Abstract
Background
In 2012, we performed a needs assessment and gap analysis to qualitatively assess providers’ and patients’ knowledge and perceptions regarding preterm birth (PTB). During the study, we identified knowledge gaps surrounding methods to reduce the risk of occurrence of PTB and management options if preterm labor/birth occur. We targeted health messages toward these gaps. The objective of the present study was to assess the impact of our community health worker-based patient education program 3 years after it was implemented.
Methods
Fifteen focus groups including 70 participants were included in the study. The groups comprised either patients/patient couples or health providers. A minimum of two facilitators led each group using 22 a priori designed and standardized lead-in prompts for participants with four additional prompts for providers only. A single researcher recorded responses, and transcript notes were reviewed by the facilitators and interpreters immediately following each group discussion to ensure accuracy.
Results
The understanding of term vs preterm gestation was generally accurate. Every participant knew of women who had experienced PTB, and the general perception was that two to three women out of every ten had this experience. The majority of respondents thought that women should present to their local health clinic if they experience preterm contractions; few were aware of the use of antenatal steroids for promoting fetal lung maturity, but many acknowledged that the neonate may be able to receive life-sustaining treatment if born at a higher level of care facility. The majority of participants were aware that PTB could recur in subsequent pregnancies. All respondents were able to list ways that women could potentially reduce the risk of PTB.
Conclusion
After employing targeted health messages, the majority of participants expressed improved understanding of the definition of PTB, methods to prevent risk of PTB, and management options for preterm labor or PTB.
Supplementary material
Table S1 Lead-in prompts for providers only
Acknowledgments
We would like to acknowledge Debora Nanthuru and Bertha Banda for their excellent leadership, guidance, and language and cultural skills as the research project managers for this project in Lilongwe, Malawi. We would like to also acknowledge Rose Chirwa, Mary Nyondo, Ellina Marko, Andrew Chigayo, Hanna Mkwate, Rabecca Kabati, Saukani Petro, and Kondwani Nkhwazi, who are community health workers in Malawi, for their subject matter expertise and for coordinating the focus group sessions. We would also like to acknowledge Dr Susan Ramin for her guidance and oversight of this project, her critical review of the manuscript, and for her role building and maintaining Baylor College of Medicine’s clinical and academic partnership with Kamuzu Central Hospital and the surrounding clinics in Lilongwe, Malawi. This work is supported by the March of Dimes (S Raine and KM Aagaard), Thrasher Foundation (KM Aagaard), and USAID/Bill & Melinda Gates Foundation Saving Lives at Birth Grand Challenges Grant: AID-OAA-G-11-00062 (KM Aagaard). Dental findings were presented in a poster at the Society of Maternal-Fetal Medicine’s 36th Annual Meeting – The Pregnancy Meeting TM, Atlanta, GA, USA, February 1–6, 2016, Abstract Number 549.
Author contributions
All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.