Could Participatory Maternal and Newborn Health Groups improve wellbeing in the UK?

Participatory Learning and Action for Maternal and Newborn Health (PLA-MNH) improves maternal and newborn health and reduces mortality. It does this through empowering communities in low and middle income countries to identify health barriers and implement local, feasible solutions.

With the support of Costello Medical, we are exploring whether PLA-MNH could be adapted for the UK to mitigate inequalities in maternal and neonatal health (MNH).

A recent study, led by Professor Monica Lakhanpaul and supported by the NIHR Applied Research Collaboration (ARC) North Thames, trialled PLA in East London to improve infant feeding, care and dental hygiene amongst South Asian children under 2 years old. The study reported promising results, suggesting PLA-MNH could be transferable to high-income settings. 

The inequalities in maternal and neonatal health are associated with intersectional factors including ethnicity, socioeconomic status and age, which affect access to and quality of care, as well as maternal and neonatal health outcomes.  

Through conducting focus groups and interviews with experts in community interventions and MNH, we have compiled the key factors to consider if PLA-MNH is adapted to a UK setting to address MNH inequalities. 

The key factors for adapting for the UK

The success of an MNH intervention relies on building trust within communities. Due to challenges individuals have faced whilst accessing healthcare, such as discrimination based on race, poverty, religion, and age, there can be a general distrust of government services among some people or communities.

To overcome this distrust, a trauma-informed approach should be taken, e.g. keeping women informed, respecting communication preferences, and ensuring tasks are completed as promised. 

It is crucial to collaborate with community gatekeepers and local organisations to facilitate the building of trust. They are embedded and well-trusted within communities, and will be able to support the recruitment of participants and ensure interventions are inclusive and meet community needs.  

When introducing an MNH intervention to a new community, the community gatekeepers and organisations contacted should represent the full range of cultures, religions and experiences in the community.  

The role of the facilitator is also pivotal for the success of an MNH intervention. The same facilitator should be used throughout the MNH intervention so they can build trust with the participants over time.

The facilitator also needs to be able to meet the community’s unique needs, such as having translational and first language speaking abilities, and an awareness of cultural sensitivities (such as taboo topics that participants might be hesitant to discuss).

Whilst being an attentive listener, the facilitator should also be able to steer discussions towards evidence-based practice.   

The organisers of an MNH intervention need to ensure facilitators receive suitable payment, as well as career progression opportunities and recognition for their work.  

The MNH intervention needs to be easily accessible to participants. For example, offering multiple dates and formats for participation (e.g. home visits and focus groups) to accommodate participants’ preferences and time constraints.

Interpreters and materials in multiple languages should be provided, and digital access issues should be addressed by using tools like virtual forums and WhatsApp.  

These findings emphasise the need for a community-led approach when considering interventions to improve MNH.

What’s Next

Given the co-development principles that PLA-MNH is based on, and the optimism from experts that PLA-MNH could meet the challenges currently faced by communities, we are hopeful that PLA-MNH would be suitable for implementation in a UK setting to mitigate inequalities in MNH.  

We are looking to build partnerships with local organisations, healthcare providers and representatives from the local integrated care board and public health teams.

If you would be interested in learning more about PLA-MNH and exploring potential partnerships, please contact us.  

Acknowledgements 

Thank you to the people who shared their thoughts and expertise during our focus groups and interviews:   

• Benash Nazmeen, Assistant Professor in Midwifery at University of Bradford 

• Hannah Rayment-Jones, Advanced Research Fellow and Midwife at Kings College London 

• Ima Miah, Asian Resource Centre Croydon, CEO 

• Jenny Gilmour, 0-19 Development Lead, previously Clinical Director at Integrated 0−19 Services Health Visiting & School Health and Wellbeing at Tower Hamlets GP Care Group 

• Julia Clark, Research Officer at Sands 

• Katherine Miller Brunton, Policy, Communications and Engagement Officer, Birth Companions 

• Laura Seebohm, Chief Executive of Maternal Mental Health Alliance  

• Mike Davies, Coordinator and Manager at Jigso Swansea 

• Rahima Ahad, Asian Resource Centre Croydon, Project Researcher  

• Rosie Murphy, Health Equalities Lead, Central London Community Healthcare NHS Trust