Factors affecting take up of community based antenatal programmes in high income countries: a rapid realist review

• Problem Take up can be lower than expected, despite additional needs-targeted support, in health and wellbeing antenatal interventions aimed at specific populations. • What is Already Known Different models of antenatal provision can be delivered in the community, to engage those who may benefit from, but not otherwise access it. There is a gap in knowledge about how, why and in what contexts parents-to-be access programmes in high income countries. • What this Paper Adds Theories regarding different factors that impact on whether a parent-to-be accesses these programmes. Evidence that practitioners, especially midwives, play an important role in assuring parents-to-be about the value of provision. Information to support future research about the use of marketing and engaging via referral pathways. Highlights a gap in evidence about issues for parents-to-be who are not engaging in the community antenatal system. : Take up of antenatal programmes based in the community was lower than expected in a deprived UK case study area, despite targeted support. More understanding was required regarding why, to make effective changes. : Different models of antenatal programme can be delivered in community settings, to help improve the health of children from deprived areas. : To identify theories associated with how, why and in what contexts parents-to-be access community based antenatal programmes in high income countries, to increase service use . : Rapid Realist Review, incorporating initial review of national policy documents, reports, observations of antenatal pathway meetings, development of review programme theories with Reference Group support. Forty eight papers met the Review criteria and were included: 11 systematic reviews, meta-syntheses; realist reviews, protocols; 34 single studies; two dissertations, one grey literature article. Evidence identified gaps in knowledge to optimise attendance and highlighted the importance of health practitioners but details on impact were lacking. Several factors appeared to impact on access to antenatal support, specifically marketing and inclusivity, perceived candidacy for care, needs prioritisation, practitioner promotion of programmes, stereotypes of fathers’ roles, site accessibility, timings, transport, negativity with venues. : Mechanisms were not easily identified within the literature reviewed. Many papers and reports focussed on background and context. There was an absence of information on how programmes had been advertised, contact and referral processes. : This review found several factors that may encourage engagement with antenatal programmes. Further research is required to uncover mechanisms regarding access, or how practitioners can support these. Voices of those not engaging should be included, including those from White, Eastern European backgrounds and fathers/partners.