Factors affecting take up of community based antenatal programmes in high income countries: a rapid realist review

Problem Take up of antenatal programmes based in the community was lower than expected in a deprived UK case study area, despite targeted support. More understanding was required regarding why, to make effective changes. Background Different models of antenatal programme can be delivered in community settings, to help improve the health of children from deprived areas. Objective To identify theories associated with how, why and in what contexts parents-to-be access community based antenatal programmes in high income countries, to increase service use. Review Methods Rapid Realist Review, incorporating initial review of national policy documents, reports, observations of antenatal pathway meetings, development of review programme theories with Reference Group support. Results Forty eight papers met the Review criteria and were included: 11 systematic reviews, meta-syntheses; realist reviews, protocols; 34 single studies; two dissertations, one grey literature article. Evidence identified gaps in knowledge to optimise attendance and highlighted the importance of health practitioners but details on impact were lacking. Several factors appeared to impact on access to antenatal support, specifically marketing and inclusivity, perceived candidacy for care, needs prioritisation, practitioner promotion of programmes, stereotypes of fathers’ roles, site accessibility, timings, transport, negativity with venues. Discussion Mechanisms were not easily identified within the literature reviewed. Many papers and reports focussed on background and context. There was an absence of information on how programmes had been advertised, contact and referral processes. Conclusions This review found several factors that may encourage engagement with antenatal programmes. Further research is required to uncover mechanisms regarding access, or how practitioners can support these. Voices of those not engaging should be included, including those from White, Eastern European backgrounds and fathers/partners.