“Providers” |
Health care personnel to implement the model |
Profile |
Multidisciplinary team: may include professional midwives, medical staff, nursing staff, health educator. It is important that they feel comfortable with a change of mentality and have a positive attitude to implement a new model. |
No explicitly identified |
Medical, nursing and health promotion staff. |
Number |
One, two or three facilitators per group. |
7 |
Two to three facilitators per group. |
Continuity of care |
Same team of facilitators in each session. |
6 |
Train two teams of facilitators in the same health center who have the capacity to follow-up with women if necessary. |
Training (cost and logistics) |
Funding and support from the people in charge of the health care services, for local training. |
No explicitly identified |
Schedule trainings with multiple health centers. Build and train of local “trainers” who can replicate the workshops in the country. |
To achieve a facilitating style and a more horizontal relationship between health care personnel and the user |
Reinforce during the training that information should be facilitated among the entire group rather than solely provided by health care personnel. Facilitators guide but do not control the discussion. Facilitators should avoid clothing that denotes hierarchy (e.g., lab coats). Women are involved in measuring some health parameters. |
2, 3, 5, 8, 9 |
Ensure during all the sessions, at least in the first group, a person who is helping to reinforce the new dynamic and at the end of the session share with the facilitators what happened during the session and what can be improved. |
Material resources and physical inputs |
Physical space |
Look for a semi-private space in the clinic that allows at the same time the presence of 10-12 people in a circle and that in the same space but behind the circle a space can be installed to carry out physical examinations. |
1, 5, 8 |
Use waiting rooms or similar rooms during not busy times, an open space under the trees, parking lot, the house of one person of the group, a tent and preferably early in the morning or in the afternoon to avoid high temperatures. Search for community places such as churches or other spaces. |
Find a place close to the clinic (government space, church, public center) that is semi-private, free, that allows a short transfer of the health care personnel and the material to be used, and that is accessible to women. |
Adaptation of the material and recurrent costs |
Adapt the material considering aspects such as socioeconomic status, race, religion, language and culture. |
4 |
Use local literature, experts, and locals to adapt the material. |
Work on the adaptation of the material with experts and a multidisciplinary team that knows the population and think about activities that do not require regular purchases. Identify recurring material (e.g., sheets of paper, batteries for sphygmomanometers) and make a plan to apply for support at state or federal level. |
Organizational |
Management and coordination within the units / clinics |
Involve clinic managers directly in the project emphasizing the importance of support and knowledge of all clinical staff to solve unexpected situations and flexibility during the days needed to conduct group prenatal care. |
No explicitly identified |
National regulations |
Adapt materials following national regulations, designing a curriculum taking into consideration the topics referred in the Mexican Official Norms that pregnant women should see during their prenatal consultations; but being flexible enough to include emerging topics of interest to women. |
4 |
Users |
Users of the model |
Recruitment |
Recruit participants with similar weeks of gestation. |
7 |
It is important that all clinical staff is aware of the benefits of the model so that they can invite women to participate and that people who have the initial contact with pregnant women are trained into how to recruit women. The person recruiting women should be a health worker who women trust. Print flyers or materials to help explain the model during the recruitment process. If possible, include the partner during the recruitment process. |
|
Identify places with enough volume of pregnant women. |
Retention |
Retention of participants with similar weeks of gestation. |
6 |
Electronic reminders of the next session. |
Language and educational level of users |
Adapt materials to the educational level and language of the key population. |
4 |
Have trained facilitators who speak the language of the population. Carry out activities that do not require women to read but only talk, also activities that include songs from the community. Conduct the self-evaluation always with the support of the facilitators. |
Identify simple activities and materials and adapt the materials with the help of experts and a multidisciplinary team that knows the population, adapt popular games of the place. |
Privacy |
Use music and have a space for clinical exams behind the circle a little far from it. |
1 |
Use a screen or curtain to separate the clinical assessment space. |
Use a screen to separate the clinical review space. |
For women to adhere to the rules established in the group (schedule, bring or not companions) |
Make group rules clear in the first session and allow women to change rules that do not suit their needs. |
6,7 |
In some cases allow companions during all sessions, including children. |
Flexibility to start the session 15-20 minutes later, or to allow some women to come into the session and incorporate them into the activities. Allow them to bring their companions even if it is not consistent, especially their partners, since they may have trouble being granted permission at work to attend all sessions. |