The Phoenix Project: Re-Introducing Group Prenatal Care

Purpose To develop strategies to implement a sustainable program of group prenatal care (GPNC) in settings with a prior history of failing to sustain GPNC. Research Question What are prior and current barriers to sustaining group prenatal care, and what are key ingredients for successfully sustaining group prenatal care in this community? Significance Despite evidence that GPNC improves perinatal outcomes and racial and ethnic health disparities, sustaining GPNC is challenging. This research is part of a larger project using community-engaged methods to introduce sustainable GPNC programs in a community where 2 GPNC programs providing care to women who have low income and are minorities were discontinued. In community-engaged research, community and academic partners develop collaborative strategies to modify environments and individual behaviors. This research represents the first phase in this project. Methods Using qualitative description, we conducted 16 semi-structured interviews of stakeholders in 4 settings in one community to explore interest in and potential strategies for re-introducing GPNC. Settings were 2 university-affiliated clinics that had provided GPNC (now discontinued) and 2 clinics with flourishing GPNC programs: one clinic providing GPNC and another clinic providing group well-child care. Participants included midwives, physicians, nurses, and administrators. Interviews were audio-recorded, transcribed, and entered into ATLAS.ti qualitative software. A priori and inductive coding schemes were developed; code content was compared across individuals, types of professionals, and settings. Thematic development focused on eliciting an understanding of participant perceptions of what might enhance or impede sustainability. Results Stakeholders were universally enthusiastic about using community-engaged approaches to reintroduce GPNC. Participants from settings that had discontinued GPNC identified pitfalls to avoid and potential alternate implementation strategies; these focused primarily around the need for adequate resources, staffing, and robust recruitment strategies. Stakeholders from continuing and discontinued settings identified key ingredients they believed would promote sustainability, including vigorous, opt-out recruitment plans; engaging community health workers in patient recruitment and group facilitation; taking advantage of university resources for clinician training; fostering interdisciplinary education; tailoring existing GPNC models to local population needs; and enlisting sustained and practical buy-in on all levels including top administrators, clinicians, and staff. Discussion A community-engaged approach holds promise for implementing GPNC in challenging settings. We are continuing the community-academic partnership, while increasing consumer involvement; developing plans for piloting GPNC in settings where it was discontinued; developing a GPNC model that meets community needs; and obtaining administrative commitment for resources for initial implementation as well as long-term sustainability.