Table 5. Experience of adaptation and implementation of a Group Prenatal Care model in Mexico, 2016-2018.
| Adaptation and implementation of the model in Mexico | Description | ||
|---|---|---|---|
| Phases of the feasibility study | Consisted of six phases carried out from June 2016 to August 2018. 1. Involvement of the Department of Health and training of the Mexican team . We negotiated the implementation of the model with decision makers from two Mexican states (Morelos and Hidalgo). Simultaneously, two members of the research team were trained as facilitators in an intensive CenteringPregnancy workshop in the United States. During this and subsequent phases, we had the support of an international expert in the model. 2. Adaptation of the Centering Pregnancy model to the Mexican context. We created a curriculum based on the guidelines of prenatal care by the Department of Health, the perception of pregnant women and experts in the subject of maternal health. We also adapted material resources and physical inputs. 3. Selection of participating places. We did a pre-feasibility study in several first-level care centers in the states of Morelos and Hidalgo, identifying structural elements (number of clinics, health staff, available spaces, etc.) as well as the volume women in prenatal care (number of prenatal visits in the last year). Considering this information and support from the international expert, we selected the health centers where the model was implemented. 4. Training of health staff at health centers. We trained health providers (nurses, medical and social workers) to take on the role of facilitators of the model. This phase also helped to consolidate two team members as model trainers. 5. Pilot Study. In this phase we began the implementation of the model in two sites, one in each state. We provided the necessary material for implementation and gave advice for the initial recruitment of women. The research team provided direct support in solving problems. We adapted the processes, the instruments, the topics, the methodology and the logistical aspects together with the international expert. 6. Implementation. Considering all the adaptations of the previous phases, we extended the implementation of the model to all the selected sites. | ||
| States where we implemented the model | The selected states were: Morelos and Hidalgo. The Sanitary Jurisdictions*: Morelos- Jurisdiction 1. Hidalgo- Jurisdiction 3.* The implementation places belong to the Department of Health (Public Health Services) that provides services to the population that does not have any kind of social security, the most vulnerable population of the country that does not have a job in the formal sector of the economy. | ||
| Number and places where we implemented the model | Implementation places in Morelos (3): Centros de Salud Acatlipa, Temixco and Emiliano Zapata Implementation places in Hidalgo (1): Centro de Salud de Tula | ||
| Number and profile of trained facilitators per location | A total of 23 health care providers were trained during the study (3 trainings of 2 days each), of which 15 participated as group facilitators in different centers: | ||
| Location | Total of facilitators | Facilitators’ profile | |
| Acatlipa, Morelos | 3 | 2 medical doctors and 1 nurse | |
| Temixco, Morelos | 2 | 1 medical doctor and 1 nurse | |
| Emiliano Zapata, Morelos | 5 | 2 medical doctors, 2 nurses and 1 health promoter (Degree in Psychology) | |
| Tula, Hidalgo | 5 | 2 medical doctors, 2 nurses and 1 social worker | |
| Number of groups implemented | A total of 11 groups were conducted in both states (seven in Morelos and four in Hidalgo): • Morelos: Acatlipa (3 groups), Temixco (2 groups), Emiliano Zapata (2 groups) • Hidalgo: Tula (4 groups) | ||
| Number of pregnant women recruited | The total number of pregnant women recruited for the 11 groups was 142. | ||
| Number of pregnant women who completed the model | 76.0% (108) completed group prenatal care. | ||
| Gestational age at the beginning of the model | Average gestational age at the beginning of prenatal group care: 23.0 weeks gestation. Range: 21.9 - 24.1. | ||
| Average number of prenatal visits | 5.5 visits per woman | ||
| Percentage of women with at least 5 prenatal visits | The total number of women who complied the provisions of the Official Mexican Norm on prenatal care was 115 (81.0%). | ||
* Refers to a technical-administrative unit decentralized from the Public Health Services, with capacity for planning, administration, direction, operation and evaluation of resources to “provide medical care to the uninsured population, with the purpose of adequately conducting the actions of the sector in its area of influence”28.