Co-designed and co-delivered place-based community interventions to reduce inequity in early initiation of antenatal care: findings from the cluster randomised controlled community REACH trial

作者：Angela Harden, Meg Wiggins, Lorna Sweeny, Mary Sawtell, Cathryn Salisbury, Thomas Hamborg, Sandra Eldridge, Lauren Greenberg, Rachael Hunter, Ekaterina Bordea, Christine McCourt, Bethan Hatherall, Gail Findlay, Adrian Renton, Ruth Ajayi, Ceri Durham, Adebowale Adeyemo, Belinda Harvey, Kade Mondeh, Logan Vanlessen · 发表于：Journal of Epidemiology & Community Health · 年份：2025 · DOI：10.1136/jech-2024-223248 · 被引用次数：2 · 研究领域：Infant Development and Preterm Care、Health Policy Implementation Science、Interprofessional Education and Collaboration

BACKGROUND: Early initiation of antenatal care provides timely screening, advice and support. Inequities in early care initiation exist in high-income countries, but there is scant evidence on effective interventions. The community REACH (Research for Equitable Antenatal Care and Health) trial aimed to assess the effectiveness of co-produced place-based interventions to strengthen community support for early care initiation. METHODS: Matched-pair cluster randomised trial in socially disadvantaged and ethnically diverse areas in England. Electoral wards with low rates of early care initiation were matched and randomly allocated to intervention or control (usual care) (n=10 pairs). Following a 3-month co-design phase, community organisations and volunteers in intervention sites conducted targeted outreach activities over 6 months. The primary outcome was initiation of antenatal care by the 12th completed week of pregnancy. RESULTS: There was no evidence of a difference in the primary outcome (OR 1.07, 95% CI 0.89 to 1.28). There were also no statistically significant differences in rates of emergency caesarean, preterm birth, low birth weight, smoking or breastfeeding. There was a higher rate of care initiation by 10 weeks and fewer antenatal admissions in the intervention arm during the intervention period, although differences were not sustained after it finished. CONCLUSION: This rigorous evaluation found a limited impact of short-term place-based interventions to strengthen...