Abstract:
Background: For a large trial of the effect of group antenatal care on
perinatal outcomes in Rwanda, a Technical Working Group customized the
group care model for implementation in this context. This process analysis
aimed to understand the degree of fidelity with which the group antenatal
care model was implemented during the trial period.
Methods: We used two discreet questionnaires to collect data from two
groups about the fidelity with which the group antenatal care model was
implemented during this trial period. Group care facilitators recorded
descriptive data about each visit and self-assessed process fidelity with a
series of yes/no checkboxes. Master Trainers assessed process fidelity
with an 11-item tool using a 5-point scale of 0 (worst) to 4 (best).
Results: We analyzed 2763 questionnaires completed by group care
facilitators that documented discreet group visits among pregnant and
postnatal women and 140 questionnaires completed by Master Trainers
during supervision visits. Data recorded by both groups was available for 84
group care visits, and we compared these assessments by visit.
Approximately 80% of all group visits were provided as intended, with
respect to both objective measures (e.g. group size) and process fidelity.
We did not find reliable correlations between conceptually-related items
scored by Master Trainers and self-assessment data reported by group visit
facilitators.
Conclusions: We recommend both the continued participation of expert
observers at new and existing group care sites and ongoing
