Best Practices for the Design, Implementation and Evaluation of Prenatal Health Programs
Introduction Prenatal health programs provide health education, reproductive care and related services to women. Programs may be administered individually or collaboratively by agencies including public health units, hospitals, health clinics, community and non-governmental organizations. Prenatal health disparities among populations at-risk may be reduced through the provision of accessible health education, services and resources to help women mitigate modifiable risks to pregnancy. Although standardized guidelines inform clinical screening, testing and maternity care, gaps exist regarding the design, implementation and evaluation for comprehensive prenatal health programs. Methods Using a multijurisdictional approach, prenatal health guidance documents released by clinical associations and regional governments across Canada, Australia, the United States, the United Kingdom and Ireland were systematically evaluated to identify standards and practices regarding the design, implementation and evaluation of prenatal health programs. Results Evidence-based, surveillance/monitoring, and expert/stakeholder collaborations were principles affirmed by guidance documents across all jurisdictions. Each jurisdiction described tailored strategies to optimize prenatal health in their respective communities. Divergence between jurisdictions was noted for patient care models and promotion of providers and companions of choice. Discussion A best practices model is proposed describing recommendations as follows: prenatal health programs should be grounded in a theoretical approach, fundamentally woman-centered and designed to address interacting prenatal health determinants across the lifespan. Accessible and inclusive prenatal health care can be achieved through provider training and community stakeholder collaborations. Identification of best practices for prenatal health program design, implementation and evaluation ensures that service standards are harmonized across communities, thereby optimizing maternal and child health.
KeywordsPregnancy Health promotion Prenatal care Prenatal health Woman-centered care
Funding was provided by Faculty of Health Sciences, University of Ottawa.
- Australian Government Department of Health. (2015). National antenatal care guidelines. Retrieved October 22, 2017, from. http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-antenatal-care-index.
- Feijen-De Jong, E. I., Jansen, D. E., Baarveld, F., Van Der Schans, C. P., Schellevis, F. G., & Reijneveld, S. A. (2012). Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: A systematic review. European Journal of Public Health, 22(6), 904–913.CrossRefGoogle Scholar
- Government of Nunavut, Department of Health and Social Service. (2009). Nunavut Maternal and Newborn Health Care Strategy 2009–2014. Iqaluit, Nunavut: Department of Health and Social Services, Government of Nunavut; ISBN 978-1-55325-169-9.Google Scholar
- Heaman, M. I., Moffatt, M., Elliott, L., Sword, W., Helewa, M. E., Morris, H., et al. (2015). Perceptions of barriers, facilitators, motivators related to use of prenatal care: A qualitative descriptive study of inner city women in Winnipeg. SAGE Open Medicine. https://doi.org/10.1186/s12884-015-0431-5.Google Scholar
- Johnson, K., Posner, S. F., Biermann, J., Cordero, J. F., Atrash, H. K., Parker, C. S., et al. (2006). Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recommendations and Reports, 55(6), 1–23.Google Scholar
- Muhajarine, N., Ng, J., Bowen, A., Cushon, J., & Johnson, S. (2012). Understanding the impact of the Canada prenatal nutrition program: A quantitative evaluation. Canadian Journal of Public Health, 103(7 Suppl 1), eS26–eS31.Google Scholar
- Public Health Agency of Canada. (2013). Implementing the population health approach. Retrieved October 22, 2017, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/implementing-population-health-approach/implementing-population-health-approach.html.
- Smylie, J., Kirst, M., McShane, K., Firestone, M., Wolfe, S., & O’Campo, P. (2016). Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: A realist review. Social Science & Medicine, 150, 128–143.CrossRefGoogle Scholar
- United Nations. (1996). Report of the fourth world conference on women, Beijing, 4–15 September 1995. New York: United Nations, ISBN 92-1-130181-5.Google Scholar
- World Health Organization. (1986). Health promotion, the Ottawa Charter for Health Promotion. Retrieved October 22, 2017, from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/.
- World Health Organization. (2015) WHO recommendations on health promotion interventions for maternal and newborn health. Geneva: World Health Organization.Google Scholar