"Each moon we come to weigh the pregnancy:" Exploring the experience of group antenatal care processes in Benin and their contributions to self-efficacy.

Group antenatal care (G-ANC) is a model that brings pregnant women with similar estimated delivery dates together for clinical assessment and participatory learning in a supportive social context. A qualitative study was nested in a trial assessing the community impact of G-ANC on ANC retention and uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in Atlantique Department, Benin. This nested qualitative study assessed women's experience of G-ANC, and ways participation could foster self-efficacy to perform a variety of prevention and care-seeking behaviors. Ten semi-structured focus group discussions were conducted with 129 women who attended G-ANC; deductive thematic codes were informed by Bandura's four sources of efficacy expectations. Recently pregnant women's 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, even in G-ANC. G-ANC processes fostering self-efficacy to overcome barriers to ANC attendance may have facilitated women's 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 health behaviors like timely care-seeking, pregnancy management, pregnancy self-care, and facility birth.