BACKGROUND Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women's groups suggests that group care models may both improve access to care and the quality of care delivered through women's empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. METHODS The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. RESULTS A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1-91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. CONCLUSION Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.

中文翻译：

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衡量保真度，可行性和成本：在尼泊尔农村进行的一组产前保健团体对照试验的实施评估。

背景技术已经证明，获得高质量的产前护理服务对母婴健康是有益的。2016年，世卫组织发布了基于证据的产前护理建议，旨在提高利用率，护理质量和患者体验。尼泊尔的先前研究表明，缺乏社会支持，计划生育和资源匮乏是农村社区获得服务的障碍。妇女团体的CenteringPregnancy和参与式行动的成功表明，团体照护模式可以通过赋予妇女权力和建立社会网络来改善获得照护的机会和照护质量。我们介绍了尼泊尔农村地区的团体产前护理模式，该模式由医疗保健提供机构Nyaya Health Nepal设计并实施，以及对实施成果的评估。方法该研究是通过尼泊尔非营利组织Nyaya Health Nepal与卫生和人口部之间的公私合作伙伴关系，在尼泊尔阿克汉姆的Bayalata医院进行的，并得到了美国非营利组织“可能”的资助。 。我们在六个村庄集群中将团体产前护理作为一项前瞻性，非随机，集群控制，I型混合型有效性实施研究。实施方法允许迭代改进设计，进行更改以提高干预质量。实施过程和模型逼真度的评估是由护士主管填写的移动清单和项目负责人填写的观察表进行的。我们使用描述性统计数据每季度评估一次数据，以识别趋势。通过沉浸式结晶对定性访谈和团队沟通进行了分析，以确定在实施过程中演变出的主要主题。结果在研究期间共进行了141组产前检查。本文报告了实施结果，而我们在本期刊的补充论文中分析并提出了患者水平的有效性结果。该模型具有较高的流程保真度，其中85.7％（95％CI 77.1-91.5％）的访问完成了所有流程要素，并且内容保真度高，所有村庄集群均满足80％主题的最低目标频率。团体产前护理的年人均费用为0.50美元。定性分析揭示了稳定的妊娠匹配组成员组成的折衷，以使干预可行。在培训，文档编制，反馈和后勤方面进行了重大调整。结论与当地政府诊所合作提供的团体产前护理有潜力为尼泊尔农村妇女提供容易获得的优质产前护理。干预是个人产前保健的可行且负担得起的替代方法。我们的经验表明，对以前的模型进行改编对于使该计划在国家医疗体系内的本地环境中取得成功至关重要。试验注册ClinicalTrials.gov标识符：NCT02330887，注册日期：2015年1月5日，追溯注册。在培训，文档编制，反馈和后勤方面进行了重大调整。结论与当地政府诊所合作提供的团体产前护理有潜力为尼泊尔农村妇女提供容易获得的优质产前护理。干预是个人产前保健的可行且负担得起的替代方法。我们的经验表明，对以前的模型进行改编对于使该计划在国家医疗体系内的本地环境中取得成功至关重要。试验注册ClinicalTrials.gov标识符：NCT02330887，注册日期：2015年1月5日，追溯注册。在培训，文档编制，反馈和后勤方面进行了重大调整。结论与当地政府诊所合作提供的团体产前护理有潜力为尼泊尔农村妇女提供容易获得的优质产前护理。干预是个人产前保健的可行且负担得起的替代方法。我们的经验表明，对以前的模型进行改编对于使该程序在国家医疗保健系统的本地环境中取得成功至关重要。试验注册ClinicalTrials.gov标识符：NCT02330887，注册日期：2015年1月5日，追溯注册。结论与当地政府诊所合作提供的团体产前护理有潜力为尼泊尔农村妇女提供容易获得的优质产前护理。干预是个人产前保健的可行且负担得起的替代方法。我们的经验表明，对以前的模型进行改编对于使该计划在国家医疗体系内的本地环境中取得成功至关重要。试验注册ClinicalTrials.gov标识符：NCT02330887，注册日期：2015年1月5日，追溯注册。结论与当地政府诊所合作提供的团体产前护理有潜力为尼泊尔农村妇女提供容易获得的优质产前护理。干预是个人产前保健的可行且负担得起的替代方法。我们的经验表明，对以前的模型进行改编对于使该程序在国家医疗保健系统的本地环境中取得成功至关重要。试验注册ClinicalTrials.gov标识符：NCT02330887，注册日期：2015年1月5日，追溯注册。