Figure 1
PRISMA flow diagram.
Table 1
Summarized aims, methods, and findings of all included studies.
| NR. | REFERENCE | AIM | METHODS | PARTICIPANTS AND SETTING | RESULTS RELATING TO CONTINUITY OF CARE |
|---|---|---|---|---|---|
| 1. | Barimani and Hylander (2012) | To investigate strategies to improve continuity of care for expectant and new mothers and to elaborate on a preliminary substantive grounded theory model of “linkage in the chain of care” which was developed by Barimani and Hylander in 2008. | Data collection: structured interviews, participant observation and document analysis Sample: theoretical | Mothers who visited a family health centre with clear collaboration policies (n = 11) Mothers who visited a medical centre without such policies (n = 10) Country: Sweden | Midwives and CHC professionals working in the same building does not guarantee collaboration. Mothers clearly notice when CHC professionals and midwives work as a team and are very positive about teamwork. Mothers appreciate to have both a pre- and postnatal relationship with both midwife and CHC professional. Collaborative home visits were highly appreciated as well as joined policies and breastfeeding support. Continuity of care policies seem to lead to a more positive care experience. |
| 2. | Barimani et al. (2015) | To explore ways in which parents experience support from health professionals in the early postpartum period and understand how parenting support is related to management, informational, and relational continuity. | Data collection: Focus group interviews Sample: convenience | Mothers (n = 18) and fathers (n = 16) between 20–46 years of age form urban area with one or more children, whose youngest child is ≤ 1 year old. Country: Sweden | With regard to management continuity parents value: receiving consistent advice, knowing who to ask questions regarding care, getting access to care when needed, feeling confident on various pathways and being involved in discharge planning. With regard to informational continuity parents value: receiving consistent information about self-management for both mother and baby and being was valued. Regarding relational continuity parents value: team or clinic care consistency, trust in a specific person, interest in mother from CHC, inter-pregnancy continuity of carer and later withdrawal of midwifery care and earlier introduction of the CHC were valued. |
| 3. | Vikström and Barimani (2016) | To explore (i) ways in which partners experienced support from care systems before, during, and after childbirth in relation to their parenting roles and (ii) their suggested ways to improve postnatal support. | Data collection: focus groups Sample: convenience | Partners of mothers who had given birth in a Swedish hospital, with one or more children, whose youngest child is ≤ 1 year old who read and speak Swedish (n = 17). Country: Sweden | Follow-up appointments with the postnatal care unit provide a sense of security. However, the postnatal care unit only felt accessible to the participants during the first week after the birth. After being discharged parents feel child health and medical care are prioritized most. (Mental) care for the partners is missed. Conflicting advice (specifically about breastfeeding) given by health care providers creates uncertainty. Partners might also benefit from follow up, such as routine mental screening. |
| 4. | Woodward, Zadoroznyj, Benoit (2016) | To provide qualitative insights into women’s experiences of the different forms of postnatal care in the community, and identify where improvements could be made to service provision. | Data collection: semi structured interviews Sample: purposive | Mothers whose youngest child is ≤ 1 year old, who have used one of the different postnatal services in Australia (n = 15). Country: Australia | It is import for mothers to know what follow up will look like and where they will be able to find support. When this lacks, mothers experience a gap in care. Structured postnatal follow-up provides parents with information, reassurance and confidence. Continuity of relationships is important for mothers to build trust. Mothers would appreciate women-centred care, also after birth. Antenatal care is felt to be more women-centred than care provided at the CHC clinic. Mothers will seek support elsewhere (pharmacy or GP) when they feel the care at the CHC clinic lacks. |
| 5. | Franck, McNulty and Alderdice (2017) | To discover parents’ views, experiences, concerns, and recommendations about the care provided to them and their babies throughout the perinatal and neonatal healthcare journey in a UK context. | Data collection: focus groups Sample: convenience | Mothers (n = 33) and fathers (n = 7) of babies who received care in 1 of the 7 NICUs in Northern Ireland within the past 3 years. Country: Northern Ireland | Mother and child being discharged at different times can lead to problems with follow-up care. Going home after being in the NICU environment can be a scary transition. Parents feel they have become dependent on care personnel to care for their baby. Feeling excluded from decision making or lacking access to information about child care negatively impacts parents and their relationship with their child. Mental health issues can present themselves after post discharge support services have been withdrawn. Participants are distressed by a lack of continuity of carer, incomplete transfers of information and inconsistencies in information and care practices. After leaving the NICU parents could feel discouraged to contact the NICU when problems occurred. CHC professional and communal midwifes sometimes lack specific knowledge about the growth and care of premature babies and lacked confidence in care for them. Parents would like better access to a community midwife or health visitor, when they get home from the NICU. |
| 6. | Aquino, Olander and Bryar (2018) | To explore women’s (i) experiences of maternity care as collaboratively provided by midwives and CHC professionals, and (ii) their perspectives of how their maternity care can best be provided by these healthcare professionals together. | Data collection: focus groups Sample: convenience | Mothers ≥ 18 years of age with a child ≤ 18 months old who read and speak English (n = 12). Country: England | Mothers observe there was little to no contact between the midwife and the CHC professional. Disagreements between care providers harms confidence in care professionals. In the ideal maternity care pathway the CHC professional is introduced prenatally and the midwife provides care until first month after birth. Continuity of carer is valued, but it is acknowledged it might not be realistic. Centralized records, joint appointments and classes would be appreciated. Clarity on the roles and tasks of health care providers, specifically the public health nurse would be valued. |
| 7. | Olander et al. (2019) | To explore recent mothers’ experiences and views of the continuity of information shared and provided by midwives and CHC professionals during and after pregnancy. | Data collection: semi-structured interviews Sample: convenience | Mothers ≥ 18 years of age who have had a baby within 12 months prior to the interview, read and speak English and have had antenatal and postnatal care (n = 29). Country: England | What information is shared between the midwife and the CHC professional, and how is unclear to mothers, who sometimes doubt any information sharing occurs. Mothers are often positive about information sharing. Sharing sensitive information with the CHC clinic is sometimes feared however, due to their (perceived) role as ‘frontline social service’. Having to repeat information is often disliked, especially about traumatic experiences. However, storytelling can also be a way to get to know a healthcare provider. Flexible, individualized care and teamwork are highly valued by the participants. Joint working, training and development of guidelines are suggested as possible solutions to increase continuity of information. |
| 8. | Olander, Aquino and Bryar (2019) | To explore midwives,’ CHC professionals and postnatal women’s experiences and views of co-location of midwifery and health visiting services and collaborative practice. | See previous article (same study). | See previous article (same study). | Not all respondents were convinced of the importance of service co-location. Service integration was deemed more important. Midwives and CHC professionals were viewed as having different roles and functioning separately. Possible benefits to co-location could be reducing how often parents need to repeat information and reducing the amount of conflicting advice. Only having to go to one place for all care could also be beneficial for those in difficult social circumstances as it can be more convenient and cheap. It also creates a place to meet other parents. |
| 9. | Forss, Mangrio and Hellström (2022) | To illuminate first-time parents’ experience of a home visit conducted by a midwife and a child health care nurse 1–2 weeks postnatal. | Data collection: semi-structured interviews Sample: convenience | First time mothers (13) and fathers (12) who participated in a new combined home visit program. Country: Sweden | It was important to have the known midwife at the home visit. The combined interprofessional knowledge base of the midwife and the CHC nurse made parents feel secure and ensured the needs of the whole family were met. The great availability of the professionals made parents feel secure. Having the CHC professional visit at home creates the possibility to spot possible safety hazards and was found convenient. Mothers and fathers had different needs and appreciated the possibility to discuss their specific concerns with both professionals. |
| 10. | Frederiksen, Schmied, Overgaard (2022) | To explore the role of continuity of care in creating a coherent care journey for vulnerable parents during pregnancy and the postnatal period. | Data collection: observation and informal semi-structured interviews Sample: purposive | Mothers (n = 26) and partners (n = 13) who: expect a child or have recently given birth, reside in the municipality under study, speak Danish, and receive high level services due to one or more vulnerability factors. Country: Denmark | Getting to know professionals over time is valued, facilitates reaching out for support and being honest about challenges and provides a sense of security. Meeting new professionals can be scary due to a fear of judgement and stigmatization. Continuity of carer and information transfer allow for more individualized care. A non-judgemental and supportive approach thus allows parents to feel secure with professionals they do not know. Transfer of information enables parents to experience a degree of coherence in their journey and prevents parents from having to repeat information, which can be demanding. Parents should be ensured which information is transferred as knowing information is transferred can make them feel more secure. However, handover of information (to social services) can also be experienced as risky. Care systems need to be flexible and adaptable to meet the fluctuating care needs of parents and prevent gaps in care. To ensure coherent care it is paramount that parents receive timely, flexible and relevant services that match their current needs for support. |
Table 2
Parent-reported issues complicating continuous care, based on reviewed papers.
| DURING PREGNANCY | WITHDRAWING MATERNITY CARE | TRANSFERRING CARE BETWEEN PROVIDERS | BEING AT HOME IN BETWEEN SCHEDULED APPOINTMENTS | THE APPOINTMENTS AT THE CHC CLINIC | THE MATERNITY CARE FOLLOW- UP |
|---|---|---|---|---|---|
|
|
|
|
|
|
Table 3
Partent-reported helpful practices promoting continuous care, based on reviewd papers (references 23–32).
| DURING PREGNANCY | WHEN WITHDRAWING MATERNITY CARE | WHEN TRANSFERRING CARE BETWEEN PROVIDERS | IN BETWEEN SCHEDULED APPOINTMENTS | DURING APPOINTMENTS AT THE CHC CLINIC | DURING THE MATERNITY CARE FOLLOW-UP | LONG TERM ORGANIZATIONAL REFORM | |
|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
|