Centering Pregnancy: an group visit model for prenatal care

The current ANS “Editor’s Pick” article addresses the challenges of implementing an innovative, new model of care.  The article, titled “Using Focus Groups and Social Marketing to Strengthen Promotion of Group Prenatal Care” is authored by a team of nurse midwives: Susan C. Vonderheid, PhD, RN; Carrie S. Klima, PhD, CNM; Kathleen F. Norr, PhD; Mary Alice Grady, MS, CNM; and Claire M. Westdahl, MPH, CNM, FACNM. Members of this team have been using this model of care for over a decade, and have produced evidence of its benefits and effectiveness.  But the concept of group care remains a challenge for many clinical settings – a challenge this team of authors addressed using social marketing. Visit the ANS web site now to download your copy of this informative article at no cost while it is featured!  Dr. Vonderheid shared this message, and a video (below) providing some background on their work to promote adoption of the model in various settings throughout Illinois:

Innovations in prenatal care are greatly needed to reduce racial disparities in maternal and infant outcomes in the US. The Yale-Emory randomized clinical trial (RCT) that tested the effectiveness of CenteringPregnancy, a multifaceted group visit model of prenatal care, showed amazing reductions in preterm birth and improvements in other maternal and infant outcomes (Ickovics et al., 2007). These study findings influenced many organizations to commit resources to implement this innovative prenatal care model. Funded by the Maternal Child Health Bureau, our investigator team at the University of Illinois was initially focused on evaluating whether the effectiveness of the RCT could be replicated in non-experimental conditions in clinics throughout Illinois and identifying the potential mechanisms by which CenteringPregnancy was effective. But, as we worked with our clinic partners to prepare for the evaluation, we found that clinics faced challenges related to organizational change and some even struggled to implement CenteringPregnancy. Major challenges included

Dr. Susan C. Vonderheid

enrolling women into groups and obtaining organizational “buy-in” to create large enough groups for effective and sustainable programs. These challenges had to be addressed before conducting the evaluation. To address these challenges, we offered workshops to help clinic staff build social marketing skills to improve communication with the numerous  “customers” of CenteringPregnancy. Social marketing is the “application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence voluntary behavior of target audiences in order to improve their personal welfare and that of their society (Andreasen, 1995). Our article describes how we adapted the 3-step social marketing communication strategy previously used by Claire Westdahl (co-author) to promote breastfeeding and more recently to help other clinics implement CenteringPregnancy.

In our video (below), we role-play a clinic staff member using the 3-step social marketing strategy to “sell” group care to a key customer – a pregnant woman. Listen as the seller crafts a message that reduces the buyer’s concern (reason for not participating) and offers information about the benefits of group related to this concern to increase the chance of “buying” group care. Social marketing can be used to guide customers to understand the benefits of CenteringPregnancy (and other evidence-based innovations), and make decisions about participating that are beneficial to them. We hope this provides nurses and other health care professionals with one more tool in their toolkit when leading the charge for organizational change!