Harsha Bangura, A, Nirola, I, Thapa, P ; https://orcid.org/0000-0002-3333-1434, Citrin, D, Belbase, B, Bogati, B, B.k., N, Khadka, S, Kunwar, L, Halliday, S, Choudhury, N, Schwarz, R, Adhikari, M, Kalaunee, SP, Rising, S, Maru, D, Maru, S, Harsha Bangura, A, Nirola, I, Thapa, P ; https://orcid.org/0000-0002-3333-1434, Citrin, D, Belbase, B, Bogati, B, B.k., N, Khadka, S, Kunwar, L, Halliday, S, Choudhury, N, Schwarz, R, Adhikari, M, Kalaunee, SP, Rising, S, Maru, D, and Maru, S
Background: Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women's groups suggests that group care models may both improve access to care and the quality of care delivered through women's empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. Methods: The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. Results: A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas w