Implementation of Centering-Based Antenatal Group Care in Flanders (Belgium): Experiences of woman and health care providers. Modalities for sustainable integration into the health care system

Background: In Belgium, antenatal care is characterized by one-to-one care; with limited integration of community-based approaches. Centering-Based Group Care (CBGC), derived from the CenteringPregnancy® model, offers an alternative by combining clinical follow-up, health education, and peer support in group sessions. This study evaluates the implementation of CBGC in three Flemish cities (Aalst, Gent, Leuven) as part of the European Union GC_1000 project, focusing on participant and facilitator experiences and identifying factors influencing sustainable integration into the healthcare system. Methods: A realist evaluation design was applied, using the Consolidated Framework for Implementation Research (CFIR) to guide analysis. Data were collected through interviews, focus groups, and observations involving service users, facilitators, and stakeholders. A total of 193 women participated in 30 CBGC trajectories between 2021 and 2023. Thematic analysis was conducted using the Framework Method. Results: Participants reported high satisfaction with CBGC, highlighting four key benefits: (1) social support and connection, (2) active involvement in care, (3) enhanced learning and empowerment, and (4) continuity and trust in care relationships. Facilitators emphasized the model’s potential to improve quality of care, promote professional growth, and foster interprofessional collaboration. Challenges addressed included language barriers, recruitment difficulties, time constraints, and limited system-level support. Structural barriers such as fragmented care pathways and lack of reimbursement mechanisms hindered full integration in the health care system. Successful implementation was supported by trained facilitators, engaged coordinators, and local partnerships. Conclusions: CBGC is a feasible and valued model of antenatal care in Belgium. It enhances participant engagement, peer learning, and relational care. Sustainable integration requires policy-level support, structural alignment between primary and hospital care, and appropriate funding mechanisms. Expanding CBGC to a population broader than those living in vulnerable situations and embedding it within integrated care pathways could strengthen its impact and sustainability. This study contributes to the growing evidence base supporting group antenatal care as a promising model for improving care experiences, integrated care and preventive community health.