Clinical trial NCT02938936: 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
Overall status: COMPLETED
Phase: NA
Conditions: Pregnancy
Lead sponsor: Harvard School of Public Health (HSPH)
Sponsor class: OTHER
Collaborators: name: London School of Economics and Political Science
First posted: 2016-10-19
Enrollment: 597
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

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

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

Primary outcomes:
measure: Change in percent of women completing at least 4 prenatal care visits before and after intervention
timeFrame: 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
measure: Change in average waiting time before being seen for prenatal care before and after intervention
timeFrame: 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 outcomes:
measure: Change in nurses satisfaction with their job (1-5 scale)
timeFrame: Measured before the start of the intervention, and 6 months after the start of the intervention
measure: 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.
timeFrame: Measured at baseline and 6 months after the start of the intervention
Other outcomes:
Locations:
Study officials:
References:
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.