BackgroundAntenatal care is the first step in providing maternity services to pregnant women. It is recommended that antenatal care begins early in pregnancy so that women can be supported to have a healthy pregnancy and birth. Positive experiences with antenatal care are also very important for women to get the full benefits from care. The REACH Pregnancy Programme [Research for Equitable Antenatal Care and Health] aims to generate high quality evidence on how to improve access to antenatal care, and enhance the value and experience of the care that is received, for pregnant women living in areas with high levels of poverty and high ethnic diversity. It is a five-year programme of research, funded by the National Institute for Health Research. The programme is jointly led by Barts Health NHS Trust and the University of East London, in collaboration with other academic and service partners.
The research programme contains three main parts, summarised below:
(i) Pregnancy Circles
One package of work will evaluate group-based antenatal care at the maternity services of Barts Health NHS Trust. Group-based antenatal care involves offering a care arrangement where women acquire their antenatal care in a group context with 8-12 other women at the same stage of pregnancy. The clinical content of the care and schedule of appointments remains the same as the usual arrangement, but the group-based model involves an additional “reunion” session approximately one month postnatally. Each group session is facilitated by the same two midwives, who have participated in learning opportunities in group facilitation. The sessions involve information sharing, self-care activities, and brief one-to-one sessions with a named midwife for individual health checks.
We conducted a feasibility study of group-based antenatal care. Phase 1 involved (i) interviewing key members of staff working with/in the Trust maternity services to identify barriers and facilitators to implementing this model of care within the service, and (ii) conducting workshops with local women to explore their opinions of the proposed group-based care. As part of our feasibility work we also conducted a realist review of the international literature on the implementation of group-based antenatal care. Findings from the feasibility Phase 1 have been used to develop a tailored group model of antenatal care (Pregnancy Circles). Four ‘test’ groups are currently ongoing in each of the three Barts Health maternity services.
A pilot trial of Pregnancy Circles will be conducted within the maternity services of Barts Health NHS Trust to assess the feasibility of full trial methods, and determine the most appropriate outcomes to measure in order to examine effectiveness. We will conduct a full RCT with approx. 2,000 women. We expect to examine effectiveness through (i) maternal and infant health and safety outcomes, and (ii) satisfaction with care. Focus groups and interviews will also be conducted with midwives and women participating in the intervention, to better understand the benefits and challenges of this model.
(ii) The Community REACH study
Another package of work will examine the effectiveness and cost-effectiveness of a community-centred intervention to engage women in valuing early uptake of antenatal care, and to support women in how to access appropriate care. We are working in partnership with local communities and community organisations across North and East London, and Essex, to develop intervention messages, and to communicate and deliver the intervention messages, through a trained network of local peer volunteers. The intervention will be evaluated through a cluster randomised controlled trial, with integrated process and economic evaluations. Six NHS Trusts are participating in this study and routine data from the maternity services of these Trusts will be analysed to determine whether the intervention was effective in increasing early initiation of ANC, and whether the intervention also had any impact on antenatal, maternity and infant outcomes.
(iii) Strengthening service user involvement in maternity services
This package of work involves:
- A systematic review of strategies to support effective and representative service user involvement in the planning, monitoring and improvement of maternity services
- A web-based national survey of all (n= 152) Maternity Service Liaison Committees (MSLCs) to assess the strategies used to support effective and representative user involvement;
- Support to three local MSLCs to strengthen their user involvement
- Co-development and dissemination of a practical e-handbook on representative and effective user involvement in maternity services.
- Haora P, Da Motta G, Harden A, Kaur I, McCourt C, Rayment J, Wiggins M (2016) “An ‘Integrated’ Realist Review: Informing Service Innovation in Maternity Care”, 2nd International Conference on Realist Evaluation & Synthesis, Conference Proceedings; 2nd -5th October, Centre for the Advancement of Realist Evaluation & Synthesis (CARES), University of Liverpool, London.
- Wiseman O, Da Motta G, Rayment J, McCourt C, Haora P, Kaur I, Wiggins M, Sawtell M, Syed A & Harden A on behalf of the REACH Pregnancy Programme Team (2016) “The feasibility of setting up group antenatal care (‘Pregnancy Circles’) in an area of high socio-economic, linguistic and ethnic diversity”, Royal College of Midwives (RCM) Annual Conference Proceedings, 19th -20th October, Harrogate, Yorkshire.
- Salisbury C; Harden A; Findlay G; Sweeney L; Wiggins M; Sawtell M; Sheridan K; on behalf of the REACH Pregnancy Programme Team (2016) “Using a co-design approach to reduce health inequalities: a process evaluation of a community intervention to promote early initiation of antenatal care”, Faculty of Public Health Annual Conference, 14th -15th June, Brighton Centre, Brighton.
- Sweeney, L., Sawtell, M., Wiggins, M., Salisbury, C. & Harden A, on behalf of the REACH Pregnancy Programme Team (2016) “Community REACH: A community-centred intervention to increase early uptake of antenatal care”, International Health Conference, 22nd June King's College London;
- Haora P, Rayment J, McCourt C, Falvey-Browne C, Castro Cardona F, Kaur I, Harden A, on behalf of the REACH Pregnancy Programme Team (2015) “The REACH Pregnancy Programme: A Feasibility Study, Pilot and Randomised Controlled Trial of a Local Model of Group Antenatal Care in East London - Work in Progress”, 10th Normal Labour & Birth Research Conference, 15th- 17th June 2015, Grange-Over-Sands, UK.
Professor Angela Harden (University of East London; Barts Health NHS Trust)
Project Co-Investigators: Professor Adrian Renton (University of East London), Sandra Reading (Barts Health NHS Trust), Professor Sandra Eldridge (Queen Mary University of London), Professor Khalid Khan (Queen Mary University of London), Meg Wiggins (University College London Institute of Education), Professor Christine McCourt (City University of London), Rachael Hunter (University College London), Dr Joanne Morris (Barts Health NHS Trust), Dr Bethan Hatherall (University of East London), Ruth Adekoya (London Local Supervising Authority), Ceri Durham (Social Action for Health)
Researchers: Mary Sawtell (University College London Institute of Education), Dr Lorna Sweeney (University of East London), Dr Penny Haora (University of East London), Octavia Wiseman (University of East London), Helliner Robinson (Barts Health NHS Trust), Cathryn Salisbury (PhD student at University of East London), Giordana Da Motta (City University of London)
Funder: The REACH Pregnancy Programme is funded by the National Institute for Health Research’s Programme Grants for Applied Research Programme (Programme Reference Number RP-PG-1211-20015). http://www.nihr.ac.uk/Project Partners: Institute for Health and Human Development, University of East London; Barts Health NHS Trust; City University of London; University College London Institute of Education; Pragmatic Clinical Trials Unit, Queen Mary University of London; University College London; Whittington Health NHS Trust; Princess Alexandra Hospital NHS Trust; North Middlesex University Hospital NHS Trust; Homerton University Hospital NHS Trust; University College London Hospitals NHS Trust
For more information, contact:
Lorna Sweeney (Research Fellow, IHHD, UEL) e: L.Sweeney@uel.ac.uk t: 020 8223 4797