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.

Danielle Ashworth, Pankhuri Sharma, Sergio A. Silverio, Simi Khan, Nishtha Kathuria, Priyanka R. Garg, Mohan Ghule, V. B. Shivkumar, Atul Tayade, Sunil Mehra, Poonam Varma Shivkumar, Rachel Tribe, on behalf of the PROMISES Study Team

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Abstract

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.
Original languageEnglish
JournalBMJ Open
DOIs
Publication statusPublished - 8 Jan 2021

Keywords

  • Preterm Birth
  • India
  • Salivary Progesterone
  • LMIC
  • Pregnancy

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