Open access Original research

Self-­care interventions for

preconception, antenatal, intrapartum
and postpartum care: a scoping review
Phi-­Yen Nguyen  ‍ ‍,1,2 Cassandra Caddy,2 Alyce N Wilson,2 Kara Blackburn,2
Matthew J Page  ‍ ‍,3 A Metin Gülmezoglu  ‍ ‍,4 Manjulaa Narasimhan,5
Mercedes Bonet,5 Özge Tunçalp,5 Joshua P Vogel  ‍ ‍2

To cite: Nguyen P-­Y, Caddy C, ABSTRACT

Wilson AN, et al. Self-­care Objective  To identify current and emerging self-­care
STRENGTHS AND LIMITATIONS OF THIS STUDY
interventions for preconception, interventions to improve maternity healthcare. ⇒ Mapping all potential self-­care practices across the
antenatal, intrapartum spectrum of pregnancy care, from preconception,
Design  Scoping review.
and postpartum care: a antenatal, intrapartum to postnatal care.
scoping review. BMJ Open Data sources  MEDLINE, Embase, EmCare, PsycINFO,
Cochrane CENTRAL/CDSR, CINAHL Plus (last searched on ⇒ Use of the new WHO self-­care classification system
2023;13:e068713. doi:10.1136/
bmjopen-2022-068713 17 October 2021). to organise and categorise findings.
Eligibility criteria  Evidence syntheses, interventional ⇒ Not screening for primary studies reported within an
► Prepublication history and included evidence synthesis.
or observational studies describing any tool, resource or
additional supplemental material ⇒ Not including interventions that took place after 42
for this paper are available strategy to facilitate self-­care in women preparing to get
pregnant, currently pregnant, giving birth or post partum. days post partum, or those that related primarily to
online. To view these files,
Data extraction/synthesis  Screening and data collection care of newborns and breast feeding (which should
please visit the journal online
(http://dx.doi.org/10.1136/​ were conducted independently by two reviewers. Self-­ require dedicated reviews).
bmjopen-2022-068713). ⇒ Search limited to published reports and reports writ-
care interventions were identified based on predefined
ten in English only.
criteria and inductively organised into 11 categories.
Received 27 September 2022
Characteristics of study design, interventions, participants
Accepted 14 April 2023
and outcomes were recorded.
Results  We identified eligible 580 studies. Many BACKGROUND
included studies evaluated interventions in high-­income Self-­care is defined by the WHO as ‘the ability
countries (45%) and during antenatal care (76%). Self-­ of individuals, families and communities to
care categories featuring highest numbers of studies promote health, prevent disease, maintain
were diet and nutrition (26% of all studies), physical health, and to cope with illness and disability
activity (24%), psychosocial strategies (18%) and other with or without the support of a health
lifestyle adjustments (17%). Few studies featured self-­ worker’.1 Self-­ care may include, but is not
care interventions for sexual health and postpartum limited to, health literacy, self-­awareness of
family planning (2%), self-­management of medication physical and mental health, physical activity,
(3%) and self-­testing/sampling (3%). Several venues healthy eating, good hygiene and rational
© World Health Organization to introduce self-­care were described: health facilities
2023. Licensee BMJ. use of medicines and diagnostics.2 By exten-
(44%), community venues (14%), digital platforms (18%),
1
Methods in Evidence Synthesis sion, self-­care interventions are those that
partner/peer support (7%) or over-­the-­counter products
Unit, Monash University, can support or promote people’s self-­care.3
(13%). Involvement of health and community workers
Melbourne, Victoria, Australia
were described in 38% and 8% of studies, who supported
Self-­
care interventions can act to comple-
2
International Development, ment or even broaden delivery of health
Burnet Institute, Melbourne, self-­care interventions by providing therapeutics for home
Victoria, Australia use, training or counselling. The most common categories services, ideally improving health outcomes
3
School of Public Health and of outcomes evaluated were neonatal outcomes (eg, birth and care experiences.4 5 Humanitarian crises,
Preventive Medicine, Monash weight) (31%), maternal mental health (26%) and labour emergencies and pandemics introduce addi-
University, Clayton, Victoria, outcomes (eg, duration of labour) (22%). tional challenges to the provision of routine
Australia
4
Conclusion  Self-­care interventions in maternal care healthcare services.6 7 In this context, self-­
Concept Foundation, Geneva,
are diverse in their applications, implementation care interventions can help ensure health
Switzerland
5 characteristics and intended outcomes. Many self-­care and well-­ being is maintained with reduced
Department of Reproductive
Health and Research, World interventions were implemented with support from the in-­person contact.8
Health Organization, Geneva, health system at initial stages of use and uptake. Some In 2021, WHO published a guideline on
Switzerland promising self-­care interventions require further primary self-­
care interventions for health and well-­
research, though several are matured and up-­to-­date
Correspondence to being, which included 13 recommendations
evidence syntheses are needed. Research on self-­care in
Dr Joshua P Vogel; on selected self-­care interventions to improve
the preconception period is lacking.
​Joshua.​vogel@​burnet.​edu.​au preconception, antenatal, intrapartum and

Nguyen P-­Y, et al. BMJ Open 2023;13:e068713. doi:10.1136/bmjopen-2022-068713 1

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postpartum care.3 By encouraging women to engage then independently reviewed potentially eligible full texts
in these self-­care interventions, the overall efficiency of based on predetermined eligibility criteria. All stages of
healthcare delivery can be enhanced. In addition, there screening were conducted using Covidence software.18
are interventions for pregnant and postpartum women Any disagreement was resolved by discussion or adjudica-
that are not currently included in WHO’s self-­care guide- tion by a third reviewer (JPV).
line, but have the potential of transitioning into a self-­ The eligibility criteria for inclusion were: (A) Partici-
care paradigm. Examples include prescription medicines pants: women preparing to get pregnant, currently preg-
that can be made available over-­ the-­
counter (OTC), nant, giving birth or in the postpartum period (up to 42
self-­collection of samples for testing or home testing kits days after birth), of any age. Studies in which partners
for certain diseases. Some systematic reviews have been or family members carried out self-­care for the pregnant
conducted on self-­ care interventions in pregnancy9–11; woman, were also eligible. Interventions for abortion were
however these previous reviews focused on a few selected not eligible. We also excluded interventions that were
interventions and outcomes, and mainly the antenatal only directed at newborns and postnatal breastfeeding
or postpartum periods. No previous review has explored interventions for improving neonatal outcomes, though
the broad and heterogeneous body of research across antenatal programmes related to preparation for the
preconception, antenatal, intrapartum and postpartum postnatal period were eligible. (B) Interventions: for this
periods, in order to identify those that may be effective review, a self-­care intervention was defined as any tool,
or applicable from a self-­care perspective. We therefore resource or strategy designed to promote or facilitate self-­
aimed to identify all current and emerging self-­care inter- care by a woman intending to get pregnant, or a currently
ventions via a scoping review that have been evaluated in pregnant, labouring or in the postpartum period, for the
the context of preconception, antenatal, intrapartum and purpose of improving the quality or coverage of mater-
postpartum care. nity healthcare, and/or improving her health, well-­being
and care experiences. To be eligible, interventions must
have been aimed at reducing risks of pregnancy, child-
METHODS birth or postpartum complications and/or enabling a
The scoping review was conducted in accordance with positive pregnancy, childbirth or postpartum experience.
the methodological guide for scoping reviews by Peters Each intervention was evaluated independently by two
and colleagues,12 and reported in accordance with the reviewers for inclusion based on a set of prespecified
Preferred Reporting Items for Systematic Reviews and principles (online supplemental file 4). (C) Compar-
Meta-­Analyses guideline for Scoping Reviews13 (online ator: placebo, no treatment or standard care; single-­arm
supplemental file 1). The protocol was registered online interventional studies were also eligible. (D) Outcomes:
at https://doi.org/10.17605/OSF.IO/97X25 (online outcomes related to maternal physical, psychological
supplemental file 2). or emotional health, behavioural change affecting a
mother’s own health or diagnostic accuracy of tests for
Electronic searches women. Studies reporting economic outcomes only were
The search strategy was developed in consultation with an not included, and neither were feasibility studies evalu-
information specialist (online supplemental file 3) and ating only retention rates and acceptability. (E) Types
combined self-­care concepts with terms related to precon- of studies: randomised trials, quasi-­experimental studies
ception, antenatal, intrapartum and postpartum care, and cohort studies, scoping reviews, systematic reviews,
based on the framework proposed by Narasimhan and meta-­analyses and overviews of systematic reviews. System-
colleagues.4 The terms and concepts used were informed atic reviews and overviews must have stated some form
by previous reviews of pregnancy care and self-­care for of search strategy and presented all included studies in a
other health conditions14–16 and by inputs from team systematic manner to be eligible for inclusion. Ongoing
members with clinical and public health background. studies (defined as trials with protocols published from
The following databases were systematically searched to 2019 onwards which were not completed) were eligible;
identify published studies from inception to 17 October no restriction on date of publication was applied other-
2021: MEDLINE, Embase, EmCare and PsycINFO (via wise. Case series, case studies, case reports, dissertations
Ovid), CENTRAL/Cochrane Database of Systematic and theses, reports published as abstracts only, corre-
Reviews (via Cochrane Library) and CINAHL Plus (via spondence letters, editorials and qualitative studies were
EBSCOhost). The last date of search was 17 October excluded. Only studies with full texts written in English
2021. Reference lists of included studies were manually were eligible.
screened to identify other relevant studies. Grey literature
was not searched after considering the volume and vari- Data collection and analysis
able quality of such evidence.17 Two reviewers independently extracted data using a stan-
dardised extraction form we developed to suit the review
Study selection (online supplemental file 5). Data extracted included
Two reviewers (P-­YN and CC) first independently screened characteristics of each study’s population, interventions
all titles and abstracts to exclude irrelevant studies, and and outcomes measured. Study designs were classified as

2 Nguyen P-­Y, et al. BMJ Open 2023;13:e068713. doi:10.1136/bmjopen-2022-068713

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evidence syntheses, interventional studies, observational

studies or diagnostic accuracy studies. Countries where
studies took place were classified based on the World
Bank 2021 country income levels.19 For population char-
acteristics, we recorded whether the studies included
women under the age of 18 and whether those with high-­
risk pregnancies were included. For each study, the self-­
care activities that the intervention aimed to promote
or facilitate, and the period of pregnancy during which
the intervention took place (preconception, antenatal,
intrapartum or postpartum period) were recorded. An
inductive thematic analysis process was undertaken.20
After all self-­care interventions were identified, we anal-
ysed their descriptions and identified themes among
groups of interventions. For example, interventions
involving taking dietary supplements or adjusting diet
intakes were grouped under the theme ‘Diet and nutri-
tion’. These themes were refined until all interventions
were accounted for, creating the final set of self-­care cate-
gories. In addition, we matched the interventions to the Figure 1  Preferred Reporting Items for Systematic
categories listed in WHO’s classification of self-­care inter- Reviews and Meta-­Analyses flowchart of record retrieval and
ventions for self-­carers and caregivers.21 We also recorded selection.
the venues of access to self-­care, that is, the setting or loca-
tion where participants were orientated to or carried out of randomised trials (n=306, 53%). Evidence syntheses
self-­care, based on this classification framework.21 Lastly, (n=165) accounted for 28% of all studies, out of which
we recorded whether any external support person was 109 were meta-­analyses (19%). Observational studies were
required to promote or facilitate self-­care. These informa- less common (n=32, 6%) and were mainly retrospective
tion were recorded for primary studies only, as evidence or prospective cohort studies (n=25, 4%). Study designs
synthesis studies may include studies with different char- used were largely similar across all self-­care categories,
acteristics. Any disagreement was resolved via consensus with some exceptions (figure 2A, online supplemental
or adjudication by a third reviewer (JPV). In line with file 8). In self-­management of medication, the propor-
scoping review methodology,12 quality assessment of tion of non-­randomised studies (n=7, 41%) was similar to
included studies was not performed. Descriptive statistics that of randomised trials (n=6, 35%). In self-­testing and
(frequency and percentage) were used to report study, self-­collection of samples, many studies (n=10, 56%) were
participant and intervention characteristics. Studies that diagnostic accuracy studies.
feature more than three self-­ care interventions were Most studies took place in high-­ income countries
analysed and reported separately. R V.4.1.2 was used to (n=260, 45%), followed by middle-­income (n=146, 25%)
calculate the frequencies of various intervention char- and low-­income countries (n=11, 2%); 163 studies (28%)
acteristics, participant characteristics and outcomes for were reviews with no geographical restriction, and usually
each self-­care intervention, aggregate these frequencies included studies from multiple countries. Countries with
by self-­care categories and present them as bar charts. the most studies were the USA (n=86, 15%), Iran (n=46,
Patient and public involvement statement 8%), UK (n=33, 6%) and Australia (n=30, 5%). Self-­care
Patients were not included in the design, conduct and interventions most commonly took place in the antenatal
plans for dissemination of results of this review. (n=439, 76%) and postpartum periods (n=119, 21%).
Few studies related to the preconception (n=21, 4%)
RESULTS or intrapartum periods (n=62, 11%) (figure 2B, online
A total of 12 215 records from six databases were retrieved, supplemental file 8).
together with an additional 182 records from manual Thirty-­eight studies (7%) included women under the
reference screening (figure 1). In total, 10 712 reports age of 18. One-­third of included studies (n=170, 29%)
were excluded at the title/abstract screening stage and included women with high-­ risk pregnancies. High-­risk
another 743 reports at full-­text screening (online supple- pregnancies were variably defined—the most common
mental file 6). The final sample consisted of 580 unique definitions included pregnant women with gestational
studies (616 reports) (online supplemental file 7), 18 or existing diabetes (n=54, 9%), obesity or overweight
(3%) of which were ongoing studies. (n=35, 6%) and ex-­smokers/current smokers (n=31, 5%).

Characteristics of included studies Self-care interventions and their characteristics

Among 580 studies, two-­ thirds were interventional Among included studies, 35 studies (6%) described a
studies (n=365, 63%), many of which reported results complex intervention involving more than three different

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Figure 2  Characteristics of included studies.

self-­care activities (online supplemental file 9). The WHO categories were interventions for improving
remaining 545 studies (94%), which featured up to three capacity and promoting autonomy in self-­care (n=325,
self-­care activities, constituted the final sample for identi- 56%), self-­ care prevention including risk avoidance
fication of self-­care interventions. A total of 112 unique and support for physical and mental health and well-­
self-­care interventions were identified and organised into being (n=296, 51%) and self-­care for short-­term health
11 broad categories (figure 3; online supplemental file conditions (n=189, 33%). Some WHO categories did
10). The most common self-­ care categories identified not feature among included studies, such as on-­demand
included diet and nutrition (n=143/545, 26%), phys- information services for health information, diagnostic
ical activity (n=132, 24%), psychosocial strategies (n=97, devices in community locations, online symptom checkers
18%) and lifestyle adjustments (n=90, 17%). Few studies for diagnosis and interventions enabling individuals to
featured self-­care interventions under the categories of identify location of health facilities/structures. Notably,
sexual health and family planning (2%), self-­management we identified no studies that targeted self-­care outside
of medication (3%) and self-­testing/sampling (3%). All the context of a specific health issue, such as campaigns
identified interventions demonstrate various degrees to promote awareness about self-­care or programmes to
of interaction with the health system,4 from little to no improve health and digital literacy.
direct contact (self-­awareness/regulation), some interac- Among 545 studies under analysis, self-­care was acces-
tion (self-­management of health conditions) and close sible through several avenues as described in the WHO
linkage with the health system for follow-­up (self-­testing classification framework.20 These avenues include health
and diagnosis) (figure 3). facilities (n=238/545, 44%), digital platforms (n=97,
The identified interventions correspond to a range of 18%), community and non-­facility venues (n=74, 14%),
categories from WHO’s classification of self-­care interven- partner or peer support (n=37, 7%) or OTC products,
tions (online supplemental file 11). The most common for example, nutritional supplements, topical products or

4 Nguyen P-­Y, et al. BMJ Open 2023;13:e068713. doi:10.1136/bmjopen-2022-068713

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Figure 3  All self-­care interventions identified from included studies and their interactions with the health system. HPV, human
papillomavirus; IPTp, intermittent preventive treatment of pregnancy; PPH, postpartum haemorrhage; STD/STI, sexually
transmitted diseases/infections; PrEP, pre-­exposure prophylaxis; URTI, upper respiratory tract infection; UTI, urinary tract
infection

support devices (n=69, 13%). In 80 studies (15%), there planning (67% of studies in this category), psychosocial
was insufficient detail to determine that the aforemen- strategies (45%) or physical activity (44%) (figure 4B,
tioned modes of access were used. No studies were iden- online supplemental file 8). Few studies mentioned
tified where the intervention took place at the workplace, involvement of trained community health workers (n=41,
in schools or in emergency or humanitarian settings. 8%), non-­trained community members (n=25, 5%) or
Across the self-­care categories, provision of informa- family members (n=3, 1%).
tion and demonstration of self-­care were most commonly
done in health facilities, especially for self-­testing (94% Types of outcomes in self-care studies
of studies in this category) and self-­monitoring (58%). Included studies used a diverse range of outcomes,
Provision of similar services outside health facilities, such including both maternal and neonatal outcomes (online
as via community health workers or at community-­based supplemental table 1). The most commonly measured
venues, was mainly for the support of self-­management ones were neonatal outcomes (birth weight, Apgar
of medication (41%) and physical activity (28%). Home-­ scores, preterm birth, admission to neonatal intensive
based self-­care (ie, direct access to self-­
care resources care unit and other neonatal complications) (n=177,
and information at home) was less frequent, mainly in 31%); maternal mental well-­ being and quality of life
the categories of breast or nipple care (23%) and lifestyle (n=150, 26%), and labour outcomes (duration of labour
adjustments (20%). Digital platforms were popular in stages, labour pain, mode of delivery or labour induc-
some categories, notably self-­monitoring (51%). Use of tion methods) (n=125, 22%). A total of 147 studies
OTC products was common in complementary/alterna- (25%) measured behavioural outcomes, mainly related
tive therapies (39%) and breast and nipple care (27%). to reductions in risky behaviours such as smoking or
Lastly, peer or partner support was relatively less common alcohol consumption. Maternal mortality (n=20, 3%)
across categories (7%), and we observed that partner and perinatal mortality (n=67, 12%) were less commonly
support (1%) was relatively less frequent than support evaluated.
from peers (eg, other women, members of support
groups) (6%) (figure 4A, online supplemental file 8).
A large number of studies described the involvement
of health workers in promoting or facilitating self-­care
(n=208/545, 38%), especially for sexual health and family

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Figure 4  Characteristics of self-­care interventions. OTC, over-­the-­counter.

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DISCUSSION supplementation. Although many studies reported on the

Main findings prevalence and determinants of self-­medication during
In this scoping review, 580 studies were identified pregnancy,30–32 none investigated interventions aimed at
pertaining to 112 self-­care interventions across precon- promoting safe self-­medication practices or how to seek
ception, antenatal, intrapartum and postpartum periods. information when self-­medicating. There were also few
These interventions encompassed multiple modalities, self-­care interventions aimed at communicable disease
settings and levels of provider involvement. Most self-­care detection and prevention during or after pregnancy.
interventions required close engagement with health Future research is warranted to investigate how these
facilities, in which healthcare workers or community aspects of clinical care during and after pregnancy could
health workers would teach self-­ care skills or provide be approached from a self-­care perspective.
therapeutics for home use. Previous studies also suggest We identified studies describing self-­testing options for
that healthcare services are a critical starting point for urinary tract infections and HIV, but few or no studies
successful self-­ care approaches.22–24 As such, self-­ care on malaria, syphilis or chlamydia self-­testing, for which
should be viewed as an extension of, and not a separate rapid test technologies are available but not yet scaled
entity to, formal healthcare services. Our findings also up or tested in pregnancy.33–35 Similarly, self-­collection
reflect a broader trend towards task-­sharing in order to of vaginal samples for reproductive tract infections is an
increase maternity care coverage.7 25 While the majority of emerging alternative to clinic-­ based sampling.36 While
self-­care interventions were implemented in the antenatal some studies have investigated diagnostic accuracy of
period, many of these studies aimed to equip pregnant self-­sampling for reproductive tract infections in preg-
individuals with self-­care skill via workshops or counsel- nancy, evidence on their benefits, harms and effective
ling, which can be used in the intrapartum (eg, relax- linkages with health systems is currently lacking.37 Lastly,
ation methods during labour) or postpartum periods we identified self-­care studies on insecticide-­treated nets
(eg, pelvic floor exercises, breast and nipple care). Few for malaria, mostly from the sub-­Saharan Africa region.
studies examined the potential benefits of self-­care at the However there was little research on other low-­cost strat-
preconception period. Few interventions featured digital egies amenable to a self-­care approach (indoor residual
platforms (eg, websites, mobile applications); those iden- spraying and insect repellents), or from other malaria-­
tified were mostly used for communication between endemic regions such as Asia and Latin America.38
the pregnant individual and a remote health worker, or Last but not least, we found no eligible studies on
as a platform for the pregnant individual to record her traditional and Indigenous self-­ care practices. While
medical information and receive automatic, individu- important qualitative research has been conducted on
alised health advice. While digital technologies seem to this topic,39 40 we hypothesise that there is a relative lack
currently play a limited role, they have great potential to of studies exploring the health effects of these types of
catalyse and promote maternity-­related self-­care.26 self-­care practices. Future research on these topics could
Most studies concentrated on self-­ care interventions also provide new opportunities for improving cultural
related to lifestyle modification—such as diet, nutrition/ safety of maternity care services.
supplement intake, physical activity and sleep habits—as
well as strategies to optimise mental and social well-­being. Strengths and limitations
The established evidence base for lifestyle interventions While there are systematic reviews for some self-­care prac-
was also reflected in previous systematic reviews on self-­ tices, this is the first scoping review that maps all poten-
care for pre-­eclampsia and gestational diabetes.9 11 This tial self-­care practices across the spectrum of pregnancy
might be attributable to a perceived lower risk of harm care, from preconception, antenatal, intrapartum to
when conducting trials investigating lifestyle interven- postnatal care. This scoping review provides a compre-
tions, compared with clinical or pharmacological inter- hensive summary of the state of research on this topic,
ventions. Moreover, lifestyle interventions tend to take and lays the foundation for future systematic reviews and
place in their own living environments and in their primary research. We analysed studies based on multiple
own time, and hence may be more amenable to self-­ characteristics, as well as applying the new WHO self-­care
care approaches. Conversely, there were relatively few classification system to organise, categorise and facilitate
studies that explored self-­monitoring, self-­testing or self-­ interpretation of findings.
management of medications or pregnancy complications. This scoping review was intended to present an over-
While studies of these self-­care approaches can be complex view of the research landscape, and not to critically
or technically challenging, they could provide solutions appraise or meta-­ analyse available evidence. The total
to improving care in remote and low-­resource settings.6 number of studies identified for a given self-­care inter-
While advanced distribution and self-­administration of vention may not correlate with evidence quality, or its
misoprostol for postpartum haemorrhage prevention has effectiveness. We reported the results for complex inter-
been well-­explored,27–29 there was limited or no research ventions (ie, interventions with more than three different
on similar approaches to other therapeutics, such as self-­care practices) separately (online supplemental file
use of anthelminthics, malaria prophylaxis, antimalar- 9), since segregating each complex intervention into
ials, antiretroviral therapy or vitamin and micronutrient multiple individual interventions would overestimate

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their representation in the sample and disregard poten- primary studies, or where available primary studies were
tial synergy between the self-­care components. Besides, not designed to fully deliver the intervention in a self-­care
because these studies did not introduce any new self-­care approach. For these interventions, well-­designed primary
intervention, or a substantive number of studies for any studies that compare a self-­ care approach with stan-
single self-­care intervention that we had already identi- dard care are needed. Examples include self-­testing for
fied, it is unlikely that including them into the main anal- proteinuria, or self-­measurement of vaginal pH to detect
ysis would change our results and conclusion. Although early signs of bacterial vaginosis. Some self-­ care inter-
the number of such studies is small (n=35, 6%), they ventions may be particularly useful in limited-­resource
represent how self-­care can be implemented in real-­life, settings, and thus should be evaluated in such settings.
and future reviews should study their effects using appro-
priate methods, for example, component network meta-­
analysis.41 42 CONCLUSION
Some limitations must nonetheless be acknowledged. Self-­
care interventions during preconception, ante-
We did not formally screen those primary studies partum, intrapartum and postpartum periods are diverse
reported within an included evidence synthesis, and we in scope and implementation characteristics. Many self-­
assessed intervention and outcomes characteristics based care interventions were implemented with support from
on the review’s summary description of the included the health system at initial stages of use and uptake. Some
studies. It is possible that the number of primary studies promising self-­care interventions require further primary
was there underestimated, or the characteristics of indi- research, though several are more matured and up-­to-­
vidual primary studies might differ. Our assessment date evidence syntheses are needed. Research on self-­care
found 45 primary studies (8% of all included reports) in the preconception period is lacking. Future research
that were also included within an evidence synthesis should explore task-­sharing from clinical care to home
included in this review. Given their small number, we or community settings, or effective self-­management of
consider it unlikely that these overlapping studies would complications where access to care is unavailable.
substantively affect the overall results. Hence, the distri-
Twitter Phi-­Yen Nguyen @PhiYenNguyen3, Özge Tunçalp @otuncalp and Joshua P
bution of study designs (figure 2A, online supplemental Vogel @josh_vogel
file 8) should be considered in addition to the volume
Acknowledgements  We thank Steve McDonald (Cochrane Australia) for his
of evidence available for each intervention. We opted guidance in formulating the search strategy.
to focus on maternity-­ related self-­
care, thus excluding Contributors  The corresponding author attests that all listed authors meet
interventions that took place after 42 days post partum, authorship criteria and that no others meeting the criteria have been omitted.
or those that related primarily to care of newborns and P-­YN and JPV conceptualised the study, wrote the protocol and statistical plan
breast feeding. Our research objectives also mean that we and organised collaborative meetings. P-­YN and CC screened the literature and
extracted the data. P-­YN analysed the data, wrote the original draft and revised the
did not include qualitative studies. These exclusions do paper. MJP advised on the design of the study. CC, AW, KB, MJP, AMG, MN, MB, OT
not discount their importance, but rather acknowledge and JPV participated in technical and clinical discussions, and reviewed and revised
that these topics require separate, dedicated reviews. Our the paper. JPV is the guarantor of the study.
search of published reports means that self-­care inter- Funding  This project was funded by UNDP/UNFPA/UNICEF/WHO/World Bank
ventions that have only been evaluated in unpublished Special Programme of Research, Development and Research Training in Human
studies or grey literature would not have been identified. Reproduction (HRP), Department of Sexual and Reproductive Health and Research,
WHO (# PO 202724071). This work was also supported, in part, by the Bill &
With 45 reports excluded as not written in English (3.3% Melinda Gates Foundation INV-­001304. While members of our authorship team
of all full-­text reports), language bias is possible. (MN, MB and OT) are employed by HRP/WHO, the funder organisations had no
role in the design and conduct of the study; collection, management, analysis and
Future research interpretation of the data; preparation, review or approval of the manuscript; and
decision to submit the manuscript for publication.
This review was conducted for the purpose of guiding
Disclaimer  The author is a staff member of the World Health Organization. The
further evidence synthesis activities and assisting the
author alone is responsible for the views expressed in this publication and they
WHO with guideline development in this research area. do not necessarily represent the views, decisions or policies of the World Health
This scoping review identified two distinct groups of Organization.
self-­
care interventions, which have different pathways Competing interests  The authors declared no competing interests.
forward. The first group are those interventions with a Patient and public involvement  Patients and/or the public were not involved in
substantial number of primary studies, where no system- the design, or conduct, or reporting, or dissemination plans of this research.
atic review has been conducted or only outdated system- Patient consent for publication  Not applicable.
atic reviews exist. For these interventions—such as use of Ethics approval  Not applicable.
clean cookstoves to reduce adverse birth outcomes asso-
Provenance and peer review  Not commissioned; externally peer reviewed.
ciated with indoor air pollution, self-­care interventions
Data availability statement  Data are available in a public, open access repository.
to reduce postpartum depression, or self-­ collection of
Data supporting the findings and conclusion of this study are included in this
vaginal samples to test for sexually transmitted diseases— published article and its supplementary files. The underlying data set and analytical
up-­to-­
date systematic reviews are warranted to inform code are available at ​osf.​io/​26f7y.
guidelines, clinical practice and self-­care programmes. Supplemental material  This content has been supplied by the author(s). It has
The second group are interventions with limited or no not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been

8 Nguyen P-­Y, et al. BMJ Open 2023;13:e068713. doi:10.1136/bmjopen-2022-068713

 Open access

peer-­reviewed. Any opinions or recommendations discussed are solely those 18 Veritas Health Innovation. Covidence systematic review software,
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and Melbourne Australia. 2020. Available: www.covidence.org [Accessed
responsibility arising from any reliance placed on the content. Where the content 22 Jul 2021].
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interventions Geneva. 2021. Available: https://www.who.int/​
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