| ObjectivesHow to select the'safe, mature, cheap, easy-manipulated, high-involved and effective'maternal health care technologies is the major focus of this study. Objectives of this study are:(1) to systematically review current available international and national literatures, documents, guidelines, and policies on technologies available to maternal health care; (2) to select appropriate technologies applied in maternal health care based on concepts and principles of health technology of assessment and evidence-based medicine; (3) to apply and evaluate appropriate technologies available to maternal health care in community through an assessment model of appropriate maternal health technologies for use in community; and (4) to propose and recommend appropriate frequency, timing, pathway and contents of heath care from preconception, antenatal, intrapartum to postpartum.MethodsA comprehensive dataset was collected from literature review and field studies, and data was analyzed in individualized, technological and operational dimensions. The concept of whole process, system, and operating was applied as a framework for this study. Guided by principles of structure-process-outcome model, health technology assessment, evidence-based medicine, program administration, and work process administration, literature quantitative analysis, individual interview, group interview, qualitative and quantitative multiple demonstration, field study and comprehensive evaluation approaches were integrated in this study. Three maternal & child health care institutions in Beijing, Changzhou, and Jiaiding and 16 community health care service centers were chosen as our study fields.Outcomes1. Study on status quo of international and national maternal health careThe aim of first part of this study was to understand international and national technologies available to maternal health care. Based on a comprehensive review of literature of 24 national health care manuals,56 Chinese journal papers,48 items of national laws and regulations and 10 international health care guidelines, and the indepth interview of 40 experts and 40 pregnant women from three maternal & child health care institutions including Beijing, Changzhou, and Jiaiding and 16 community health service centers, the status quo and technologies in use have been clarified. The preconception care system was improved with the support of policy from four sides including the framework, risk-screening tool, service process and carrying pattern. The preconception care hasn't been systematic carried out due to lacking policy and inadequate demand. The antenatal care has been systematic and normative carried out for many years with the support of policy. But a model based community of maternal health care has been formed abroad and has still been less studied internal. Childbirth in hospital has been advocated both abroad and home. And a pattern based community of family visiting postpartum has been established. As technologies as concerned, there were so many technologies available to maternal health care,6 categories including 67 items were used in preconception care,7 categories including 107 items were used in antenatal care,4 categories including 24 items were used in intrapartum care,7 categories including 22 items for mother and 4 categories including 16 items for baby were used in postpartum care.2. Selection and assessment of appropriate technologies from all technologies available to maternal health careThe second part of this study aimed to select appropriate technologies from all technologies available maternal health care. So, following the concepts and methods of health technology assessment and evidenced based medicine, appropriate technologies were picked up based on literatures including 20 pieces of Chinese journal papers,186 pieces of international journal papers and 5 pieces international health care guidelines and field studies including investigation and interview to three maternal & child health care institutions including Beijing, Changzhou, and Jiaiding and 16 community health service centers and 30 experts. The outcome showed that preconception care was a cost-effective and cost-benefit program, which includes risking assessment, consultation and health promotion, informed choice and medical intervention. But most technologies available to preconception care were from advices of expert panel. The antenatal care was also a cost-effective and cost-benefit program, which includes information collecting, physical examination, obstetrical examination, lad test, file administration, risk screening and health education. The most technologies available to prenatal care have been evaluated by systematic reviews, which indicated many technologies applied in clinical care widely had no support of evidences. Technologies related to delivery were classified four, including benefit technology, in common use but not appropriate technology, unclear technology and be abolished technology. Postpartum care was also a cost-effective and cost-benefit program without intricate technologies, which including health assessment and health education for mother and baby. Besides the universal appropriate technologies (such as collecting history, physical examination and health education),27 items were chosen from technologies available to maternal health care, and 11 articles related to childbirth were involved.3. Establishment of an assessment model of appropriate maternal health technologies for use in communityThe third part of this study aimed to establish an assessment model of appropriate maternal health technologies for use in community. Through literature study of 417 pieces of journal papers and expert consultation combined with the characteristic of domestic community, a framework of the assessment model of appropriate maternal health technologies for use in community was mapped out. Then an assessment model of appropriate maternal health technologies for use in community consisting of 6 first-level indicators,16 second-level indicators and 24 third-level indicators was established through the method of Delphi involving 30 experts from 16 community service centers of Beijing, Changzhou and Jiading. Weights for each indicator were also determined, and the weights of six first-level indicators are following:safety is 0.2710, economic attribute is 0.1737, validity is 0.1796, maturity is 0.1397, convenience is 0.1333, participation is 0.1027.4. Selection and evaluation of appropriate technologies of maternal health care in communityThe Forth part of this study aimed to choose and evaluate appropriate technologies of maternal health care in community through the assessment model of appropriate maternal health technologies for use in community and to verify the feasibility of applying appropriate technologies into community. So, with the help of the assessment model, according to the grade standard and screening method, with the principle of appropriateness more than 7 score,10 items have been selected from 16 articles of appropriate technologies through literature study and field study which includes 30 experts and 40 pregnant women from 16 community service centers of Beijing, Changzhou and Jiading.Then, the feasibility and acceptance of appropriate technologies selected through the assessment model have been evaluated by baseline investigation and staged appraisal. The outcomes showed that the appropriate technologies picked up by the assessment model could be well complemented in communities and the development of maternal health care in community was unbalanced. Maternal health care services withered due to lack of resources and the demand in some communities. However, many inappropriate technologies have been excessively supplied to pregnant women in other communities. And then the appropriate frequency, timing, paths and contents of stages heath care from preconception, antenatal, intrapartum to postpartum were suggested.ConclusionsIt is strongly recommended that the promotion of preconception care should be stressed from policy, the supply and the demand level, and community-based preconception care model should be established step by step. The model of community-based perinatal health care should be built with the policy guiding and resource support from government. Community health care center should provide mother and baby package with appropriate frequency according to local economic level and the capacity of supplying. Moreover, technological and administrating norm should be formed to encourage the application of appropriate technologies and avoiding inappropriate technologies. It is also recommended to apply appropriate childbirth technologies, and strengthen community-based postpartum care, so as to improve mother and baby's health.
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