Mehay Anita, Motta Giordana Da, Hunter Louise, Rayment Juliet, Wiggins Meg, Haora Penny, McCourt Christine, Harden Angela
School of Health and Psychological Sciences, City, University of London, Myddelton Street, London, EC1R 1UW, UK.
Oxford Brookes University, Oxford, UK.
BMC Pregnancy Childbirth. 2024 Oct 1;24(1):625. doi: 10.1186/s12884-024-06792-6.
There is growing interest in the benefits of group models of antenatal care. Although clinical reviews exist, there have been few reviews that focus on the mechanisms of effect of this model.
We conducted a realist review using a systematic approach incorporating all data types (including non-research and audiovisual media), with synthesis along Context-Intervention-Mechanism-Outcome (CIMO) configurations.
A wide range of sources were identified, yielding 100 relevant sources in total (89 written and 11 audiovisual). Overall, there was no clear pattern of 'what works for whom, in what circumstances' although some studies have identified clinical benefits for those with more vulnerability or who are typically underserved by standard care. Findings revealed six interlinking mechanisms, including: social support, peer learning, active participation in health, health education and satisfaction or engagement with care. A further, relatively under-developed theory related to impact on professional practice. An overarching mechanism of empowerment featured across most studies but there was variation in how this was collectively or individually conceptualised and applied.
Mechanisms of effect are amplified in contexts where inequalities in access and delivery of care exist, but poor reporting of populations and contexts limited fuller exploration. We recommend future studies provide detailed descriptions of the population groups involved and that they give full consideration to theoretical underpinnings and contextual factors.
The protocol for this realist review was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42016036768).
人们对产前护理的群体模式的益处越来越感兴趣。尽管存在临床综述，但很少有综述关注这种模式的作用机制。
我们采用系统方法进行了一项实效主义综述，纳入所有数据类型（包括非研究性和视听媒体），并按照背景-干预-机制-结果（CIMO）结构进行综合分析。
我们识别出了广泛的资料来源，总共产生了100个相关来源（89份书面资料和11份视听资料）。总体而言，尽管一些研究已经确定了对于那些更脆弱或通常在标准护理中服务不足的人群有临床益处，但并没有明确的“在何种情况下对谁有效”的模式。研究结果揭示了六个相互关联的机制，包括：社会支持、同伴学习、积极参与健康、健康教育以及对护理的满意度或参与度。还有一个与对专业实践的影响相关的、相对不太成熟的理论。大多数研究都有一个总体的赋权机制，但在如何从集体或个体角度对其进行概念化和应用方面存在差异。
在护理获取和提供存在不平等的情况下，作用机制会被放大，但对人群和背景的报告不足限制了更全面的探索。我们建议未来的研究提供所涉及人群组的详细描述，并充分考虑理论基础和背景因素。
本实效主义综述的方案已在国际系统评价前瞻性注册库（PROSPERO CRD42016036768）中注册。
