Community-Based Initiatives to Improve Maternal and Newborn Health in High-Income Settings: A Mixed-Methods Systematic Review.

Abstract

Introduction: Although community-based interventions, including Participatory Learning and Action (PLA) groups, have demonstrated significant success in improving maternal and newborn health outcomes and promoting equity in low to middle-income countries, the evidence in high-income settings remains limited. This systematic review, carried out in collaboration with Women and Children First (a UK-based charity focusing on improving the lives of women and children globally), explores community-based initiatives that are currently used in high-income countries (HICs) to enhance maternal and newborn health, as well as the effectiveness of these initiatives in improving maternal and newborn health outcomes. Additionally, the review aims to examine the relationship between community-based initiatives and PLA methodology.

Methods: This is a mixed-method systematic review with a narrative synthesis of results. MEDLINE, Embase, CINAHL, and MIDIRS databases were searched for community-based initiatives for any maternal and neonatal health outcome between 2000 and 2023. Both quantitative and qualitative studies were included and assessed for methodological quality using the Mixed-Methods Appraisal Tool. A convergent results-based synthesis approach was used.

Results: A total of18 studies were included for review. Three main types of community-based interventions were identified: peer support, social support, and health education. Most interventions had beneficial effects on their maternal and neonatal health outcomes of interest. Qualitative analysis revealed 4 main aspects of peer support-connectedness, emotional validation, self-efficacy, and information sharing-which helps to explain the positive effects of peer support, particularly for breastfeeding and maternal mental health. The community-based initiatives linked to PLA methodology in some ways but were lacking in promoting community mobilization since the majority were aimed at the individual or group level, as opposed to engaging whole communities.

Discussion: Community-based initiatives can be effective in HICs for improving aspects of maternal and neonatal health, particularly maternal mental health and breastfeeding. There is very limited research on more participatory community-based initiatives, such as PLA, in HICs that promote community-wide engagement and mobilization. Further research is needed in this area.