Rural maternal health interventions: A scoping review and implications for best practices.
Rachel D'Amico Gordon, Alyson Kishi, Jordyn A Brown, Christiane Voisin, Nicole Thomas, Sean R Riley, Naleef Fareed, Alicia Bunger, Shannon L Gillespie, Kartik K Venkatesh, Lisa Juckett, Seuli Bose Brill
Author Information
Rachel D'Amico Gordon: Department of Internal Medicine, Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, USA. ORCID
Alyson Kishi: The Ohio State University College of Medicine, Columbus, USA.
Jordyn A Brown: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Christiane Voisin: Department of Internal Medicine, Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, USA.
Nicole Thomas: Center for the Advancement of Team Science, Analytics, and Systems Thinking, The Ohio State University, Columbus, USA.
Sean R Riley: Department of Internal Medicine, Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, USA.
Naleef Fareed: Department of Biomedical Informatics, The Ohio State University, Columbus, USA.
Alicia Bunger: Department of Internal Medicine, Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, USA.
Shannon L Gillespie: Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, USA.
Kartik K Venkatesh: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University College of Medicine, Columbus, USA.
Lisa Juckett: Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, USA.
Seuli Bose Brill: Department of Internal Medicine, Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, USA.
PURPOSE: Maternal health outcomes in rural areas of the United States are persistently poor, with pregnant individuals in rural areas facing complex health care obstacles. Interventions adapted to the needs of rural patients are critical to mitigate worsening health disparities. To inform future efforts in this field, we conducted a scoping review, given the complex and diverse nature of existing interventions, to synthesize the literature on rural maternal health interventions, analyze mechanisms to improve care, and identify barriers and facilitators to intervention implementation. METHODS: We conducted a scoping review of peer-reviewed literature across six databases for maternal health interventions in rural populations. Relevant studies were analyzed for study setting, intervention type, impact on maternal health outcomes, and facilitation and barriers of intervention implementation mapped to the Consolidated Framework for Implementation Research. FINDINGS: We identified 64 studies published between 2010 and 2024 through comprehensive database searches relevant to our review. We determined six proposed mechanisms of action via thematic analysis across the pregnancy continuum: increased care connection, social support, care frequency, education, self-efficacy, and positive reinforcement. While the facilitators and barriers to implementation varied across the six themes, common facilitators included state-level buy in, integration of community partnerships, cultural humility in study design, and dedicated interdisciplinary teams. Common barriers included lapses in insurance, transportation difficulties, and communication challenges. CONCLUSIONS: Our review shares lessons that future interventions and policies can build upon to improve peripartum care for individuals living in rural communities. Further work is needed to address intersectional disparities in rural maternal health and ensure equitable implementation.
