背景:在寻求高质量的产前护理(ANC)和积极的怀孕经验的过程中,全面的女性手持案例笔记的价值再怎么强调都不为过。然而,马拉维妇女的健康护照簿存在阻碍提供优质护理的差距,尤其是在怀孕期间。我们旨在开发一种压缩更新的女性手持病例笔记工具(健康护照簿),该工具反映了世卫组织2016年马拉维ANC指南。
方法:从2022年7月到2022年8月,我们在与主要利益相关者的3个研讨会中采用了共同创作的参与式方法,以将当前的ANC工具内容与WHO2016年ANC指南进行比较。决定要改变的关键要素,以提高实践中的坚持和变化,并重新设计妇女的健康护照工具,以反映变化。小组内讨论导致了整个小组的讨论和共识,由改进的标称组技术指导。主持人指导讨论,同时确保小组成员在审议中的自主权。记录和转录讨论。通过专题分析对数据进行了分析,以及关联图中的简化和摘要。2023年7月,国家安全孕产技术工作组(TWG)批准在马拉维的医疗保健系统中实施该工具。
结果:分析中确定了五个主题。这些是(I)当前工具中错过的关键组件,(ii)重新构想当前的ANC工具,(iii)进行超声扫描和记录的机会,(iv)与实施新开发的工具有关的预期障碍,以及(v)培养成功的实施。与会者还建议加强现有的卫生政策和投资,加强公私伙伴关系,和持续的医疗服务提供者的能力建设,以确保他们的技能是最新的。
结论:如果实践中的工具反映了所制定的指南,那么实现高质量的ANC目标和医疗保健的普遍性是可能的。我们的努力反映了马拉维改善妇女手持笔记的开创性尝试,我们知道,这有助于提高护理质量,提高整体妇女对医疗保健系统的满意度。
BACKGROUND: In the quest for quality antenatal care (ANC) and positive pregnancy experience, the value of comprehensive woman hand-held
case notes cannot be emphasised enough. However, the woman\'s health passport book in Malawi presents gaps which hinder provision of quality care, especially during pregnancy. We aimed to develop a compressive updated woman hand-held
case notes tool (health passport book) which reflects WHO 2016 ANC guidelines in Malawi.
METHODS: From July 2022 to August 2022, we applied a co-creative participatory approach in 3 workshops with key stakeholders to compare the current ANC tool contents to the WHO 2016 ANC guidelines, decide on key elements to be changed to improve adherence and change in practice, and redesign the woman\'s health passport tool to reflect the changes. Within-group discussions led to whole-group discussions and consensus, guided by a modified nominal group technique. Facilitators guided the discussions while ensuring autonomy of the group members in their deliberations. Discussions were recorded and transcribed. Data was analysed through thematic analysis, and reduction and summaries in affinity diagrams. The developed tool was endorsed for implementation within Malawi\'s healthcare system by the national safe motherhood technical working group (TWG) in July 2023.
RESULTS: Five themes were identified in the analysis. These were (i) critical components in the current tool missed, (ii) reimagining the current ANC tool, (iii) opportunity for ultrasound scanning conduct and documentation, (iv) anticipated barriers related to implementation of the newly developed tool and (v) cultivating successful implementation. Participants further recommended strengthening of already existing policies and investments in health, strengthening public private partnerships, and continued capacity building of healthcare providers to ensure that their skill sets are up to date.
CONCLUSIONS: Achieving goals of quality ANC and universality of healthcare are possible if tools in practice reflect the guidelines set out. Our efforts reflect a pioneering attempt in Malawi to improve women\'s hand-held
case notes, which we know help in enhancing quality of care and improve overall women\'s satisfaction with their healthcare system.