Barriers and facilitators to implementation of peer support after miscarriage: a systematic review using thematic synthesis methods

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Burton, Leanne ORCID: 0000-0002-5870-4161, Charles, Juanita, Cherry, Mary Gemma, Corcoran, Rhiannon ORCID: 0000-0001-8900-9199, Hassan, Shaima ORCID: 0000-0001-7840-3342, Hill, Ruaraidh ORCID: 0000-0002-2801-0505, Little, Sarah, Maden, Michelle ORCID: 0000-0002-5435-8644, Mulholland, Helen ORCID: 0000-0002-6679-7257, Perkins, Elizabeth ORCID: 0000-0002-0213-8105 et al (show 3 more authors) , Slade, Pauline, Wallis, Selina ORCID: 0000-0002-5490-0528 and Marshall, Paul ORCID: 0000-0002-3913-3359 (2026) Barriers and facilitators to implementation of peer support after miscarriage: a systematic review using thematic synthesis methods BMJ OPEN, 16 (6). e113671-. ISSN 2044-6055, 2044-6055

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Abstract

Objectives: Miscarriage, defined in the UK as loss of pregnancy prior to 24 weeks gestation, can have long-term psychological implications. Clinical guidelines for perinatal bereavement care do not provide guidance on how best to support the mental health of women, and their partners, after miscarriage. Peer support (support from those who share common characteristics) is often sought, but there is little understanding of its access and use. We conducted a systematic review to understand the barriers to and facilitators of the implementation of peer support to improve mental health outcomes for parents after miscarriage. Design: Systematic review and thematic synthesis. Data sources: A comprehensive systematic search across nine databases (MEDLINE, CINAHL, APA PsycINFO, Web of Science (all databases), EMBASE, CENTRAL, LENS.org, British Nursing Index and Health Management Information Consortium) was conducted in June 2025. Grey literature was identified through website searching, contact with topic experts and a national Call for Evidence. Eligibility criteria: Qualitative and mixed-methods studies exploring motivations, experiences and preferences for peer support after miscarriage were included. Data extraction and synthesis: Two independent reviewers used standardised methods to search, screen, extract and code included studies. Suitable studies were evaluated using the Critical Appraisal Skills Programme Qualitative Research Checklist. Findings were extracted and subjected to a thematic synthesis. Results: Across nine studies included in the review, three overarching themes were developed, with seven subthemes, capturing both barriers and facilitators. ‘Engaging in relational recognition’ reflects the validation and connection that arise through experiential resonance, often heightened by the context of exclusion from broader social or clinical support. ‘Mechanisms of Communality’ describe how communality is enacted through dynamic peer interactions, including modelling and facilitating grief, benchmarking physical change and mattering through reciprocity, highlighting mutual support and shared coping. ‘Dynamics of Access’ consider factors which shape engagement, including changing needs of individuals across time and modalities of support and their effects. Conclusions: These findings form the first synthesis of peer support after miscarriage and bring a nuanced service user perspective of barriers and facilitators by examining evidence from diverse studies. Peer support after miscarriage was seen to be a dynamic, relational process shaped by shared experience, mutual exchange and context-specific factors. Findings underscore key policy and practice considerations, including the use of trauma-informed, loss-sensitive approaches and consideration of intersectionality, that should be reflected when offering peer support services, with and for, those who have experienced miscarriage. PROSPERO registration number: CRD42024518248.

Item Type:	Article
Uncontrolled Keywords:	MENTAL HEALTH, Systematic Review, Pregnancy, Peer Group
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Population Health Faculty of Health & Life Sciences > Inst. Population Health > Inst. Population Health (T&R Staff) Faculty of Health & Life Sciences > Inst. Population Health > Primary Care & Mental Health
Depositing User:	Symplectic Admin
Date Deposited:	20 May 2026 07:58
Last Modified:	26 Jun 2026 19:47
DOI:	10.1136/bmjopen-2025-113671
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3198555
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