A study of implementation fidelity to an adapted community-based model of enhanced group prenatal care

BACKGROUND: Group prenatal care (GPC) is a promising intervention for improving maternal health outcomes and reducing disparities. However, implementation can be challenging, and the role of community partnerships in supporting delivery is not well understood. PURPOSE: This study examined the implementation fidelity of an enhanced GPC (eGPC) program, Glow! GPC and support, delivered collaboratively by prenatal care providers and a community agency, either virtually or in person, within a randomized trial comparing eGPC to enhanced individual prenatal care. METHODS: Using a mixed methods convergent design, quantitative surveys completed by co-facilitators assessed adherence to core content and process components, while qualitative data from provider interviews (n = 6) and a facilitator focus group (n = 6) explored implementation experiences. Descriptive statistics and thematic analysis were integrated using a joint display to identify convergence, divergence, and expansion across data sources. RESULTS: Of 59 cohorts initiated, 49% were canceled due to low enrollment. Among 26 completed cohorts (n = 159; mean = 6 participants), mean content fidelity was 68%, higher in virtual (73%) than in-person (61%) cohorts. Process fidelity was high (89%), though virtual sessions had lower adherence to health checks. Qualitative data revealed four themes related to strong facilitator engagement, recruitment challenges, integration with routine care, and virtual delivery. Integration demonstrated convergence between qualitative and quantitative data. CONCLUSIONS: Despite moderate-to-high fidelity, eGPC implementation was constrained by recruitment and childcare barriers due to the COVID-19 pandemic. Integrated findings underscore community partnerships as critical to strengthening delivery and sustaining scale-up in resource-limited clinical settings.