The PROMISES Study: A mixed methods approach to explore the acceptability of salivary progesterone testing for pre-term birth risk amongst pregnant women and trained frontline healthcare workers in rural India.

TY - JOUR

T1 - The PROMISES Study

T2 - A mixed methods approach to explore the acceptability of salivary progesterone testing for pre-term birth risk amongst pregnant women and trained frontline healthcare workers in rural India.

AU - Ashworth, Danielle

AU - Sharma, Pankhuri

AU - Silverio, Sergio A.

AU - Khan, Simi

AU - Kathuria, Nishtha

AU - Garg, Priyanka R.

AU - Ghule, Mohan

AU - Shivkumar, V. B.

AU - Tayade, Atul

AU - Mehra, Sunil

AU - Shivkumar, Poonam Varma

AU - Tribe, Rachel

AU - on behalf of the PROMISES Study Team, null

PY - 2021/1/8

Y1 - 2021/1/8

N2 - Introduction: India has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth annually and contribute to approximately a quarter of preterm births globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of preterm birth risk) we present a mixed methods explanatory sequential feasibility sub-study of the salivary progesterone test.Methods: A pre- and post-training questionnaire to assess Accredited Social Health Activists (n=201) knowledge and experience of preterm birth and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with Accredited Social Health Activists (n=10) and pregnant women (n=9) and were analysed using Thematic Framework Analysis to explore the barriers and facilitators influencing the use of this test in rural India.Results: Before training ASHAs knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All four hundred women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: Implementation of Intervention; Networks of Influence; and Access to Healthcare. Qualitative data were stratified and presented as barriers and facilitators.Conclusion: This study suggests support for ongoing investigations validating preterm birth testing using salivary progesterone in rural settings.

AB - Introduction: India has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth annually and contribute to approximately a quarter of preterm births globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of preterm birth risk) we present a mixed methods explanatory sequential feasibility sub-study of the salivary progesterone test.Methods: A pre- and post-training questionnaire to assess Accredited Social Health Activists (n=201) knowledge and experience of preterm birth and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with Accredited Social Health Activists (n=10) and pregnant women (n=9) and were analysed using Thematic Framework Analysis to explore the barriers and facilitators influencing the use of this test in rural India.Results: Before training ASHAs knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All four hundred women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: Implementation of Intervention; Networks of Influence; and Access to Healthcare. Qualitative data were stratified and presented as barriers and facilitators.Conclusion: This study suggests support for ongoing investigations validating preterm birth testing using salivary progesterone in rural settings.

KW - Preterm Birth

KW - India

KW - Salivary Progesterone

KW - LMIC

KW - Pregnancy

U2 - 10.1136/bmjopen-2020-040268

DO - 10.1136/bmjopen-2020-040268

M3 - Article

SN - 2044-6055

JO - BMJ Open

JF - BMJ Open

ER -