Qualitative assessment of knowledge transfer regarding preterm birth in Malawi following the implementation of targeted health messages over 3 years

Abstract

Kathleen M Antony,1,2 Judy Levison,1 Melissa A Suter,1 Susan Raine,1 Grace Chiudzu,3 Henry Phiri,3 Joseph Sclafani,1,3,4 Michael Belfort,1 Peter Kazembe,4 Kjersti M Aagaard1 1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; 2Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Wisconsin-Madison, Madison, WI, USA; 3Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi; 4Baylor College of Medicine Children’s Clinical Center of Excellence, Kamuzu Central Hospital, Lilongwe, Malawi Background: In 2012, we performed a needs assessment and gap analysis to qualitatively assess providers’ and patients’ knowledge and perceptions regarding preterm birth (PTB). During the study, we identified knowledge gaps surrounding methods to reduce the risk of occurrence of PTB and management options if preterm labor/birth occur. We targeted health messages toward these gaps. The objective of the present study was to assess the impact of our community health worker-based patient education program 3 years after it was implemented.Methods: Fifteen focus groups including 70 participants were included in the study. The groups comprised either patients/patient couples or health providers. A minimum of two facilitators led each group using 22 a priori designed and standardized lead-in prompts for participants with four additional prompts for providers only. A single researcher recorded responses, and transcript notes were reviewed by the facilitators and interpreters immediately following each group discussion to ensure accuracy.Results: The understanding of term vs preterm gestation was generally accurate. Every participant knew of women who had experienced PTB, and the general perception was that two to three women out of every ten had this experience. The majority of respondents thought that women should present to their local health clinic if they experience preterm contractions; few were aware of the use of antenatal steroids for promoting fetal lung maturity, but many acknowledged that the neonate may be able to receive life-sustaining treatment if born at a higher level of care facility. The majority of participants were aware that PTB could recur in subsequent pregnancies. All respondents were able to list ways that women could potentially reduce the risk of PTB.Conclusion: After employing targeted health messages, the majority of participants expressed improved understanding of the definition of PTB, methods to prevent risk of PTB, and management options for preterm labor or PTB. Keywords: preterm birth, qualitative research, global women’s health, pregnancy, periodontal disease, prenatal education

Keywords

• Preterm birth
• qualitative research
• global women’s health
• pregnancy
• periodontal disease