AIM: This review sought to ascertain which features of antenatal models promote better outcomes among Indigenous pregnant women living in rural areas. METHODS: Four databases were searched, and then peer-reviewed research comparing models of antenatal care were critically appraised and themes identified. RESULTS: Twenty-nine articles met inclusion criteria and were of acceptable methodological quality for data extraction and analysis. Three main themes around service structure, accessibility and environment emerged, which were broken down into 17 subthemes. Most studies emphasised the importance of involving Indigenous elders and family, as well as Indigenous and female staff, to build community-based and controlled antenatal care, resulting in more holistic and culturally safe practices. A focus on communication, relationship-building and development of trust improved levels of preventative healthcare, risk screening, past negative experiences addressed and health education. In addition to conventional clinical care, home visiting, outreach programmes and quality-improvement approaches (CQI) proved vital for accessibility, engagement and overall model success. CONCLUSION: Successful models of antenatal care for Indigenous women living rurally are those created, managed and run by the community, and should have a focus on culturally safe communication, relationship-building, preventative healthcare and education. PRACTICE IMPLICATIONS: These findings can inform the development of evidence-based, culturally safe antenatal models of healthcare at clinical and policy level, in partnership with and for rural Indigenous women; as well as guide funding and work personnel allocation.
Anderson et al. (Mon,) studied this question.