• antenatal care;
  • childbirth education;
  • community health workers;
  • hard-to-reach community group;
  • midwifery;
  • perinatal;
  • pregnancy;
  • programme evaluation

hesselink a.e. & harting j. (2011) Process evaluation of a multiple risk factor perinatal programme for a hard-to-reach minority group. Journal of Advanced Nursing 67(9), 2026–2037.


Aim.  This article is a report of an evaluation of a multiple risk factor perinatal programme tailored to ethnic Turkish women in the Netherlands.

Background.  The programme was directed at multiple risk factors and aimed at improving maternal lifestyle, infant care practices and psychosocial health during pregnancy and after delivery. The programme was carried out by ethnic Turkish community health workers in collaboration with midwives and physiotherapists.

Methods.  Our multiple case study included three Parent-Child Centres providing integrated maternity and infant care. Participants (n = 119) were first and second generation pregnant ethnic Turkish women with relatively unfavourable risk profiles. Data were collected between 2005 and 2008 using mixed methods, including field notes, observations and recordings of group classes, attendance logs, semi-structured individual interviews, a focus group interview, and structured questionnaires.

Findings.  Most participants (82%) were first generation ethnic Turkish; 47% had a low educational level; 43% were pregnant with their first child; and 34% had a minimal knowledge of the Dutch language. The community health workers’ Turkish background was vital in overcoming cultural and language barriers and creating a confidential atmosphere. Participants, midwives and health workers were positive about the programme. Midwives also observed improvements of knowledge and self-confidence amongst the participants. The integration of the community health workers into midwifery practices was crucial for a successful programme implementation.

Conclusions.  A culturally sensitive perinatal programme is able to gain access to a hard-to-reach minority group at increased risk for poor perinatal health outcomes. Such a programme may be well received and potentially effective.