A team of peer volunteers will go door-to-door in ten of London’s most deprived wards to persuade pregnant women to start antenatal care before the 12th week of pregnancy. This matters because women from socially disadvantaged and ethnically diverse communities in the UK are far more likely to book late for antenatal care, or miss appointments entirely, and they also face higher rates of maternal and infant death and illness. The REACH programme tests two practical fixes: a community outreach campaign to boost early booking, and group-based antenatal classes (8 to 12 women due in the same month) as an alternative to one-on-one appointments. A third work package examines how to make maternity service user committees genuinely representative of the women they serve. If the trials succeed, the NHS could adopt a scalable model for reaching women who currently fall through the cracks. That would mean fewer emergency caesareans, fewer preterm births, and lower rates of low birth weight—concrete improvements in health outcomes for some of the UK’s most vulnerable mothers and babies.
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Aims and objectives We aim to generate high quality evidence on how to improve access to, and enhance the value and experience of, antenatal care (ANC) for socially disadvantaged and ethnically diverse women. We will conduct four work packages (WP) with the following research questions: WP1: What is the effectiveness and cost effectiveness of a community-based intervention for increasing early uptake of ANC and improving health outcomes? WP2: What are the optimum methods for testing the effectiveness of group-based ANC in an NHS setting serving populations with high levels of social deprivation and cultural, linguistic and ethnic diversity? WP3: What is the effectiveness and cost effectiveness of group-based antenatal care for improving health and safety outcomes for women and babies and satisfaction with ANC.? WP4: How can user involvement in planning, monitoring and improving maternity services be strengthened so that it is more effective and equitable? Background and rationale Inequalities in maternal and infant mortality and morbidity are a challenge for public health policy and service delivery in the UK. Antenatal care (ANC) can prevent adverse outcomes for both mothers and babies and has an important role in giving every child the best start in life. Effective approaches are needed to overcome the challenges in delivering accessible and engaging care, particularly in socially disadvantaged and ethnically diverse communities where there are high rates of late and irregular ANC uptake and large numbers of women with complex medical and social needs. Research plan WP1: Cluster randomized controlled trial (RCT) of a community intervention to increase early uptake of ANC The trial will aim to raise awareness of the value of early uptake of ANC for the health of women and children, and support women in how and when to access ANC. The intervention will be implemented in 10 wards throughout North East London and beyond into Essex and Hertfordshire. It will consist of: (i) training a group of peer volunteers to promote ANC through social networks; (ii) development and distribution of campaign materials; and (iii) community events to promote key messages. Each component will be developed using a community co-design process. The primary outcome will be the proportion of pregnant women who have started ANC by the end of the 12thweek of pregnancy, secondary outcomes will include: antenatal admissions, emergency caesarean; pre-term birth and low birth weight. WP2: A pilot study of group-based ANC The pilot trial will assess the feasibility of full trial methods, determine the most appropriate primary outcome and adapt group-based antenatal care for settings with high levels of ethnic diversity. WP3: An RCT of group-based ANC The trial will take place within the maternity services at Barts Health NHS Trust. ANC in the intervention arm will be delivered in groups of 8 to 12 women who have expected delivery dates within the same month. Primary and secondary outcomes will include maternal and infant health and safety outcomes; satisfaction with care will be a secondary outcome. Outcomes will be measured via validated instruments. WP4: Strengthening effective and equitable user involvement in maternity services This WP involves: a) Systematic review to investigate what is known about strategies to engage underserved groups of women in improving maternity services; b) a web-based national survey of all (n= 152) Maternity Service Liaison Committees (MSLCs) to assess the strategies used to support effective and equitable user involvement; c) support to three local MSLCs to strengthen their user involvement; and d) co-develop and disseminate a practical e-handbook on equitable and effective user involvement in maternity services. Dissemination & projected outputs The findings will be presented at national/international conferences, published in peer reviewed and practitioner journals and reported as briefing papers to
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