The 'active ingredients' for successful community engagement with disadvantaged expectant and new mothers: a qualitative comparative analysis.
OBJECTIVE
To explore which conditions of community engagement are implicated in effective interventions targeting disadvantaged pregnant women and new mothers.


BACKGROUND
Adaptive experiences during pregnancy and the early years are key to reducing health inequalities in women and children worldwide. Public health nurses, health visitors and community midwives are well placed to address such disadvantage, often using community engagement strategies. Such interventions are complex; however, and we need to better understand which aspects of community engagement are aligned with effectiveness.


METHODS
Qualitative comparative analysis conducted in 2013, of trials data included in a recently published systematic review.


METHODS
Two reviewers agreed on relevant conditions from 24 maternity or early years intervention studies examining four models of community engagement. Effect size estimates were converted into 'fuzzy' effectiveness categories and truth tables were constructed. Using fsQCA software, Boolean minimization identified solution sets. Random effects multiple regression and fsQCA were conducted to rule out risk of methodological bias.


RESULTS
Studies focused on antenatal, immunization, breastfeeding and early professional intervention outcomes. Peer delivery (consistency 0·83; unique coverage 0·63); and mother-professional collaboration (consistency 0·833; unique coverage 0·21) were moderately aligned with effective interventions. Community-identified health need plus consultation/collaboration in intervention design and leading on delivery were weakly aligned with 'not effective' interventions (consistency 0·78; unique coverage 0·29).


CONCLUSIONS
For disadvantaged new and expectant mothers, peer or collaborative delivery models could be used in interventions. A need exists to design and test community engagement interventions in other areas of maternity and early years care and to further evaluate models of empowerment.
EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, UK; Cambridge University Hospitals NHS Foundation Trust, UK.
Ginny
G
Brunton
Alison
A
O'Mara-Eves
James
J
Thomas
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D019058:Community Networks; D003299:Cooperative Behavior; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland; D008297:Male; D016389:Maternal-Child Nursing / Q000379:methods; D008875:Middle Aged; D008960:Models, Psychological; D009035:Mothers / Q000523:psychology*; D010358:Patient Participation / Q000379:methods; D011209:Power, Psychological; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011637:Public Health Nursing / Q000379:methods; D036301:Qualitative Research; D012944:Social Support; D013315:Stress, Psychological / Q000517:prevention & control*; D006113:United Kingdom; D014481:United States; D035862:Vulnerable Populations / Q000523:psychology*; D055815:Young Adult
community; health visiting; maternity nursing; patient participation; public health nursing; qualitative approaches