{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T18:20:14Z","timestamp":1793643614753,"version":"4.5.1"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health; Eunice Kennedy Shriver National Institute of Child Health & Human Development","award":["RO1HD096277"],"award-info":[{"award-number":["RO1HD096277"]}]},{"DOI":"10.13039\/100007270","name":"University of Michigan","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007270","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Dodawa Health Research Centre"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>An essential component to improving maternal and newborn outcomes is antenatal care. A trial of group antenatal care was implemented in Ghana where 7 health care facilities were randomized to be intervention sites and 7 control sites continued traditional antenatal care. Group antenatal care, where 10\u201314 women with similar due dates meet together for visits, includes traditional components such as risk assessment with increased opportunity for education and peer support. The study aim was to assess and report the process evaluation of the implementation of a group antenatal care intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Process evaluation data were collected alongside intervention data and included both quantitative and qualitative data sources. Midwives at the health facilities which were randomized as intervention sites completed tracking logs to measure feasibility of the intervention. Research team members traveled to intervention sites where they conducted structured observations and completed fidelity and learning methods checklists to determine adherence to the model of group antenatal care delivery. In addition, midwives facilitating group antenatal care meetings were interviewed and focus groups were conducted with women participating in group antenatal care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the majority of cases, midwives facilitating group antenatal care completed all components of the meetings with fidelity, following best practices such as sitting with the group rather than standing. Across 7 intervention sites, 7 groups (622 pregnant women) were documented in the tracking logs and of these participants, the majority (74%) attended more than half of the meetings, with 32% attending all 8 group meetings. Three themes were identified in both the midwife interviews and focus groups with pregnant women: 1) information sharing, 2) sense of community, and 3) time management challenges. An additional theme emerged from the focus groups with the women: women who had already given birth noticed a disconnect between what they learned and treatment received during labor and birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This process evaluation determined that group antenatal care can be implemented with fidelity in low and middle-income countries. Time management was the biggest challenge, however both midwives and pregnant women found the model of care not only acceptable, but preferable to traditional care. The knowledge shared and sense of community built during the meetings was a valuable addition to the individual model of antenatal care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0291855","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T13:25:56Z","timestamp":1699363556000},"page":"e0291855","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["\u201cWith group antenatal care, pregnant women know they are not alone\u201d: The process evaluation of a group antenatal care intervention in Ghana"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5119-9123","authenticated-orcid":true,"given":"Ruth","family":"Zielinski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vida","family":"Kukula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Apetorgbor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Awini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5796-157X","authenticated-orcid":true,"given":"Cheryl","family":"Moyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina","family":"Badu-Gyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Lockhart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jody","family":"Lori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,7]]},"reference":[{"key":"pone.0291855.ref001","first-page":"1","volume-title":"Newborns: improving survival and well-being","author":"World Health Organization","year":"2020"},{"key":"pone.0291855.ref002","author":"World Health Organization","year":"2015","journal-title":"Trends in maternal mortality: 1990 to"},{"key":"pone.0291855.ref003","unstructured":"United Nations. Sustainable Development Goals Available from: https:\/\/sdgs.un.org\/goals"},{"key":"pone.0291855.ref004","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1016\/S0140-6736(16)31533-1","article-title":"Diversity and divergence: the dynamic burden of poor maternal health.","volume":"388","author":"W Graham","year":"2016","journal-title":"The Lancet"},{"key":"pone.0291855.ref005","article-title":"Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis","author":"B Chmielewska","year":"2021","journal-title":"Lancet Glob Heal"},{"key":"pone.0291855.ref006","unstructured":"WHO recommendations on antenatal care for a positive pregnancy experience [Internet]. 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