Table 1.

Results Related to Process to CenteringPregnancy

Essential Elements		Pilot	Potential Challenges
Grou p Healthcare Delivery
1	A facilitative leadership Style is used	After 2 days of training, providers “got it.” They would have liked more time to practice these skills in training, but we observed that they were able to apply the skills to lead the CP-Africa sessions.	Important to ensure adequate training and practice for providers since usual education and health promotion model is didactic lecture. Administrators need to be included to allow for organizational adjustments.
2	The group is conducted In a circle	At the sites where the pilot was conducted we were able to use movable chairs. Other group care models have been conducted in circles while sitting on the ground.	Some health facilities have fixed long benches so sites may have to adjust to what is available.
3	There is stability of group leadership	This was not problematic in the pilot. Community health workers, as co-facilitators, A could provide stability. They are less likely to be called away for medical emergencies.	Providers may have difficulties May be difficult for providers to have uninterrupted time, especially in small clinics.
4	Group size is optimal to promote the process	This was not problematic in our pilot	Pressures from worker shortages and overcrowding could lead to enlarging beyond the ideal size
5	The composition of group is stable but not rigid	Unproblematic in pilot; all women attended both sessions	Attendance may be affected by seasonality.
Health Assessment
6	Health assessment takes place within the group space	Assessment in group space was acceptable to providers and clients. Women learned quickly and helped each other expressing pride in their accomplishment.	No challenges identified
7	Participants are involved in self-care activities	Despite low literacy, women were able to conduct and record these measures successfully. More literate women helped those who could not write.	No challenges identified
Education
8	Each session has an overall plan	The CP-Africa content exceeded the minimum requirements of the Ministries of Health and FANC.	Under the FANC model, there will be fewer opportunities to review content.
9	Attention is given to the core content; emphasis may vary	Providers were surprised at how much content was covered when free discussion was encouraged. They were able to gauge women’s knowledge level and easily moved between teaching and discussion when necessary.	Since didactic approaches are more common, facilitators may have to be reminded about the centering approach to avoid falling back into a purely teaching mode of communication.
Support
10	Group conduct honors the contributions of each member	Occurred clearly in pilot; contributions of group members were valued by participants and facilitators.	No challenges identified
11	Involvement of family support people is optional	This will vary by group. In our study one group voted that it was better to not include others. The other group did not discuss this option.	Family support people are not usually included at ANC. If groups choose to include other members, there may be space issues.
12	Opportunity for socialization within the group is provided	Socialization occurred before, during, and after sessions.	No challenges identified
Evidence-based Practice
13	There is ongoing evaluation of outcomes	ANC facilities already collect birth statistics; if type of ANC received can be noted on reports this should be feasible.	No individual records are kept at the site, so modifications will be needed to link type of ANC with birth outcomes in order to track the relationships between type of care and health outcomes.