背景:处于不利地位的人群(如来自少数族裔群体和具有社会复杂性的女性)面临的不良结果和经历的风险增加。健康结果的不平等包括早产,孕产妇和围产期发病率和死亡率,和低质量的护理。干预措施对这一人群的影响尚不清楚,在高收入国家(HIC)。该审查旨在确定和评估与HIC中有针对性的健康和社会护理服务干预措施有关的当前证据,这些干预措施可以改善育龄妇女和婴儿在不成比例的不良结果和经历风险中所经历的健康不平等。
方法:十二个数据库搜索了所有HIC的研究,从任何方法论设计。搜索于8/11/22结束。纳入标准包括针对弱势群体的干预措施,这些干预措施提供了不同于标准产妇护理的临床护理组成部分。
结果:纳入46项指标研究。国家包括澳大利亚,加拿大,智利,香港,英国和美国。进行了叙事综合,结果显示了三种干预类型:助产护理模式,跨学科护理,和以社区为中心的服务。这些干预类型已经单独提供,但也相互组合,展示了重叠的特征。总的来说,结果表明,干预措施与初级(孕产妇,围产期,和婴儿死亡率)和次要结果(经验和满意度,产前护理保险,获得护理,护理质量,交货方式,分娩镇痛的使用,早产,低出生体重,母乳喂养,计划生育,免疫)然而,意义和影响各不相同。助产护理模式采取了人际和整体的方法,因为他们专注于照顾者的连续性,家访,在文化和语言上适当的照顾和可及性。跨学科护理采取了结构性方法,协调对需要多机构健康和社会服务的妇女的护理。以社区为中心的服务采取了基于地方的方法,其干预措施适合其社区及其规范的需求。
结论:有针对性的干预措施存在于HIC中,但是这些根据标准产妇护理的背景和基础设施而有所不同。多干预方法可以增强针对高危人群的针对性方法,特别是将助产护理模式与以社区为中心的方法相结合,为了提高可访问性,较早的订婚,增加出勤率。
背景:PROSPERO注册号:CRD42020218357。
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.
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.
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.
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.
PROSPERO Registration number: CRD42020218357.