duration of one-to-one medical check-ups. These strategies were primarily the result of joint decisions made by the implementation team, influenced by multiple context-related factors. Different perspectives emerged regarding for whom these strategies were applied, with some stating it as being for the benefit of the participants, while others aimed to align with facilitators’ preferences and familiarity with providing routine care.

Conclusions: The role of differing perspectives in the adaptation process when implementing Group Care and the challenge for facilitators to align their attitudes, beliefs and skills toward the Group Care model within an individually focused healthcare system, emerged as underlying factors to fully adopt the health assessment. Furthermore, our study demonstrates that, despite the locally context-driven nature of modifications in implementation, it remains valuable to examine them within a cross-country design to identify transferable insights that inform future implementation efforts and implementation science.

Publication Type:	Article
Additional Information:	This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher Keywords:	Group Care, Adaptations, Qualitative survey, Implementation challenges, Modifications
Subjects:	R Medicine > RG Gynecology and obstetrics
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:	Symplectic Administrator

Export

Downloads