PDF(Pubmed)
Abstract：
BACKGROUND: By addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation.
METHODS: Contextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree.
RESULTS: Outer setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname.
METHODS: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners.
METHODS: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs.
CONCLUSIONS: While the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.
METHODS: Contextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree.
RESULTS: Outer setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname.
METHODS: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners.
METHODS: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs.
CONCLUSIONS: While the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.
摘要：
背景：通过解决身体和心理社会需求，团体护理(GC)改善健康相关行为，同行支持，父母与提供者的互动，并可能改善分娩结局。因此，鼓励全球实施GC。实施之前的上下文分析对于阐明哪些因素可能支持或阻碍实施至关重要。
方法：比较了在荷兰和苏里南进行的上下文分析，以确定与医疗保健专业人员（HCP）认为的GC可实施性相关的因素。对荷兰和苏里南医疗保健专业人员进行了32次半结构化访谈。使用框架方法对录音进行逐字转录和编码。实施研究综合框架指导了面试指南和编码树的开发。
结果：外部环境：两国对资金的担忧浮出水面。由于医疗保险覆盖面有限，额外费用将限制苏里南的可访问性。在荷兰,助产士担心由于支持一对一护理的报销政策而导致收入下降。内部设置：一个荷兰人和三个苏里南人设施中没有适当的GC空间。在荷兰，关于GC实施的角色划分比苏里南更明确。
方法：来自两国的HCP期望增加社会支持，妇女的健康知识，和护理的连续性(R)。个人/创新交付者：自我效能感和动机是两国实施GC的相互交织的决定因素。个人/创新接受者：竞争需求可能会降低两国对GC的接受度。虽然荷兰的HCP优先考虑与母亲进行公开对话，苏里南人方案小组鼓励加入合作伙伴。
方法：提出了提高GC意识的活动。语言障碍是荷兰人关注的问题，但苏里南人不关注。
结论：虽然两国在外部环境中发现了最显著的差异，它们滴流并影响上下文的所有层次。最终,在稍后的阶段，过程评估将显示我们在实施之前确定的那些外部设置障碍是否实际上阻碍了GC的实施。医疗保健系统的变化将确保两国的持续实施，而这一结论将成为一个更一般的讨论：当上下文分析揭示了无法用可用的时间和资源来解决的障碍时，如何进行。
方法：比较了在荷兰和苏里南进行的上下文分析，以确定与医疗保健专业人员（HCP）认为的GC可实施性相关的因素。对荷兰和苏里南医疗保健专业人员进行了32次半结构化访谈。使用框架方法对录音进行逐字转录和编码。实施研究综合框架指导了面试指南和编码树的开发。
结果：外部环境：两国对资金的担忧浮出水面。由于医疗保险覆盖面有限，额外费用将限制苏里南的可访问性。在荷兰,助产士担心由于支持一对一护理的报销政策而导致收入下降。内部设置：一个荷兰人和三个苏里南人设施中没有适当的GC空间。在荷兰，关于GC实施的角色划分比苏里南更明确。
方法：来自两国的HCP期望增加社会支持，妇女的健康知识，和护理的连续性(R)。个人/创新交付者：自我效能感和动机是两国实施GC的相互交织的决定因素。个人/创新接受者：竞争需求可能会降低两国对GC的接受度。虽然荷兰的HCP优先考虑与母亲进行公开对话，苏里南人方案小组鼓励加入合作伙伴。
方法：提出了提高GC意识的活动。语言障碍是荷兰人关注的问题，但苏里南人不关注。
结论：虽然两国在外部环境中发现了最显著的差异，它们滴流并影响上下文的所有层次。最终,在稍后的阶段，过程评估将显示我们在实施之前确定的那些外部设置障碍是否实际上阻碍了GC的实施。医疗保健系统的变化将确保两国的持续实施，而这一结论将成为一个更一般的讨论：当上下文分析揭示了无法用可用的时间和资源来解决的障碍时，如何进行。
