Evidence map›Paper›PMID 41381192›Full record

Trial reportJournal of epidemiology and community health2026

Co-designed and co-delivered place-based community interventions to reduce inequity in early initiation of antenatal care: findings from the cluster randomised controlled community REACH trial.

Angela Harden, Meg Wiggins, Lorna Sweeny, Mary Sawtell, Cathryn Salisbury, Thomas Hamborg, Sandra Eldridge, Lauren Greenberg, Rachael Maree Hunter, Ekaterina Bordea and 10 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of epidemiology and community health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Angela HardenCity St George's, University of London, London, UK angela.harden@city.ac.uk.ORCID http://orcid.org/0000-0002-8621-5066
Meg WigginsSocial Research Institute, UCL, London, UK.ORCID http://orcid.org/0000-0003-1443-2456
Lorna SweenyCity St George's, University of London, London, UK.
Mary SawtellSocial Research Institute, UCL, London, UK.
Cathryn SalisburyCity St George's, University of London, London, UK.
Thomas HamborgPragmatic Clinical Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
Sandra EldridgeWolfson Institute of Population Health, Queen Mary University of London, London, UK.
Lauren GreenbergRegion Hovedstaden, Hillerod, Denmark.
Rachael Maree HunterDepartment of Primary Care and Population Health, UCL, London, UK.
Ekaterina BordeaUCL, London, UK.
Christine McCourtCentre for Maternal and Child Health, City St George's, University of London, London, UK.
Bethan HatherallCity St George's, University of London, London, UK.
Gail FindlayUniversity of East London, London, UK.
Adrian RentonUniversity of East London, London, UK.
Ruth AjayiCity St George's, University of London, London, UK.
Ceri DurhamSocial Action for Health, London, UK.
Adewale AdeyemoNorth Middlesex University Hospital NHS Trust, London, UK.
Belinda HarveyPrincess Alexandra Hospital NHS Trust, Harlow, UK.
Kade MondehBarts Health NHS Trust, London, UK.
Logan VanLessenWhittington Health NHS Trust, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEarly initiation of antenatal care provides timely screening, advice and support. Inequities in early care initiation exist in high-income countries, but there is scant evidence on effective interventions. The community REACH (Research for Equitable Antenatal Care and Health) trial aimed to assess the effectiveness of co-produced place-based interventions to strengthen community support for early care initiation.

methodsMatched-pair cluster randomised trial in socially disadvantaged and ethnically diverse areas in England. Electoral wards with low rates of early care initiation were matched and randomly allocated to intervention or control (usual care) (n=10 pairs). Following a 3-month co-design phase, community organisations and volunteers in intervention sites conducted targeted outreach activities over 6 months. The primary outcome was initiation of antenatal care by the 12th completed week of pregnancy.

resultsThere was no evidence of a difference in the primary outcome (OR 1.07, 95% CI 0.89 to 1.28). There were also no statistically significant differences in rates of emergency caesarean, preterm birth, low birth weight, smoking or breastfeeding. There was a higher rate of care initiation by 10 weeks and fewer antenatal admissions in the intervention arm during the intervention period, although differences were not sustained after it finished.

conclusionThis rigorous evaluation found a limited impact of short-term place-based interventions to strengthen community support for early initiation of antenatal care. Future initiatives may benefit from embedding in integrated health and care structures to ensure sufficient time and resources for mobilisation of community assets and focusing on smaller 'hyper-local' neighbourhoods. Actions to tackle wider structural and organisational barriers are also needed. TRIAL REGISTRATION NUMBER: ISRCTN registry: registration number 63066975. Registered on 18 August 2015.

Indexed as

Healthcare DisparitiesPrenatal CareAdultCluster AnalysisEnglandFemaleHumansPregnancyYoung AdultHealth inequalitiesHEALTH SERVICESPREGNANCY

Identifiers

PMID41381192
PMCPMC13018804

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.