Barriers and Facilitators in Rural Maternal Care: An Integrative Review

Abstract

Objective: To answer the following questions: (1) What is the existing evidence on rural maternity care and shared decision making, and (2) what are the knowledge gaps and directions for future research?

Methods: The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal tool.

Data Sources: With librarian support, searches were conducted in PubMed, CINAHL, PsycINFO, and ProQuest. Filters limited results to English-language, full-text publications from January 2019 to January 2026.

Study Selection: The search identified 1,186 research studies. After removing duplicates, the citation mining of six articles and screening, 54 full texts were reviewed; 29 were excluded, leaving 25 studies included in the review.

Data Extraction: Of the 25 studies, 20 (75%) used quantitative, 2 (8%) qualitative, and 3 (12%) mixed methods. Major themes included maternity care deserts, hospital closures, distance to maternity care, insurance, telehealth, social determinants of health, severe maternal morbidity and mortality (SMMM), and shared decision making (SDM) or relational care.

Data Synthesis: Barriers such as hospital closures, maternity care deserts, and travel distances worsened maternal outcomes. Insurance instability, under-reimbursement, and workforce shortages further limited access. Telehealth showed promise but was constrained by broadband gaps. Social drivers compounded risks, with rural Black, Indigenous, and People of Color (BIPOC) experiencing the poorest outcomes. Studies addressed SDM, though continuity of care, relationships, and communication were emphasized.

Conclusions: Improving rural maternal patients’ access to high-quality care is necessary to decrease the risk of SMMM. Nurses promote patient-centered communication, evidence-based interventions, and address social drivers of health through education and advocacy. Expanding the SDM evidence base in rural maternity care will strengthen nursing’s role in engagement, empowerment, and health equity.

DOI:  https://doi.org/10.14574/ojrnhc.v26i1.814