Health engagement: a systematic review of tools modifiable for use with vulnerable pregnant women

ObjectiveTo examine available health engagement tools suitable to, or modifiable for, vulnerable pregnant populations.DesignSystematic review.Eligibility criteriaOriginal studies of tool development and validation related to health engagement, with abstract available in English, published between 2000 and 2022, sampling people receiving outpatient healthcare including pregnant women.Data sourcesCINAHL Complete, Medline, EMBASE and PubMed were searched in April 2022.Risk of biasStudy quality was independently assessed by two reviewers using an adapted COSMIN risk of bias quality appraisal checklist. Tools were also mapped against the Synergistic Health Engagement model, which centres on women's buy-in to maternity care.Included studiesNineteen studies were included from Canada, Germany, Italy, the Netherlands, Sweden, the UK and the USA. Four tools were used with pregnant populations, two tools with vulnerable non-pregnant populations, six tools measured patient-provider relationship, four measured patient activation, and three tools measured both relationship and activation.ResultsTools that measured engagement in maternity care assessed some of the following constructs: communication or information sharing, woman-centred care, health guidance, shared decision-making, sufficient time, availability, provider attributes, discriminatory or respectful care. None of the maternity engagement tools assessed the key construct of buy-in. While non-maternity health engagement tools measured some elements of buy-in (self-care, feeling hopeful about treatment), other elements (disclosing risks to healthcare providers and acting on health advice), which are significant for vulnerable populations, were rarely measured.Conclusions and implicationsHealth engagement is hypothesised as the mechanism by which midwifery-led care reduces the risk of perinatal morbidity for vulnerable women. To test this hypothesis, a new assessment tool is required that addresses all the relevant constructs of the Synergistic Health Engagement model, developed for and psychometrically assessed in the target group.PROSPERO registration numberCRD42020214102.

Automated summary

The objective of this study was to examine health engagement tools suitable for vulnerable pregnant populations. A systematic review was conducted on original studies from 2000 to 2022 related to tool development and validation. The results showed that existing maternity engagement tools focused on communication, woman-centred care, and shared decision-making, but did not assess the key construct of buy-in. Therefore, a new assessment tool is needed to address the health engagement needs of vulnerable pregnant women.