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Purpose

To study the association of process and content fidelity to the CenteringPregnancy model with perinatal outcomes. We examined 2 types of fidelity: process fidelity reflected how facilitative leaders were and how involved participants were in each session, and content fidelity reflected whether recommended content was discussed in each group session.

Hypotheses

We hypothesized that participants in CenteringPregnancy groups with higher fidelity to facilitative group process and to content recommendations would have a lower likelihood of preterm birth, more adequate care, and higher likelihood of initiating breastfeeding.

Significance/Background

CenteringPregnancy provides prenatal care to women in groups. In a randomized controlled trial comparing CenteringPregnancy with individual care, CenteringPregnancy reduced the likelihood of preterm birth by 33%, reduced the likelihood of inadequate care, and increased breastfeeding initiation. This model, therefore, shows promise for improving perinatal outcomes, particularly the intractable problem of preterm birth. However, there is likely variation in how the model is implemented in clinical practice, which may be associated with efficacy and, therefore, variation in outcomes.

Methods

We conducted a secondary analysis of data from the clinical trial that demonstrated improved rates of preterm birth, adequate care, and breastfeeding initiation in women receiving CenteringPregnancy care. The sample included 519 women aged 14 to 25 years receiving group prenatal care in 2 urban clinics. Fidelity was rated at each group prenatal care session by a trained researcher. Preterm birth and adequacy of care were abstracted from medical records. Participants self-reported breastfeeding initiation 6 months postpartum.

Findings

Controlling for clinical predictors, greater process fidelity was associated with significantly lower odds of both preterm birth (B = –0.43, Wald χ2 = 8.65, P = .001) and excessive utilization of care (B = –0.29, Wald χ2 = 3.91, P = .05). Greater content fidelity was associated with lower odds of excessive utilization of care (B = –0.03, Wald χ2 = 9.31, P = .001).

Discussion

Understanding the impact of fidelity to the CenteringPregnancy model can contribute to developing a better understanding of how to implement this model to further enhance outcomes. Training in facilitative leadership for group prenatal care should include developing an awareness of the critical role that creating a participatory atmosphere may have in improving outcomes and reassurance that content suggestions are simply recommendations, not requirements.