"Each moon we come to weigh the pregnancy." Self-efficacy in group antenatal care in Benin

Group antenatal care (G-ANC) is a model that convenes women of similar gestational age for participatory education and antenatal care. A qualitative study was embedded in a trial assessing the impact of G-ANC on ANC retention and intermittent preventive treatment of malaria in pregnancy (IPTp) uptake to assess womens experience of G-ANC, and ways participation could foster self-efficacy. Ten semi-structured focus group discussions were conducted with 129 women who attended G-ANC; deductive thematic codes were informed by Banduras four sources of efficacy expectations. Recently pregnant womens experiences with individual ANC versus G-ANC were assessed via household surveys. G-ANC participation proffered three sources of self-efficacy expectations: performance accomplishments, verbal persuasion, and vicarious experience. Among household survey respondents, 96% (134/140) of women who participated in G-ANC would prefer it over individual ANC for future pregnancies. While a higher proportion of G-ANC participants felt that the provider answered all their questions in a way they could understand, most women reported that not all their questions were answered. G-ANC processes fostering self-efficacy to overcome barriers to ANC attendance may have facilitated womens participation in G-ANC meetings as well as taking more doses of IPTp. Self-efficacy of pregnant women participating in G-ANC could be strengthened by providers addressing all participants questions in a more complete and understandable way, contributing to more effective verbal persuasion. Other parallel processes during G-ANC need to be maintained to provide multiple sources of self-efficacy for behaviors like emergency care-seeking, pregnancy management, pregnancy self-care, and facility birth.