Understanding Experiences and Views of Community Antenatal Services v1

• Research type

  Research Study

• Full title

  Understanding Inequities in Accessing Antenatal Services: a realist evaluation of take up of community-based antenatal programmes (study 3: ethnography)

• IRAS ID

  287618

• Contact name

  Maria Bryant

• Contact email

  maria.bryant@york.ac.uk

• Sponsor organisation

  University of Leeds

• Duration of Study in the UK

  0 years, 7 months, 28 days

• Research summary

  Research Summary

  Background
  The Better Start Bradford (BSB) programme is a health intervention that offers a number of antenatal programmes to improve the health and wellbeing of local families. These are separate to standard clinical monitoring appointments. This additional provision aims to provide: parent education; social and emotional support; assistance with communication and language; help with diet and nutrition. Some programmes are well attended and others struggle to engage local families.

  This overall portfolio of research uses a realist approach and aims to understand what is impacting on take up of these programmes, who accesses them, in what circumstances and why. It will illustrate how different contexts may result in different outcomes, in terms of whether an expectant parent and their partner access this provision. It incorporates 3 steps:

  • Step 1: Development of initial programme theories via a rapid realist review, analysis of existing BSB data and systems mapping exercise
  • Step 2: Testing of theories via an ethnography of parents-to-be, and their interactions with staff who provide access to BSB services
  • Step 3: Refinement of programme theories and development of recommendations to increase take-up.

  This application is concerned with Step 2, the ethnography.

  Aim
  To test candidate programme theories associated with how, why and in what contexts parents-to-be access community based antenatal programmes.
  Design
  An ethnography will be undertaken, incorporating:

  -Observations of service users and interactions with staff in settings where women and their partners may be informed about BSB’s programmes, incorporating specific programme sessions; community centres; online social media pages*
  -Documentary review of BSB literature used in different settings to encourage BSB service uptake
  -Interviews with staff who give information out to expectant parents
  -Interviews with expectant parents
  -Participant observations with pregnant women
  -Diary entries from a sample of expectant parents about their experiences as users and nonusers of services.

  *Will also include Glucose Tolerance Test (GTT) clinics and midwifery booking appointments if current Covid-19 restrictions for non-clinical research at hospital sites are removed.

  Expected outcomes
  The study will result in refined theories about what is influencing access to provision, for which groups of people and why. It will help programmes to consider the needs of different groups of expectant parents.

  Summary of Results

  -Being asked questions about their lives helped women to feel listened to and understood. This also helped them to trust the practitioner and details they might have been given about local projects
  -There are other things that take priority in women’s lives because they need immediate attention (e.g.: living status; finances; supporting the health of other family members), leaving little time or resources to attend projects
  -It matters to women if venues feel familiar, so they know how to get there and what to expect from the venue
  -Women and their partners may not have the money for transport or the knowledge or confidence to arrange travel if a venue is not within easy walking distance
  -It is helpful for women to know they will be understood and supported at antenatal sessions and some may feel more comfortable knowing others with similar backgrounds and needs may also be there, as they may feel better understood
  -It is possible that some women may feel uncomfortable attending venues that also host other agencies, such as social services, because of a fear of other agencies interfering with their home life
  -A range of options for timings and formats of sessions (face-to-face and online), including evening slots, may increase the feeling that the community antenatal provision is ‘for them’
  -Practitioners and pregnant women said that comments from families and different people’s beliefs can influence whether women think antenatal projects are important or needed for their pregnancy
  -Health professionals, such as midwives are seen to be trustworthy and projects might be seen as worth attending if the midwife has judged it to be valuable
  -Practitioners who may have contact with a pregnant woman felt a specific time set aside to ask them about their lives and any needs and concerns they may have helped their relationship with them
  -Practitioners felt it was important to have specific time to give out information about what community antenatal projects are on in the local area and why these could help them with their individual needs and to answer any questions women may have about these"

• REC name

  Yorkshire & The Humber - Bradford Leeds Research Ethics Committee

• REC reference

  20/YH/0332

• Date of REC Opinion

  28 Jan 2021

• REC opinion

  Further Information Favourable Opinion