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Waiting Time. Wasting Time

Primary Purpose

Pregnancy

Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Pre-natal visit scheduling
Sponsored by
Harvard School of Public Health (HSPH)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Pregnancy

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

Inclusion criteria for individual study participants enrolled after delivery:

1. Women who delivered at the health facility during the weeks of recruitment

Inclusion criteria for women whose waiting time is measured:

1. Women at the health facility to seek care for antenatal care or another reproductive health service (anticipate total enrollment of 800 women)

Inclusion criteria for the health care provider survey is that the provider

  1. Have worked in the health facility for at least 6 months
  2. The health care worker provides ANC as part of their routine duties (anticipate total enrollment of 4 health care workers)

Exclusion Criteria:

Exclusion criteria for individual study participants enrolled after delivery:

  1. Women under 18 years of age will be excluded
  2. Women whose babies die during labor or childbirth from the delivery exit interviews

There are no exclusion criteria for the sample of women whose waiting time will be measured There are no exclusion criteria for the health care provider survey

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    No Intervention

    Arm Label

    Scheduling Intervention

    Control

    Arm Description

    Pre-natal visit scheduling

    Outcomes

    Primary Outcome Measures

    Change in percent of women completing at least 4 prenatal care visits before and after intervention
    Change in average waiting time before being seen for prenatal care before and after intervention

    Secondary Outcome Measures

    Change in nurses satisfaction with their job (1-5 scale)
    Change in proportion of key ANC services respondent reports receiving at most recent prenatal care visit, 9 possible services measured in exit survey at discharge from delivery.
    9 key services include: IPTP dose provided, measured by self-report Delivery plan discussed, measured by self-report Hemoglobin test measured by patient report of having had their blood drawn Recommendations for family planning and breast feeding provided, measured by self-report Detection of breech measured by report of the provider palpating the tummy Blood pressure Measurement of uterine height Urine test Recommendation for what to do in emergencies

    Full Information

    First Posted
    October 17, 2016
    Last Updated
    April 30, 2018
    Sponsor
    Harvard School of Public Health (HSPH)
    Collaborators
    London School of Economics and Political Science
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02938936
    Brief Title
    Waiting Time. Wasting Time
    Official Title
    Waiting Time. Wasting Time: A Randomized Control Trial to Investigate the Health Impacts of Improving the Quality of Antenatal Care in Mozambique
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2018
    Overall Recruitment Status
    Completed
    Study Start Date
    October 1, 2016 (Actual)
    Primary Completion Date
    July 1, 2017 (Actual)
    Study Completion Date
    July 1, 2017 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Harvard School of Public Health (HSPH)
    Collaborators
    London School of Economics and Political Science

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    Our study's principle purpose is to determine whether decreasing waiting time before being seen for antenatal care increases demand for and use of antenatal care services in Mozambique.
    Detailed Description
    This protocol describes a pilot study that will test the impact of a scheduling intervention intended to reduce waiting times for antenatal care. The study will include one intervention health clinic and one control clinic in Maputo, Mozambique. In the intervention facility women attending antenatal care will be informed that if they return at their scheduled date and time they will be seen within one hour by clinic staff rather than having to wait for an indefinite amount of time before being seen for care. Appointment cards will be clipped into ANC cards, which collect routine health data and are kept by women at the end of their ANC visit. Health facility staff will be trained to identify women who return at their scheduled time and to manage patient flow such that scheduled women are received quickly. After the start date of the intervention, all women attending ANC at the health facility will be provided a scheduled return date and time window. Baseline and endline exit interview surveys will be conducted in both intervention and control facilities to compare changes in waiting time, number of ANC visits, and provider satisfaction over the course the study period between clinics.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Pregnancy

    7. Study Design

    Primary Purpose
    Health Services Research
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Non-Randomized
    Enrollment
    597 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Scheduling Intervention
    Arm Type
    Experimental
    Arm Description
    Pre-natal visit scheduling
    Arm Title
    Control
    Arm Type
    No Intervention
    Intervention Type
    Other
    Intervention Name(s)
    Pre-natal visit scheduling
    Intervention Description
    This intervention will include a scheduled date and time for prenatal care follow-up visits. Women in the intervention group seeking care for their first ANC appointment will be offered several appointment slots on their return date by the nurse providing their first ANC visit. Women will be able select among the time options and will be provided an appointment card with their scheduled date and time. Staff will limit the number of scheduled women per hour by maintaining an appointment book. Clinic staff will be trained to differentiate between women returning for a scheduled visit from first prenatal visits, emergencies, and unscheduled return visits. First visits and emergencies will be seen during the first 2 hours after clinic opening and unscheduled women will be seen during a one-hour time slot midday. When women return on their date, they will be seen within one hour of their appointment time by clinic staff.
    Primary Outcome Measure Information:
    Title
    Change in percent of women completing at least 4 prenatal care visits before and after intervention
    Time Frame
    During most recent pregnancy, as reported in an exit survey conducted at discharge from delivery at baseline and six months after the start of the scheduling intervention
    Title
    Change in average waiting time before being seen for prenatal care before and after intervention
    Time Frame
    Measured for 4 weeks at baseline before the start of the intervention, and for 4 weeks, 3 months after the start of the intervention
    Secondary Outcome Measure Information:
    Title
    Change in nurses satisfaction with their job (1-5 scale)
    Time Frame
    Measured before the start of the intervention, and 6 months after the start of the intervention
    Title
    Change in proportion of key ANC services respondent reports receiving at most recent prenatal care visit, 9 possible services measured in exit survey at discharge from delivery.
    Description
    9 key services include: IPTP dose provided, measured by self-report Delivery plan discussed, measured by self-report Hemoglobin test measured by patient report of having had their blood drawn Recommendations for family planning and breast feeding provided, measured by self-report Detection of breech measured by report of the provider palpating the tummy Blood pressure Measurement of uterine height Urine test Recommendation for what to do in emergencies
    Time Frame
    Measured at baseline and 6 months after the start of the intervention

    10. Eligibility

    Sex
    Female
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Inclusion criteria for individual study participants enrolled after delivery: 1. Women who delivered at the health facility during the weeks of recruitment Inclusion criteria for women whose waiting time is measured: 1. Women at the health facility to seek care for antenatal care or another reproductive health service (anticipate total enrollment of 800 women) Inclusion criteria for the health care provider survey is that the provider Have worked in the health facility for at least 6 months The health care worker provides ANC as part of their routine duties (anticipate total enrollment of 4 health care workers) Exclusion Criteria: Exclusion criteria for individual study participants enrolled after delivery: Women under 18 years of age will be excluded Women whose babies die during labor or childbirth from the delivery exit interviews There are no exclusion criteria for the sample of women whose waiting time will be measured There are no exclusion criteria for the health care provider survey

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    31803509
    Citation
    Steenland M, Dula J, de Albuquerque A, Fernandes Q, Cuco RM, Chicumbe S, Gudo ES, Sequeira S, McConnell M. Effects of appointment scheduling on waiting time and utilisation of antenatal care in Mozambique. BMJ Glob Health. 2019 Nov 25;4(6):e001788. doi: 10.1136/bmjgh-2019-001788. eCollection 2019.
    Results Reference
    derived

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