Identifying anticipated challenges when implementing group care: Context-analyses across seven countries to develop an anticipated challenges framework

Midwifery, vol. 139, pp. 104166

Abstract

PROBLEM: Despite increasing interest in Group Care worldwide, implementation is challenging. BACKGROUND: Group Care is an evidence-based perinatal care model including three core components: health assessment, interactive learning, and community building. It has several advantages for service users and providers compared to individual perinatal care. AIM: We aimed to identify anticipated challenges when implementing Group Care, and to develop a supporting tool based on these challenges. METHODS: Context analyses through Rapid Qualitative Inquiries were conducted in 26 sites in seven countries to gain insight into the anticipated challenges when implementing Group Care. Data triangulation and investigator triangulation were applied. The context analyses generated 330 semi-structured interviews with service users and other stakeholders, 10 focus group discussions, and 56 review meetings with the research teams. FINDINGS: We identified six surface structure anticipated challenges categories (content, materials, facilitators, timing, location, group composition), and five deep structure anticipated challenges categories (health assessment, scheduling Group Care into regular care, enrolment, (possible) partner organisations, financials) occurring in all participating sites, leading to the development of the Anticipated Challenges Framework. CONCLUSION: Completing the Anticipated Challenges Framework raises awareness of anticipated challenges if sustainable Group Care implementation is to succeed and encourages the initiation of a concrete action plan to tackle these challenges. Application of the framework may offer important insights to health systems administrators and other key stakeholders before implementing Group Care. In the medium- and long-term, insights gained may lead to greater possibilities for sustainability and to the most cost-effective approaches for implementing Group Care.

Authors 16

1. Astrid Van Damme

   Vrije Universiteit Brussel · Universitair Ziekenhuis Brussel

   Affiliation as printed

   Department of Public Health, Vrije Universiteit Brussel (VUB), Jette, Belgium; Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium. Electronic address: astrid.van.damme@vub.be

2. Florence Talrich

   Vrije Universiteit Brussel · Universitair Ziekenhuis Brussel

   Affiliation as printed

   Department of Public Health, Vrije Universiteit Brussel (VUB), Jette, Belgium; Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium

3. Mathilde R. Crone Aachen

   Leiden University Medical Center · Maastricht University

   Affiliation as printed

   Leiden University Medical Center Department of Public Health and Primary Care, the Netherlands; Maastricht University, Department of Health Promotion, the Netherlands

4. Marlies E. B. Rijnders Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center Department of Public Health and Primary Care, the Netherlands; TNO Child Health, Leiden, the Netherlands

5. Crystal L. Patil

   University of Michigan

   Affiliation as printed

   University of Michigan School of Nursing, United States

6. Sharon Schindler Rising
   Affiliation as printed

   Group Care Global, Philadelphia, United States

7. Jedidia Abanga

   Ghana Health Service

   Affiliation as printed

   Presbyterian Church of Ghana Health Service (PHS), Accra, Ghana

8. Deborah L. Billings

   University of South Carolina

   Affiliation as printed

   Group Care Global, Philadelphia, United States; Department of Health Promotion and Behavior and Institute for Families in Society, University of South Carolina, United States

9. Ashna D. Hindori‐Mohangoo
   Affiliation as printed

   Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname

10. Manodj P. Hindori
    Affiliation as printed

    Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname

11. Nele Martens Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center Department of Public Health and Primary Care, the Netherlands

12. Shanaaz Mathews

    University of Cape Town

    Affiliation as printed

    Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

13. Vlorian Molliqaj
    Affiliation as printed

    Action for Mothers and Children, Kosovo

14. Marsha Orgill

    University of Cape Town

    Affiliation as printed

    Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

15. Wiedaad Slemming

    University of Cape Town

    Affiliation as printed

    Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

16. Katrien Beeckman

    Vrije Universiteit Brussel · Universitair Ziekenhuis Brussel

    Affiliation as printed

    Department of Public Health, Vrije Universiteit Brussel (VUB), Jette, Belgium; Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium