Development of strategies to enhance holistic antenatal care in Limpopo Province, South Africa: A qualitative method protocol

Abstract Background: Holistic antenatal care encompasses a range of services, including mental, physical, social, intellectual, emotional, and spiritual. Antenatal care is regarded as the cornerstone of maternal health. As such, a lack of holistic antenatal care can lead to poor pregnancy outcomes, such as maternal and perinatal mortality. This study aims to develop strategies to enhance holistic antenatal care in Limpopo Province, South Africa. Methods: The population for the study is pregnant women, midwives, and operational managers in selected community health centers in Limpopo Province, South Africa. Non-probability purposive sampling will be used to select the province, districts, municipalities, and community health centers for the study. Convenience sampling will be used to select participants for antenatal card auditing and non-participatory observations of the antenatal care process as offered by midwives. Pregnant women will engage in focus group discussions. Midwives and operational managers will be sampled for in-depth interviews using nonprobability purposive sampling. Non-participatory observation will be conducted using a checklist and an audit tool to audit antenatal cards to support the qualitative data. Data will be analysed manually using Tesch's thematic analysis method for focus groups and in-depth interviews. Quantitative data will be analysed using computerized statistical software for the social sciences (SPSS 28). Ethical considerations will be adhered to throughout the study. Significance of the study: This study aims to enhance midwives' understanding and practice of holistic antenatal care in Limpopo Province. With the data collected, strategies for enhancing holistic antenatal care will be developed, strengthening the standard of antenatal care. Holistic antenatal care has been proven to contribute to the reduction of maternal and perinatal deaths.