Barriers and Facilitators in Rural Maternal Care: An Integrative Review
Keywords:
rural maternal care, patient autonomy, patient-centered care, shared decision-makingAbstract
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.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Tammy F. Hall, PhD, RN, RDMS, Audrey Snyder, PhD, RN, CCRN, CEN, ANCP-BC, FNP-BC, FAANP, FAEN, FAAN
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share (for non-commercial purposes) the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
