Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review

Khan, Zahra; Vowles, Zoe; Fernandez Turienzo, Cristina; Barry, Zenab; Brigante, Lia; Downe, Soo; Easter, Abigail; Harding, Seeromanie; McFadden, Alison; Montgomery, Elsa; Page, Lesley; Rayment-Jones, Hannah; Renfrew, Mary; Silverio, Sergio A.; Spiby, Helen; Villarroel-Williams, Nazmy; Sandall, Jane

Abstract

Background
Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this population, in high-income countries (HIC). The review aimed to identify and evaluate the current evidence related to targeted health and social care service interventions in HICs which can improve health inequalities experienced by childbearing women and infants at disproportionate risk of poor outcomes and experiences.

Methods
Twelve databases searched for studies across all HICs, from any methodological design. The search concluded on 8/11/22. The inclusion criteria included interventions that targeted disadvantaged populations which provided a component of clinical care that differed from standard maternity care.

Results
Forty six index studies were included. Countries included Australia, Canada, Chile, Hong Kong, UK and USA. A narrative synthesis was undertaken, and results showed three intervention types: midwifery models of care, interdisciplinary care, and community-centred services. These intervention types have been delivered singularly but also in combination of each other demonstrating overlapping features. Overall, results show interventions had positive associations with primary (maternal, perinatal, and infant mortality) and secondary outcomes (experiences and satisfaction, antenatal care coverage, access to care, quality of care, mode of delivery, analgesia use in labour, preterm birth, low birth weight, breastfeeding, family planning, immunisations) however significance and impact vary. Midwifery models of care took an interpersonal and holistic approach as they focused on continuity of carer, home visiting, culturally and linguistically appropriate care and accessibility. Interdisciplinary care took a structural approach, to coordinate care for women requiring multi-agency health and social services. Community-centred services took a place-based approach with interventions that suited the need of its community and their norms.

Conclusion
Targeted interventions exist in HICs, but these vary according to the context and infrastructure of standard maternity care. Multi-interventional approaches could enhance a targeted approach for at risk populations, in particular combining midwifery models of care with community-centred approaches, to enhance accessibility, earlier engagement, and increased attendance.

Trial registration
PROSPERO Registration number: CRD42020218357.

• Journal Article Type: Article
• Acceptance Date: Jun 29, 2023
• Online Publication Date: Jul 11, 2023
• Publication Date: 2023
• Deposit Date: Jul 5, 2023
• Publicly Available Date: Jul 12, 2023
• Journal: International Journal for Equity in Health
• Electronic ISSN: 1475-9276
• Publisher: Springer Science and Business Media LLC
• Peer Reviewed: Peer Reviewed
• Volume: 22
• Article Number: 131
• DOI: https://doi.org/10.1186/s12939-023-01948-w
• Keywords: Health inequality; Targeted intervention; High-income country; Midwife models; Interdisciplinary care; Community care; Disadvantage; Social complexity; Ethnic minority
• Public URL: https://nottingham-repository.worktribe.com/output/22719094
• Additional Information: This is the peer reviewed version of the following article: Khan, Z., Vowles, Z., Fernandez Turienzo, C. et al. Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review. Int J Equity Health 22, 131 (2023), which has been published in final form at https://doi.org/10.1186/s12939-023-01948-w