The influence of community factors in the implementation of community-based interventions to improve antenatal care: a qualitative study based on the IMCHA programme in Tanzania
- PMID: 34551794
- PMCID: PMC8456547
- DOI: 10.1186/s12978-021-01225-5
The influence of community factors in the implementation of community-based interventions to improve antenatal care: a qualitative study based on the IMCHA programme in Tanzania
Abstract
Background: Efforts to improve antenatal care have been heightened to reduce global maternal deaths. In resource-limited settings, community-based interventions play a pivotal role in improving antenatal care services. However, effective implementation of community-based interventions is influenced by prevailing community-related factors. Drawing from the community-based interventions implemented in Iringa Region in Tanzania, this paper underscores how community factors influence implementation and ultimate improvement of antenatal care services.
Methods: A qualitative case study design was employed using in-depth interviews, focus group discussions and document reviews. Data was collected in Kilolo and Mufindi districts in Iringa Region where community-based interventions were implemented. A total of one hundred and forty-six (146) participants were involved in the study. Eighty-six (86) participants were interviewed and sixty (n = 60) participated in focus group discussions. Data were analysed thematically and manually by categorizing and coding emerging issues to facilitate analysis and interpretation.
Results: Key factors that influenced the implementation of the community-based interventions were the community readiness to adopt the interventions and effective local administrative systems. Stakeholders' engagement and local health system support were also pivotal for improving antenatal care services. However, the physical environment, bullying of implementers of interventions and family-related challenges constrained the implementation of the interventions.
Conclusion: This study has shown that the performance of community-based interventions is highly influenced by community-related factors. More specifically, inadequate community engagement may lead to community members' reluctance to adopt implemented interventions. Therefore, in-depth understanding and adequate management of community engagement are important during the planning, development and implementation of community-based interventions.
Keywords: Antenatal care; Community-based interventions; Context; Tanzania.
Plain language summary
Increasing uptake of antenatal care services is crucial for improving maternal and child health. One of the strategies that has been found to be relevant for improving uptake of antenatal care services in resource constrained countries especially in rural communities is implementation of community based initiatives. This study focused on the project that was implemented in Iringa region, Tanzania under the Innovating for Maternal and Child Health in Africa (IMCHA) program, which was implemented through community based initiatives.In order to understand community contextual factors that facilitated or constrained implementation of the IMCHA project, a participatory approach was applied to seek views from women groups as key project implementers and other stakeholders such as community leaders, male champions’ religious leaders, health care providers and health facility governing committees. A total of one hundred forty six people were engaged in interviews and focused group discussions.Community readiness to adopt the interventions emerged as a determining factor for success of the project. Stakeholder engagement also enabled participatory implementation. The major constraining factors were the physical environment that made navigation through the villages difficult as well as negative feedback from family members.This study concludes that community readiness and participatory approaches can be enhanced by various aspects integrated in the initial designing of project activities. This strengthens the project support system critical for sustainability.
© 2021. The Author(s).
Conflict of interest statement
The authors declare that they have no competing interests.
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References
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