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Schönborn C, Castetbon K, De Spiegelaere M. Maternal birthplace and experiences of perinatal healthcare in Belgium: Evidence from a cross-sectional survey. Midwifery 2024; 138:104139. [PMID: 39154598 DOI: 10.1016/j.midw.2024.104139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 07/18/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Patient experience is an important part of perinatal care quality. Migrant women in high-income countries often report more negative experiences than non-migrants, but evidence in Europe is patchy. In this study, we compared the experiences of two migrant populations with non-migrants, taking into account socioeconomic characteristics. METHODS We surveyed mothers born in Belgium, North-Africa, and Sub-Saharan Africa (n = 877) using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. Two patient experience scores were created using multiple correspondence analyses: a) information and communication with healthcare professionals and overall satisfaction with pregnancy care, and b) patient-centred aspects and satisfaction with delivery care. Through descriptive analyses and multivariable logistic regressions we estimated the associations of maternal characteristics with each score. RESULTS Overall, positive experiences were reported in terms of communication (83 %) and patient-centred care (86 %). North African immigrants with low language proficiency had higher odds of negative communication experience (especially problems understanding information) (ORa: 2.30, 95 %CI 1.17-4.50), regardless of socioeconomic position. Among women with language barriers, 88 % were never offered a professional interpreter, relying on family members for translation. Patient-centred care was not associated with maternal birth region but was rated more negatively by older mothers, those with longer residence in Belgium, and higher majority-language proficiency. CONCLUSION In Belgium, perinatal care experiences were generally positive, although communication with immigrants was suboptimal. Language barriers, single motherhood, and unstable housing increased communication issues. Our findings underline the necessity to improve information-exchange with immigrants and socioeconomically vulnerable women.
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Affiliation(s)
- Claudia Schönborn
- Research Centre in Social Approaches to Health, School of Public Health, Université libre de Bruxelles, Brussels, Belgium; Research Centre in Health Systems and Policies, School of Public Health, Université libre de Bruxelles, Brussels, Belgium.
| | - Katia Castetbon
- Research Centre in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Myriam De Spiegelaere
- Research Centre in Social Approaches to Health, School of Public Health, Université libre de Bruxelles, Brussels, Belgium; Research Centre in Health Systems and Policies, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
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Appelbäck M, Carlbom A, Eriksson L, Essén B. The dynamics of intercultural clinical encounters in times of pandemic crisis. Swedish healthcare providers' reflections on social norms in relation to sexual and reproductive healthcare. Midwifery 2024; 138:104129. [PMID: 39126859 DOI: 10.1016/j.midw.2024.104129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/17/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Experiences from the COVID-19 pandemic may help to better understand resilience, competences and skills for healthcare providers and the healthcare system. Within sexual and reproductive health inequalities for migrants exist and it is an area where promoting both cultural competency and healthcare equity in the clinical encounter is expected of healthcare providers yet can create tension. The aim is to explore healthcare providers experiences of encounters with migrants in the context of the pandemic and the subsequent changes in routines and norms. METHODS A qualitative study based on semi-structured interviews with 31 healthcare providers working in sexual and reproductive healthcare in southern Sweden. Interviews were conducted during the COVID-19 pandemic influencing how healthcare providers reflected on their experiences. Analysis was done using reflexive thematic data analysis. FINDINGS Healthcare providers reflected on how changes in routines increased the understanding of challenges and enablers in the intercultural encounter including the impact on communication and role of relatives and male partners. They emphasized the dynamics of culture in the clinical encounter and healthcare system through highlighting the importance of structural awareness, self-reflection and the flexibility of conducts and norms, often given a cultural connotation. CONCLUSION The COVID-19 pandemic resulted in changes of previously established routines directly affecting clinical encounters, which provided a unique opportunity for healthcare providers to reflect, with communication and self-reflection being discussed as central in complex encounters. It highlighted the dynamics of presumed deeply rooted cultural norms and the interplay with social factors affecting healthcare providers and patients alike.
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Affiliation(s)
- Mia Appelbäck
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Aje Carlbom
- Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden
| | - Lise Eriksson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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De-María B, Topa G, López-González MA. Cultural Competence Interventions in European Healthcare: A Scoping Review. Healthcare (Basel) 2024; 12:1040. [PMID: 38786450 PMCID: PMC11120989 DOI: 10.3390/healthcare12101040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Europe is undergoing rapid social change and is distinguished by its cultural superdiversity. Healthcare is facing an increasing need for professionals to adapt to this environment. Thus, the promotion of cultural competence in healthcare has become a priority. However, the training being developed and their suitability for the European context are not well known. The aim of this qualitative study has been to map the scientific literature in order to comprehend the current state of research on this topic. For this purpose, we conducted a systematic scoping review of the empirical publications focused on cultural competence interventions for healthcare professionals in European countries. The search was conducted in eight thematic (PsycINFO, MedLine, and PubPsych) and multidisciplinary databases (Academic Search Ultimate, E-Journals, Scopus, ProQuest, and Web of Science) to identify relevant publications up to 2023. Results were presented qualitatively. Out of the initial 6506 records screened, a total of 63 publications were included. Although the interventions were implemented in 23 different European countries, cultural competence interventions have not been widely adopted in Europe. Significant heterogeneity was observed in the conception and operacionalización of cultural competence models and in the implementation of the interventions. The interventions have mostly aimed at improving healthcare for minority population groups and have focused on the racial and ethnic dimensions of the individual. Future research is needed to contribute to the conceptual development of cultural competence to design programs tailored to European superdiversity. This scoping review has been registered in OSF and is available for consultation.
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Affiliation(s)
- Berta De-María
- Department of Social and Organizational Psychology, Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain; (B.D.-M.); (G.T.)
| | - Gabriela Topa
- Department of Social and Organizational Psychology, Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain; (B.D.-M.); (G.T.)
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Ternström E, Akselsson A, Small R, Andersson J, Lindgren H. Obstetric outcomes and uptake of care among 149 non-Swedish speaking migrant women attending a birth preparation visit during pregnancy - An observational study from Sweden. J Migr Health 2024; 9:100226. [PMID: 38596616 PMCID: PMC11002845 DOI: 10.1016/j.jmh.2024.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 08/31/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction In Sweden almost one third of the population is born in another country and a large number of the women who do not speak Swedish are of reproductive age. Women migrating from low-income countries have higher risks for poor obstetric outcomes than receiving country-born citizens. INFOR (a Swedish word for "before" or "ahead of") is an intervention offering language-assisted, individual birth preparation for non-Swedish speaking pregnant women unfamiliar with the maternity care system. The aim of this study was to describe the uptake of care and obstetric outcomes among non-Swedish speaking migrant women attending INFOR. Methods A descriptive study of the obstetric outcomes and uptake of care was conducted of the 149 non-Swedish speaking pregnant women who participated in INFOR between 2016 and 2020. The data were accessed retrospectively from the medical record system Obstetrix and the population-based Swedish Pregnancy Registry and analysed descriptively. Results Women participating in INFOR originated from 44 countries and spoke 35 different languages. During late pregnancy, 20 percent of the women sought care for decreased fetal movements and 80 percent of the women attended the postpartum visit. While the majority of the participants were offered professional language support during pregnancy, almost none had a professional interpreter present during labour and birth. After birth, 80 percent of the primiparous women were asked to rate their birth experience, but only half of the multiparous women were asked. Further, only half of the primiparous women attending the postpartum visit were asked about their self-rated health. Conclusion INFOR may increase uptake of some important aspects of care during pregnancy, birth and postpartum among migrants of diverse backgrounds. The findings raise concerns however about communication support for migrant women, especially during labour and birth. The offer of professional interpreting as part of standard maternity care for women who need it is essential and must be improved in order to provide equitable care for all.
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Affiliation(s)
- Elin Ternström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Akselsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | | | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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Villadsen SF, Johnsen H, Damsted Rasmussen T, Ekstrøm CT, Sørensen J, Azria E, Rich-Edwards J, Essén B, Christensen U, Smith Jervelund S, Nybo Andersen AM. Unlocking the mechanisms of change in the MAMAACT intervention to reduce ethnic disparity in stillbirth and newborns' health: integration of evaluation findings. FRONTIERS IN HEALTH SERVICES 2024; 4:1233069. [PMID: 38433990 PMCID: PMC10904659 DOI: 10.3389/frhs.2024.1233069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
Ethnic disparities in stillbirth exist in Europe and suboptimal care due to miscommunication is one contributing cause. The MAMAACT intervention aimed to reduce ethnic disparity in stillbirth and newborns' health through improved management of pregnancy complications. The intervention encompassed training of antenatal care midwives in cultural competencies and intercultural communication combined with health education materials for the expecting parents about symptoms of pregnancy complications. The evaluation consisted of a qualitative in-depth implementation analysis and a process evaluation embedded in a cluster randomized trial including 19 of 20 maternity wards in Denmark. In this article, the findings from the different evaluation perspectives are integrated. The integration follows the principles of realist evaluation by analyzing to what extent the MAMAACT activities were generating mechanisms of change in interaction with the context. The integration analysis shows that the health education materials in the MAMAACT intervention contributed to heightened health literacy concerning pregnancy complications among pregnant women. Additionally, the training of midwives in cultural competency and intercultural communication raised awareness among midwives. Nonetheless, the exclusive emphasis on midwives and the inflexibility in care provision hindered them from changing their communication practices. To enhance the cultural competence in maternity care, it is essential to implement more comprehensive initiatives involving healthcare professionals in maternity care at all levels, from pregraduate to postgraduate. Adequate interpreter services and management support should also be ensured. Currently, the Danish antenatal care system faces challenges including inadequate information transfer between healthcare sectors, insufficient differentiation of care, and inflexibility in midwife scheduling. This results in a lack of responsiveness to the individual needs of women with immigrant backgrounds, potentially reproducing health inequities.
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Affiliation(s)
- Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Johnsen
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Copenhagen, Denmark
| | - Trine Damsted Rasmussen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Janne Sørensen
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elie Azria
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Paris, France
| | - Janet Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Birgitta Essén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Signe Smith Jervelund
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Abdulle AA, Borrego N, Lundgren I. Midwives' experiences of encountering immigrant women during labour and birth who do not master the host country's language. A lifeworld hermeneutic study. Scand J Caring Sci 2023; 37:1136-1144. [PMID: 37340891 DOI: 10.1111/scs.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/27/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Immigrant women are in a vulnerable position during labour and birth due to language barriers. Communication with women who do not master the host country's language is difficult for midwives, but there are few studies about midwives' experiences. AIM To explore Norwegian midwives' experiences of encountering immigrant women during labour and birth who do not master the native language. METHOD A hermeneutic lifeworld approach. Interviews with eight midwives working at specialist clinics and hospital maternity wards in Norway. RESULTS The findings were interpreted based on four concepts in the theory "Birth territory: A theory for midwifery practice" by Fahy and Parrat presented in five themes: language barriers can cause disharmony and prevent participation, language barriers can lead to midwifery domination and poorer care, midwives strive for harmony and to be a guardian, medicalisd birth due to language barriers, and disharmony can lead to crossing boundaries. The main interpretation shows that it is midwifery domination and disintegrative power that are prominent. However, the midwives strived to use their integrative power and be guardians, but in doing so they encountered challenges. CONCLUSION Midwives need strategies for better communication with immigrant women involving the women and for avoiding a medicalised birth. To be able to meet immigrant women's needs and to establish a good relationship with them, challenges in maternity care need to be addressed. There are needs of care that focus on cultural aspects, leadership teams that support midwives, and both theoretical and organisational care models that support immigrant women.
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Affiliation(s)
- Amran Ahmed Abdulle
- Institute of Health Care and Sciences, University in Tromsø (UiT) - Norway's Arctic University, Tromsø, Norway
| | - Natalia Borrego
- Institute of Health Care and Sciences, University in Tromsø (UiT) - Norway's Arctic University, Tromsø, Norway
| | - Ingela Lundgren
- Institute of Health Care and Sciences, University in Tromsø (UiT) - Norway's Arctic University, Tromsø, Norway
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Radu I, Scheermesser M, Spiess MR, Schulze C, Händler-Schuster D, Pehlke-Milde J. Digital Health for Migrants, Ethnic and Cultural Minorities and the Role of Participatory Development: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6962. [PMID: 37887700 PMCID: PMC10606156 DOI: 10.3390/ijerph20206962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.
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Affiliation(s)
- Irina Radu
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Mandy Scheermesser
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Martina Rebekka Spiess
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Christina Schulze
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Daniela Händler-Schuster
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
- UMIT TIROL Institute for Nursing Science, Private University of Health Sciences and Health Technology, 6060 Hall in Tirol, Austria
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington 6012, New Zealand
| | - Jessica Pehlke-Milde
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
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Walløe S, Bogh SB, Birkeland SF, Pedersen LK, Lykkebo AW, Andersen LLT, Frederiksen-Møller B, Morsø L. Using complaints from obstetric care for improving women's birth experiences - a cross sectional study. BMC Pregnancy Childbirth 2023; 23:705. [PMID: 37789282 PMCID: PMC10546670 DOI: 10.1186/s12884-023-06022-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/23/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Staff shortages and quality in obstetric care is a concern in most healthcare systems and a hot topic in the public debate that has centred on complaints about deficient care. However there has been a lack of empirical data to back the debate. The aim of this study was to analyse and describe complaints in obstetric care. Further, to compare the obstetric complaint pattern to complaints from women about other hospital services. MATERIALS AND METHODS We used the Healthcare Complaints Analysis Tool to code, analyse and extract contents of obstetric complaint cases in a region of Denmark between 2016 and 2021. We compared the obstetric complaint pattern to all other hospital complaint cases in the same period regarding female patients at a large University Hospital in a cross-sectional study. RESULTS Complaints regarding obstetric care differed from women's complaints regarding other healthcare services. Women from obstetric care raised more problems per complaint, and tended to complain more about relational issues indicated by odds for complaints about staff shortage four times higher in the obstetric care group. Women from obstetric care had a lower proportion of compensation claims. CONCLUSION Systematic complaint analysis acknowledged women's experience in obstetric care and may point to areas that potentially need further attention. Complaints from obstetric care show that women experience deficiencies related to relational problems like recognition and individualized support compared to complaints from women receiving other hospital healthcare services.
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Affiliation(s)
- Sisse Walløe
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark.
- The Research and Implementation Unit PROgrez, Physio- and Occupational Therapy Unit, Naestved-Slagelse- Ringsted Hospitals, Faelledvej 2c, Slagelse, 4200, Denmark.
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark.
| | - Søren Bie Bogh
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
| | - Søren Fryd Birkeland
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 15, 2, Odense C, 5000, Denmark
| | - Lone Kjeld Pedersen
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
- Gynecological Obstetric Unit D, Odense University Hospital, Kløvervaenget 5, Odense C, 5000, Denmark
| | | | | | - Britta Frederiksen-Møller
- Women's Health and Labour, Hospital of Southern Jutland, Kresten Phillipsens Vej 15, Aabenraa, 6200, Denmark
| | - Lars Morsø
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
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Großkreutz C, Gürbüz B, Borde T, Rancourt RC, Henrich W, David M, Seidel V. Equal Alternatives or Lower Standards for Immigrant Women-Analyzing Obstetric Care for Immigrant Women in Berlin Within the Framework of Cultural Health Capital. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01732-0. [PMID: 37581765 DOI: 10.1007/s40615-023-01732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
In obstetric clinics in Berlin, Germany, more than half of the women are immigrants. The main objective of the qualitative study was to explore the staff's experiences with obstetric care for immigrants and juxtapose it with the immigrants' comments on their birth experiences. We analyze potential differences along the framework of a cultural health capital (CHC). Between May and August 2017, semi-structured interviews were carried out with 17 obstetricians and 17 midwives at four obstetric clinics in Berlin. The verbally transcribed interview material was subjected to a qualitative content analysis according to Mayring. Furthermore, a secondary data from an interview study was analyzed in the purpose of providing some insight into the practitioner study participant perspective. Between January and May 2017, in the postpartum ward at the Berlin Charité Campus Virchow Clinic, an interview study guided by the migrant-friendly maternity care questionnaire was conducted among 410 migrant and non-migrant women. For this study, the free-text comments on the pregnancy care were analyzed. The staff interviewees identified language barrier and legal status as risk factors for the late onset of obstetric care. CHC functioning potentially as alternatives to the established health care structures were voiced. Strong family ties among immigrant families bear a high potential for support. Gratefulness was voiced by the staff and immigrant patients as a source of satisfaction with care. Our study shows that obstetric care for immigrant women remains a challenge. CHC of immigrant women might partially compensate for exclusion.
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Affiliation(s)
- Claudia Großkreutz
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Burcu Gürbüz
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | | | - Rebecca C Rancourt
- Division of 'Experimental Obstetrics', Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Wolfgang Henrich
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Matthias David
- Clinic of Gynecology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Vera Seidel
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
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Bouaddi O, Zbiri S, Belrhiti Z. Interventions to improve migrants' access to sexual and reproductive health services: a scoping review. BMJ Glob Health 2023; 8:e011981. [PMID: 37311580 DOI: 10.1136/bmjgh-2023-011981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Migrants' access to sexual and reproductive health (SRH) services is constrained by several individual, organisational and structural barriers. To address these barriers, many interventions have been developed and implemented worldwide to facilitate the access and utilisation of SRH services for migrant populations. The aim of this scoping review was to identify the characteristics and scope of interventions, their underlying theory of change, reported outcomes and key enablers and challenges to improve access to SRH services for migrants. METHODS A scoping review was conducted according to the Arksey and O'Malley (2005) guidelines. We searched three electronic databases (MEDLINE, Scopus and Google Scholar) and carried out additional searches using manual searching and citations tracking of empirical studies addressing interventions aimed at improving access and utilisation of SRH services for migrant populations published in Arabic, French or English between 4 September 1997 and 31 December 2022. RESULTS We screened a total of 4267 papers, and 47 papers met our inclusion criteria. We identified different forms of interventions: comprehensive (multiple individual, organisational and structural components) and focused interventions addressing specific individual attributes (knowledge, attitude, perceptions and behaviours). Comprehensive interventions also address structural and organisational barriers (ie, the ability to pay). The results suggest that coconstruction of interventions enables the building of contextual sensitive educational contents and improved communication and self-empowerment as well as self-efficacy of migrant populations, and thus improved access to SRH. CONCLUSION More attention needs to be placed on participative approaches in developing interventions for migrants to improve access to SRH services.
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Affiliation(s)
- Oumnia Bouaddi
- International School of Public Health, Mohammed VI University of Health and Sciences (UM6SS), Casablanca, Morocco
- Knowledge for Health Policies Center, University Mohammed VI of Health and Sciences, (UM6SS), Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, (CM6), Rabat, Morocco
| | - Saad Zbiri
- International School of Public Health, Mohammed VI University of Health and Sciences (UM6SS), Casablanca, Morocco
- Knowledge for Health Policies Center, University Mohammed VI of Health and Sciences, (UM6SS), Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, (CM6), Rabat, Morocco
| | - Zakaria Belrhiti
- International School of Public Health, Mohammed VI University of Health and Sciences (UM6SS), Casablanca, Morocco
- Knowledge for Health Policies Center, University Mohammed VI of Health and Sciences, (UM6SS), Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, (CM6), Rabat, Morocco
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Rasmussen TD, Nybo Andersen AM, Ekstrøm CT, Jervelund SS, Villadsen SF. Improving health literacy responsiveness to reduce ethnic and social disparity in stillbirth and infant health: A cluster randomized controlled effectiveness trial of the MAMAACT intervention. Int J Nurs Stud 2023; 144:104505. [PMID: 37267853 DOI: 10.1016/j.ijnurstu.2023.104505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/26/2023] [Accepted: 04/12/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The MAMAACT intervention aims to reduce ethnic and social disparities in stillbirth and infant death by improving communication between pregnant women and midwives regarding warning signs of pregnancy complications. This study evaluates the effect of the intervention on pregnant women's health literacy (two domains from the Health Literacy Questionnaire) and complication management - interpreted as improved health literacy responsiveness among midwives. DESIGN Cluster randomized controlled trial, 2018-2019. SETTING 19 of 20 Danish maternity wards. PARTICIPANTS Cross-sectional survey data were collected using telephone interviews (n = 4150 pregnant women including 670 women with a non-Western immigrant background). INTERVENTION A six-hour training session for midwives in intercultural communication and cultural competence, two follow-up dialog meetings, and health education materials for pregnant women on warning signs of pregnancy complications - in six languages. MAIN OUTCOME MEASURES Differences in mean scores at post-implementation of the domains Active engagement with healthcare providers (Active engagement) and Navigating the healthcare system from the Health Literacy Questionnaire, and differences in the certainty of how to respond to pregnancy complication signs between women in the intervention and control group. RESULTS No difference was observed in women's level of Active engagement or Navigating the healthcare system. Women from the intervention group were more certain of how to respond to complication signs: Redness, swelling, and heat in one leg: 69.4 % vs 59.1 %; aOR 1.57 (95 % CI 1.32-1.88), Severe headache: 75.6 % vs 67.3 %; aOR 1.50 (95 % CI 1.24-1.82), and Vaginal bleeding: 97.3 % vs 95.1 %; aOR 1.67 (95 % CI 1.04-2.66). CONCLUSION The intervention improved women's certainty of how to respond to complication signs, but was unable to improve pregnant women's health literacy levels of Active engagement and Navigating the healthcare system, likely due to barriers related to the organization of antenatal care. A reorganization of antenatal care and a care model sensitive to diversity within the entire healthcare system might help reduce disparities in perinatal health. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03751774.
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Affiliation(s)
- Trine Damsted Rasmussen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1353 Copenhagen K, Denmark.
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1353 Copenhagen K, Denmark.
| | - Claus Thorn Ekstrøm
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1353 Copenhagen K, Denmark.
| | - Signe Smith Jervelund
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1353 Copenhagen K, Denmark.
| | - Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1353 Copenhagen K, Denmark.
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Damsted Rasmussen T, Fredsted Villadsen S, Hansen AV, Mortensen LH, Ekstrøm CT, Jervelund SS, Nybo Andersen AM. Effectiveness evaluation of an antenatal care intervention addressing disparities to improve perinatal outcomes in Denmark: A nationwide register-based analysis of a cluster randomised controlled trial (MAMAACT). BJOG 2023; 130:759-769. [PMID: 36655509 DOI: 10.1111/1471-0528.17404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate whether MAMAACT, an antenatal care (ANC) intervention, aimed at reducing ethnic and social disparities in perinatal mortality, affected perinatal health outcomes. DESIGN Cluster randomised controlled trial. SETTING Nineteen of 20 maternity wards in Denmark. POPULATION All newborn children within a pre-implementation period (2014-2017) or an implementation period (2018-2019) (n = 188 658). INTERVENTION A 6-h training session for midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials for pregnant women on warning signs of pregnancy complications in six languages. METHODS Nationwide register-based analysis of the MAMAACT cluster randomised controlled trial. Mixed-effects logistic regression models were used to estimate the change in outcomes from pre- to post-implementation in the intervention group relative to the control group. Results were obtained for the overall study population and for children born to immigrants from low- to middle-income countries, separately. Models were adjusted for confounders selected a priori. MAIN OUTCOME MEASURES A composite perinatal mortality and morbidity outcome, including stillbirths, neonatal deaths, Apgar score <7, umbilical arterial pH < 7.0, admissions to a neonatal intensive care unit (NICU) >48 h, and NICU admissions for mechanical ventilation. Additional outcomes were the individual measures. RESULTS The intervention increased the risk of the composite outcome (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 0.99-1.34), mainly driven by differences in NICU admission risk (composite outcome excluding NICU, aOR 0.98, 95% CI 0.84-1.14). The intervention slightly increased the risk of low Apgar score and decreased the risk of low arterial pH, reflecting, however, small differences in absolute numbers. Other outcomes were unchanged. CONCLUSIONS Overall, the MAMAACT intervention did not improve the composite perinatal mortality and morbidity outcome (when excluding NICU admissions). The lack of effects may be due to contextual factors including organisational barriers in ANC hindering the midwives from changing practices.
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Affiliation(s)
- Trine Damsted Rasmussen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | | | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.,Data Science Lab, Statistics Denmark, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Signe Smith Jervelund
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Smith Jervelund S, Villadsen SF. Evidence in public health: An integrated, multidisciplinary concept. Scand J Public Health 2022; 50:1012-1017. [PMID: 36245409 DOI: 10.1177/14034948221125341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Traditionally, evidence in public health has been founded in health sciences using the hierarchy of evidence. In this Commentary, we argue that we need a combination of evidence based on a broad range of scientific disciplines and methodologies to best translate research into improved public health. METHODS Using existing concepts of evidence such as the hierarchy of evidence and the evidence typology, we discuss their pitfalls in public health science and suggest a way forward. We use the case of the MAMAACT intervention to exemplify our claims. RESULTS Public health does not apply an either/or perspective, but an integrated, theoretically informed approach based on mixed and multiple methods to understand complex health problems and how to tackle them. Ideally, public health decisions should always incorporate scientific evidence, although we need to fully acknowledge that the quality of evidence is defined by more than just being placed highest in the hierarchy of evidence. No method or study design is superior in obtaining evidence, but we need the combined and supplemented contributions from a range of scientific approaches to form a whole. Thus, we propose an integrated, multidisciplinary concept of evidence in the form of cogwheels, where the public health problem followed by the research question(s) will guide the components to be studied and the use of method(s) in an interplay with the decisions of the scientific perspective(s) that include choice of theories. CONCLUSIONS We cannot understand or solve public health challenges without multidisciplinary approaches in a complimentary formation.
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Affiliation(s)
- Signe Smith Jervelund
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Denmark.,Danish Society of Public Health, Denmark
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How George Floyd and COVID-19 are highlighting structural inequities for vulnerable women, children and adolescents. Int J Equity Health 2021; 20:193. [PMID: 34454513 PMCID: PMC8401353 DOI: 10.1186/s12939-021-01540-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
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Implementation, Mechanisms and Context of the MAMAACT Intervention to Reduce Ethnic and Social Disparity in Stillbirth and Infant Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168583. [PMID: 34444335 PMCID: PMC8391863 DOI: 10.3390/ijerph18168583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
The MAMAACT intervention aimed to address ethnic and social disparity in stillbirth and infant health by improving management of pregnancy complications. This process evaluation of the intervention was guided by the British Medical Research Council’s framework. We examined implementation through dose, reach, and fidelity, important mechanisms and the influence of contextual factors. The intervention included a six-hour training session for antenatal care (ANC) midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials (leaflet and app) on warning signs of severe pregnancy complications and how to respond for pregnant women. A mixed-methods approach was applied. Cross-sectional survey data and administrative data were used to assess intervention reach and dose. Qualitative data (records from dialogue meetings with midwives, participant observations and field notes from ANC visits, focus group interviews with midwives, and individual interviews with non-Western immigrant women) evaluated intervention fidelity, mechanisms, and contextual barriers. More than 80% of women received the MAMAACT leaflet and many found the content useful. The app was used more selectively. Midwives described being more aware and reflective in their communication with women from various cultural backgrounds. Organizational factors in ANC (time pressure, lack of flexibility in visits, poor interpreter services), barriers in women’s everyday life (lack of social network, previous negative experiences/lack of trust and domestic responsibilities), and habitual interaction patterns among midwives served as contextual barriers. The reach of the intervention was high and it was evaluated positively by both pregnant women and midwives. Organizational factors hindered changes towards more needs-based communication in ANC potentially hindering the intended mechanisms of the intervention. When interpreting the intervention effects, attention should be drawn to both organizational and interpersonal factors in the clinic as well as the pregnant women’s life situations.
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