{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:01:48Z","timestamp":1792677708434,"version":"4.5.0"},"reference-count":84,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001921","name":"Public Health Research Programme","doi-asserted-by":"publisher","award":["NIHR156802"],"award-info":[{"award-number":["NIHR156802"]}],"id":[{"id":"10.13039\/501100001921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and thematic synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Qualitative and mixed-methods studies exploring motivations, experiences and preferences for peer support after miscarriage were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across nine studies included in the review, three overarching themes were developed, with seven subthemes, capturing both barriers and facilitators. \u2018Engaging in relational recognition\u2019 reflects the validation and connection that arise through experiential resonance, often heightened by the context of exclusion from broader social or clinical support. \u2018Mechanisms of Communality\u2019 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. \u2018Dynamics of Access\u2019 consider factors which shape engagement, including changing needs of individuals across time and modalities of support and their effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42024518248.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113671","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T16:05:23Z","timestamp":1780502723000},"page":"e113671","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Barriers and facilitators to implementation of peer support after miscarriage: a systematic review using thematic synthesis methods"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5870-4161","authenticated-orcid":false,"given":"Leanne","family":"Burton","sequence":"first","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanita","family":"Charles","sequence":"additional","affiliation":[{"name":"The Miscarriage Association, Wakefield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Gemma","family":"Cherry","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"},{"name":"Clinical Health Psychology, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhiannon","family":"Corcoran","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaima","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruaraidh","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Health Data Science, University of Liverpool, Liverpool, UK"},{"name":"Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Little","sequence":"additional","affiliation":[{"name":"Independent Researcher (Public Advisor), Cheshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Maden","sequence":"additional","affiliation":[{"name":"Department of Health Data Science, University of Liverpool, Liverpool, UK"},{"name":"Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Mulholland","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Perkins","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Slade","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selina","family":"Wallis","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"2026090306262413000_16.6.e113671.1","unstructured":"Department of Health & Social Care . 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