None listed
Conditions
Brief summary
There is increasing concern that over 50% of mothers and 60% of breastfed young infants in disadvantaged areas globally have micronutrient malnutrition and iron deficiency anaemia (IDA), with similar rates found in Aboriginal and Torres Strait Islander communities. Despite a decade of substantial investments in Continuous Quality Improvement (CQI) programs, many barriers still remain to the provision of antenatal care in remote areas. There have been no studies of the effectiveness of peer led clinical governance to improve antenatal in remote and disadvantaged communities who are likely to benefit most. We have been funded by the National Health and Medical Research Council (NHMRC) to undertake a study of a new locally driven enhanced support model (clinical governance and peer led targeted support) to reduce anaemia rates and improve the quality of maternal and infant primary care. The study will be based in the Kimberley region of Western Australia. The intervention is clinical governance and peer led targeted support for maternal and early infant care delivered by dedicated local midwife coordinators. We will evaluate this model of enhanced support using a rigorous stepped wedge design approach. Structured questionnaires and data collection will be used to assess acceptability, feasibility and sustainability. Our primary outcome measure is improved iron deficiency anaemia in infants aged six months. Secondary outcome measures are improved iron deficiency anaemia in mothers at six months post-partum; improved Bayley neurodevelopmental scores in infants aged six months; improved satisfaction of mothers about maternal health care. We will also assess the cost effectiveness of the model of enhanced support. Although we are aiming to measure the primary outcome at six months post-partum we will be accepting measures from 4-8 months due to difficulties in finding all infants at exactly six months post-partum. This study will be conducted over a five year period in partnership with service providers in the Kimberley. This is the first population and region based study of clinical governance and targeted peer led support in a remote region. The results of our study will be used to develop improved primary care models and to improve health outcomes for all Aboriginal and/or Torres Strait Islander mothers and infants. These are vital steps towards more equitable health service delivery for Aboriginal and Torres Strait Islander peoples in Australia.
Interventions
Two midwives will deliver the intervention. The first visit will involve the midwife consulting face-to-face with antenatal primary health care providers to discuss local needs, priorities and protocols; promote the use of best practice protocols and guidelines; and to discuss IT needs, inputs and outputs including key performance indicators reports and recall systems. Following this there will be a weekly scheduled telephone support service between the intervention midwives and primary care sta
Two midwives will deliver the intervention. The first visit will involve the midwife consulting face-to-face with antenatal primary health care providers to discuss local needs, priorities and protocols; promote the use of best practice protocols and guidelines; and to discuss IT needs, inputs and outputs including key performance indicators reports and recall systems. Following this there will be a weekly scheduled telephone support service between the intervention midwives and primary care staff delivering antenatal care in the primary care services, and ongoing support for services to conduct CQI activities. The intervention midwives will help to solve problems that affect how care is delivered for mothers and babies in the Kimberley. Each service will have direct input into the role of the supporting intervention midwives in their own clinics. This will include offering help with: 1. Improving the coordination of care and information exchange between service providers, both community based services and hospitals in the region and outside the region (e.g. referrals; communication processes; logistics [PATS, transport, accommodation]); 2. Improving and promoting the use of local service protocols and guidelines to support staff with these processes 3. Improving training especially for antenatal and infant health care, nutrition, substance abuse, social and emotional well-being, and prevention and management of maternal anaemia 4. Supporting staff to sort out the complex care sometimes required for specific health problems that mothers and babies may have; and 5. Other problem solving as requested. As this is a stepped wedge cluster randomised trial the total duration of the intervention provided to each clinic will depend on which cluster the clinic is randomised to. Cluster 1, 2, 3 and 4 will receive 23, 19, 15 and 11 months of intervention, respectively.
Sponsors
The University of Western Australia
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Healthy volunteers
Yes
Inclusion criteria
Target group for the intervention The target group for the intervention includes all clinics that provide antenatal care in the Kimberley region (this includes both primary care and hospital antenatal clinics). All consenting primary care and hospital antenatal services in the region will be eligible to receive the intervention and will be allocated to a cluster group based on geographical and health service provider boundaries. All pregnant women who are patients of these services will be able to receive the benefits of the intervention. Inclusion criteria for the intervention All primary health care clinics that provide antenatal care in the Kimberley will be included in the study Target group for the outcome data collection The target group for the six month post-partum data collection are Aboriginal and Torres Strait Islander infants aged six months and their mothers. Inclusion criteria for the outcome data collection 1. Birth mother or infant is Aboriginal and / or Torres Strait Islander 2. Birth mother aged 16 years or older, or assessed as a mature minor at the time of giving informed consent 3. Birth mother gives informed consent for her baby and herself to participate in outcome data collection.
Exclusion criteria
There will be no additional exclusions.
Outcome results
None listed