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Table 1 Key outcomes and respective measures

From: “Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya

Outcome

Quantitative Methods

Qualitative Methods

Knowledge

Cross-sectional surveys at baseline and endline included an open-ended question for clients to identify:

• danger signs/complications

• how to improve own and baby’s health

Data collectors compared the client’s response to a list of expected responses based on the educational content offered in ANC. Data was analyzed using logistic regression.

IDIs with women currently in GANC

IDIs with women who completed at least 4 GANC visits

IDIs with women who did not attend at least 4 GANC visits

FGDs with women who completed GANC

FGDs with women who did not complete 4 group ANC sessions

IDIs with health providers, facility managers, CHVs, and county health team

Questions focusing on:

What learning has made a difference in your life, if any

Likes and dislikes about participating in or implementing pregnancy club

ANC experience of care (based on WHO framework: effective communication, respect and dignity, and emotional support)

Cross-sectional surveys at baseline and endline included a question on the below topics for the client to rate using a Likert scale.

• Sharing feelings and experiences with other women (social support)

• Knowledge and competence of health workers

• Respect shown to respondent by ANC providers

• Trust in ANC providers

• Language ANC providers used toward respondent

• Information and counseling provided about pregnancy, delivery, and postnatal care

• Overall quality of care

Responses were transformed into a binary response for the purpose of hypothesis testing, as the data did not meet the proportional odds assumption of ordinal regression. For “sharing feelings and experiences with other women,” we compared women who responded they “strongly agree” to those who did not due to the heavily skewed results. For all other measures, we compared women who rated the characteristic of experience as “excellent” or “very good” to those who did not. Data was analyzed using logistic regression.

IDIs with women currently in GANC

IDIs with women who completed at least 4 GANC visits

IDIs with women who did not attend at least 4 GANC visits

FGDs with women who completed GANC

FGDs with women who did not complete 4 group ANC sessions

IDIs with health providers, facility managers, CHVs, and county health team

Questions focusing on:

Likes and dislikes about participating or implementing pregnancy club

Describe relationships between women and with health providers

Benefit of participating in pregnancy clubs

Empowerment

Cross-sectional surveys at baseline and endline included a series of questions related to pregnancy-related empowerment, defined by Patil et al. as “the quality of communication and connectedness pregnant women feel with their care providers and peers, their participation in decision-making, and their capacity to recognize and engage in pregnancy-related healthy behaviors.” Each individual question was collected using a Likert scale, with a point-value attached to each response. The sum of these point-values was used to calculate an overall PRES score for each client. Data was analyzed using logistic regression.

IDIs with women currently in GANC

IDIs with women who completed at least 4 GANC visits

IDIs with women who did not attend at least 4 GANC visits

FGDs with women who completed GANC

FGDs with women who did not complete 4 group ANC sessions

IDIs with health providers, facility managers, CHVs, and county health team

Questions focusing on:

Benefit of participating in pregnancy clubs

Likes/dislikes about pregnancy club – open-ended question that revealed knowledge improvements

Adoption of healthy behaviors

Cross-sectional surveys at baseline and endline included a question on the following topics.

• Birth preparations: open-ended question for clients to identify preparations they had made, and project technical staff compared the client’s response to a list of expected preparations based on the educational content offered in ANC

The following information was extracted from health facility registers:

• Retention: number of ANC visits by an ANC client

Data was analyzed using logistic regression, except for retention, which was analyzed using linear regression.

IDIs with women currently in GANC

IDIs with women who completed at least 4 GANC visits

IDIs with women who did not attend at least 4 GANC visits

FGDs with women who completed GANC

FGDs with women who did not complete 4 group ANC sessions

IDIs with health providers, facility managers, CHVs, and county health team

Questions focusing on:

Benefit of participating in or implementing pregnancy clubs

Likes/dislikes about pregnancy clubs