None listed
Conditions
Brief summary
Improving maternal and child health (MCH) care and outcomes has an impact throughout the lifespan. Most quality improvement interventions focus on service-level action, despite evidence that up to 2/3 of the variability in quality of care might be due to factors beyond health services. Good international evidence indicates participatory planning and implementation processes in partnership with community women can deliver real outcomes for improved MCH. Community participation is the collective involvement of local people in a geographic location, making decisions about their needs and priorities, implementing strategies, and monitoring progress in partnership with health services. Such community participation has not been tested in the Aboriginal and Torres Strait Islander primary health care (PHC) setting. This WOMB trial tests the effectiveness of community participation in improving Indigenous MCH. This stepped wedge intervention will see the formation of Participatory Women's Groups (PWGs, groups of women in a community interested in MCH improvement) at 10 sites across Australia. Community participation will involve training local facilitators of PWG groups, supportive engagement with local MCH data through workshops, PWGs identifying and prioritising issues and strengths and co-implementing solutions with health services. Outcomes will be measured with yearly MCH audits, cost-effectiveness and process evaluation. The PWG intervention will be structured on the Remote Services Futures community participation framework. If successful, the WOMB trial will provide rigorous evidence supporting community participation as a means for improving MCH in Indigenous communities, moving towards closing the gap in health outcomes across the lifespan.
Interventions
Complex intervention involving Participatory Women's Groups (PWGs) being supported to engage with Maternal and Child Health audit data from their community/PHC service and suggesting interventions to improve quality of care. These groups will use the Remote Services Futures methodology to engage with MCH audit data; collect information about strengths and limitations of MCH care in that context, co-produce a MCH quality improvement plan for that site, co-implementation of that plan and monitori
Complex intervention involving Participatory Women's Groups (PWGs) being supported to engage with Maternal and Child Health audit data from their community/PHC service and suggesting interventions to improve quality of care. These groups will use the Remote Services Futures methodology to engage with MCH audit data; collect information about strengths and limitations of MCH care in that context, co-produce a MCH quality improvement plan for that site, co-implementation of that plan and monitoring. PWGs will be formed for each community in the study and supported by local facilitators with remote support from the project team.. Two facilitators for each group will be identified from within the community with the assistance of the health service and community women and trained. Training will occur during a one week training program in the first year of the project (probably held in Cairns), covering group facilitation skills, familiarisation with MCH audit data and the RSF process as a framework for supporting the initiatiation and conduct of PWGs, with the aim of engaging with MCH audit data and facilitating action to promote quality of MCH care. This training will also help facilitators form relationships with the research team members and other facilitators to enable ongoing remote support for the process. Comprehensive refresher training will be done on site just prior to implementation of the intervention. PWGs will be supported by the PWG facilitators (with significant support from the project team include remote reminders and prompts and a project team member attending each participating health service during the first cycle of workshops) to meet for a series of four planning workshops (held at approximately monthly intervals over the first six months of the intervention at each site). Three initiatives from the community MCH improvement plan developed will be prioritised for implementation, and a series of four implementation workshops will be held over the following 8 months at approximately bi-monthly intervals. Annual meetings to bring facilitators together and disseminate their experiences will share learning and enhance the knowledge base to respond to local priorities. Adherence and fidelity of the intervention will be assessed using detailed process evaluation, including facilitator structured field journals, interviews (with PWG facilitators and PWG participatants) and direct observation .
Sponsors
James Cook University
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Healthy volunteers
Yes
Inclusion criteria
Indigenous primary health care services are eligible to take part if they: 1. are engaged in MCH auditing using a recognised tool. 2. are willing to support staff member participation in facilitator training 3. have agreement from CEO, Board and key staff to participate. Participatory women's group facilitators and PWG participants are any local community women with an interest in the health of mums and bubs - may include mothers, Elders, other community women (ideally linking in with other community initiatives). Women whose charts are audited in terms of the primary and secondary outcomes are any woman in the community with an infant aged between 2 and 14 months at the time of the audit, resident in the community for at least 6 months of her pregnancy and using the PHC service as her usual source of care.
Exclusion criteria
Does not meet inclusion criteria. Unwilling to take part or has a physical or mental health condition that makes participation in a women's group impossible.
Outcome results
None listed