The effectiveness of online versus in-person antenatal education

Abstract

This critical literature review examines the effectiveness of online versus in-person antenatal education in shaping parental knowledge, confidence, and outcomes from pregnancy through the first year postpartum. As digital delivery formats expanded rapidly following the COVID 19 pandemic, this review investigates whether online modalities serve as equivalent, superior, or complementary alternatives to traditional face-to-face instruction. A systematic search of six electronic databases (CINAHL Complete, APA PsycINFO, Cochrane Central Register of Controlled Trials, MEDLINE Complete, Scopus and Google Scholar) was conducted using a search string developed in consultation with a bibliographic expert and guided by the PICO framework. Following a rigorous screening of 1,116 hits, English-language studies published within the last five years were assessed for eligibility, and six primary studies were selected for inclusion. The six studies comprised five quantitative studies and one mixed-methods study. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and Joanna Briggs Institute (JBI) quality appraisal tools. Reflexive thematic analysis was used to analyse the data from the included studies. Four overarching themes were identified: (1) Accessibility versus relational preference, wherein online formats reduced logistical barriers particularly for rural and remote populations, yet parents consistently expressed preference for the peer support and emotional engagement of face-to-face settings; (2) Contextual efficacy and design dependency, demonstrating that both modalities can effectively improve knowledge and confidence, with outcomes mediated more by programme design and instructional quality than delivery format alone; (3) Enhanced dyadic participation through virtual antenatal education platforms, with partner attendance markedly higher in online formats; and (4) Limited impact on clinical birth outcomes despite improved antenatal preparation, reflecting that improvements in knowledge and psychological readiness did not consistently translate into measurable changes in obstetric events. The findings suggest that online and in-person education are complementary modalities. This review recommends adopting hybrid models that leverage the accessibility and partner engagement of digital tools alongside the relational depth and skill development of in-person instruction. Furthermore, all programmes should include structured postnatal content. Future research must prioritise underserved populations and utilise robust methodological designs to evaluate long-term impacts on maternal, infant, and family outcomes.