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Promoting participation in Centering Pregnancy by women from lower SES and/or ethnic minority background

Projectomschrijving

Promoten van deelname aan Centering Pregnancy

Vraagstuk

In Nederland is de sterfte en ziekte rondom de zwangerschap relatief hoog in vergelijking met andere Europese landen, vooral bij vrouwen van niet-westerse afkomst en vrouwen uit achterstandswijken. Een deel van deze complicaties kan voorkomen worden door preventie. CenteringPregnancy (CP) is verloskundige zorg in groepsvorm en is gericht op zelfmanagement, kennisontwikkeling en ondersteuning van zwangeren. CP laat veelbelovende resultaten zien. Vrouwen die deelnamen aan CP rookten minder, waren tevredener over de zorg, gaven vaker borstvoeding, gebruikten minder pijnbestrijding en bevielen vaker thuis. De deelname van vrouwen van niet-westerse afkomst of uit achterstandswijken was alleen lager dan verwacht.

Onderzoek en uitkomsten

In dit project is nagegaan wat de redenen en oorzaken zijn voor deze lagere deelname en wat de ervaringen van verloskundigen zijn als het gaat om het bereiken van deze vrouwen. Na gesprekken met vrouwen uit de doelgroep en aanbieders van CP zijn wervingsstrategieën ontwikkeld en getest in een aantal verloskundigenpraktijken.

Naast een praktijkanalyse en een training voor zorgverleners is een ‘vroege bijeenkomst’ geïmplementeerd; in deze groepsbijeenkomst worden thema’s besproken die belangrijk zijn in de eerste 12 weken van de zwangerschap. Ook ervaren vrouwen hoe groepszorg is. Door COVID-19 is deze bijeenkomst omgevormd tot een online versie.

Bijna alle vrouwen nemen deel aan CP na een vroege bijeenkomst. Deelname aan CP is vooral in een van de drie praktijken hoger na de start van de vroege bijeenkomst: met ook veel vrouwen met een lagere SES en migrantenachtergrond. Er worden met name organisatorische en wervingsknelpunten genoemd. Verloskundigen vinden dat, door de vroege bijeenkomst, vrouwen meer kennis hebben over de eerste 12 weken en beter zijn voorbereid op de intake.

Verslagen


Samenvatting van de aanvraag

In the Netherlands, perinatal mortality and morbidity is relatively high compared to other European countries. In addition, perinatal outcomes are worse for ethnic minorities and for Western women living in deprived urban areas. A part of it can be prevented by more effective prevention. CenteringPregnancy (CP) is an in the US developed, renewed type of prenatal care in which prenatal guidance mainly is offered as group prenatal care. In this group care, three important health components are integrated: self-management, knowledge development and support. TNO adapted CP to the Dutch situation, after which it was introduced into the Netherlands. The results of the Dutch CP are promising. A recent effect-evaluation showed that CP led to better health behaviours, increased satisfaction, increased likelihood of breastfeeding, and less use of pain medication and more home deliveries. Moreover, midwives are very positive about CP. In the Netherlands, CP is integrated in the Dutch routine prenatal care, which is freely accessible to all women in the Netherlands regardless of their risk. About one third of Dutch women decided to participate in CP, and about 8% stopped prematurely. The participation rates of high-risk groups such as ethnic minorities and lower-SES women is lower than could have been expected based on the regional routine perinatal registrations. Considering the increased risk of adverse perinatal outcomes in ethnic minorities and lower SES neonates and the potential positive effects of CP, it is crucial to increase engagement of these high-risk pregnant women in CP. There are however few studies that systematically investigated reasons for (non)participation and adherence or strategies for improving reach of these groups in group-based prenatal care. The primary aim of this project is to gain insight into the causes and reasons of the lower participation and attendance rates in CP, by women with an ethnic minority background or lower SES. We will focus on The Hague, as urban city with a high rate of non-western population and several deprived urban areas, having several practices providing CP and being known for having poorer perinatal outcomes when compared with other Dutch cities and finding recruitment of these ethnic minority and lower SES groups challenging. We will examine to what extent and how these causes and reasons can be influenced in a favourable way. On the basis of these insights we aim to develop a strategy or several strategies leading to a higher engagement rate in CP by women with an ethnic minority and lower SES background. This project consists of three phases. Evidence from each phase informs choices and considerations that need to be taken into account in the following phases. The following questions will be answered: - During phase 1, an answer will be provided to the questions to what extent midwifery practices succeeded in reaching (participation and attendance) ethnic minorities and lower SES women in the Netherlands and other countries, what strategies were used to (improve) the reach of these vulnerable groups, and what is known about the barriers and enablers that are related to the reach of these groups in prenatal group care. A systematic review of the literature will be conducted combined with interviews with professionals and observations of currently used strategies. We will also interview experts in the USA, Surinam, and other countries with extensive experience in the implementation of CP in vulnerable groups. - During phase 2, an answer will be provided to the question what the experiences of midwives are regarding reaching and providing prenatal (group) care to ethnic minority and lower SES groups, and what the experiences and preferences are regarding prenatal care amongst the target population. We will conduct interviews with midwives, women invited to CP (both the ones deciding to participate and the ones who didn’t), and the stakeholder with experience in working with these lower SES and ethnic groups. In addition in this phase we will select the most potential strategies to increase reach. - In phase 3, the accumulation of information in phase 1 and 2, will result in the formulation of successful strategies to increase the reach of ethnic minority and lower SES women in CP. An inclusive strategy is used, by involving stakeholders and members of the target population, to ensure the construction of a culturally appropriate strategy. The strategy will be implemented and piloted in at least two midwifery practices. On the basis of the first experiences, the strategy may again be adjusted. The project will result in strategies that can be implemented nationally to improve engagement of ethnic minority and lower SES groups in CP.

Kenmerken

Projectnummer:
543003102
Looptijd: 100%
Looptijd: 100 %
2018
2022
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
Dr. M.R. Crone
Verantwoordelijke organisatie:
Leiden University Medical Center