Abstract
BackgroundAntenatal care provides an important opportunity to improve maternal understanding of care during and after pregnancy. Yet, studies suggest that communication is often insufficient. This research examined the effect of a job aids-focused intervention on quality of counseling and maternal understanding of care for mothers and newborns.MethodsCounseling job aids were developed to support provider communication to pregnant women. Fourteen health facilities were randomized to control or intervention, where providers were trained to use job aids and provided implementation support. Direct observation of antenatal counseling sessions and patient exit interviews were undertaken to assess quality of counseling and maternal knowledge. Providers were also interviewed regarding their perceptions of the tools. Data were collected before and after the job aids intervention and analyzed using a difference-in-differences analysis to quantify relative changes over time.ResultsMean percent of recommended messages provided to pregnant women significantly improved in the intervention arm as compared to the control arm in birth preparedness (difference-in-differences [ΔI-C] = +17.9, 95%CI: 6.7,29.1), danger sign recognition (ΔI-C = +26.0, 95%CI: 14.6,37.4), clean delivery (ΔI-C = +21.7, 95%CI: 10.9,32.6), and newborn care (ΔI-C = +26.2, 95%CI: 13.5,38.9). Significant gains were also observed in the mean percent of communication techniques applied (ΔI-C = +28.8, 95%CI: 22.5,35.2) and duration (minutes) of antenatal consultations (ΔI-C = +5.9, 95%CI: 3.0,8.8). No relative increase was found for messages relating to general prenatal care (ΔI-C = +8.2, 95%CI: -2.6,19.1). The proportion of pregnant women with correct knowledge also significantly improved for birth preparedness (ΔI-C = +23.6, 95%CI: 9.8,37.4), danger sign recognition (ΔI-C = +28.7, 95%CI: 14.2,43.2), and clean delivery (ΔI-C = +31.1, 95%CI: 19.4,42.9). There were no significant changes in maternal knowledge of general prenatal (ΔI-C = -6.4, 95%CI: -21.3,8.5) or newborn care (ΔI-C = +12.7, 95%CI: -6.1,31.5). Job aids were positively perceived by providers and pregnant women, although time constraints remained for health workers with other clinical responsibilities.ConclusionsThis study demonstrates that a job aids-focused intervention can be integrated into routine antenatal care with positive outcomes on provider communication and maternal knowledge. Efforts are needed to address time constraints and other communication barriers, including introduction of on-going quality assessment for long-term sustainability.
Highlights
Antenatal care provides an important opportunity to improve maternal understanding of care during and after pregnancy
Available data suggests that patients often perceive counseling to be poor [9], and low maternal knowledge following counseling has been attributed to insufficient communication [10,11,12]
4% of providers working in the study’s maternities were not enrolled because they were not working at the clinic during the time of study and were logistically unable to participate in study activities
Summary
Antenatal care provides an important opportunity to improve maternal understanding of care during and after pregnancy. In addition to routine examination, screening, and treatment, the World Health Organization’s focused antenatal care model recommends information and counseling be provided to all pregnant women in areas related to the health needs of the pregnant woman, birth and emergency preparedness, nutrition, preventative home practices, and support for care-seeking through danger sign recognition [1]. This includes advice that promotes the health of the mother and newborn during and following delivery. Available data suggests that patients often perceive counseling to be poor [9], and low maternal knowledge following counseling has been attributed to insufficient communication [10,11,12]
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