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Malinen K, Kennedy K, MacLeod E, VanTassel B, O'Rourke K. Culturally Diverse Female-Identified Students Discuss Sexual Assault Policies: Dialectics of Safety/Danger. AFFILIA 2024; 39:407-424. [PMID: 39099643 PMCID: PMC11296935 DOI: 10.1177/08861099231208945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
This article presents dialectical themes that emerged from the grounded theory analysis of 42 focus groups about university sexual assault policies held at four universities in Nova Scotia, Canada. Fourteen cultural communities were represented. Data from female-identified focus groups representing five cultures is deployed to exemplify dialectical themes. When it comes to university sexual assault policies and services, students navigate conflicting needs for disclosure and privacy, justice, and protection. These tensions are intersectionally shaped by gender and culture. Our analysis and recommendations can inform practitioners, including social workers, as they support survivors/victims, particularly of campus sexual violence, in navigating the complexities of decisions about seeking support and/or justice.
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Affiliation(s)
- KelleyA. Malinen
- Sociology & Anthropology, Mount Saint Vincent University, Halifax, Canada
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Andrén A, Lindgren H, Akselsson A, Rådestad I, Erlandsson K. One size does not fit all: Perspectives from Swedish midwives on fetal movement counselling. Women Birth 2024; 37:101621. [PMID: 38688145 DOI: 10.1016/j.wombi.2024.101621] [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: 11/24/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PROBLEM Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden. BACKGROUND Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities. AIM To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings. METHODS Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis. FINDINGS The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures. DISCUSSION Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy. CONCLUSION To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.
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Affiliation(s)
- Anna Andrén
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden.
| | - Helena Lindgren
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden; Department of Women's and Children's Health, Karolinska Institute, Tomtebodavägen 18A, Solna SE-171 77, Sweden
| | - Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden
| | - Ingela Rådestad
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden
| | - Kerstin Erlandsson
- School of Health and Welfare, Dalarna University, Högskolegatan 2, Falun SE-791 88, Sweden
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Soman DA, Joseph A, Moore A. Influence of the Physical Environment on Maternal Care for Culturally Diverse Women: A Narrative Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241227601. [PMID: 38379226 DOI: 10.1177/19375867241227601] [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: 02/22/2024]
Abstract
OBJECTIVES This narrative literature review aims to develop a framework that can be used to understand, study, and design maternal care environments that support the needs of women from diverse racial and ethnic groups. BACKGROUND Childbirth and the beginning of life hold particular significance across many cultures. People's cultural orientation and experiences influence their preferences within healthcare settings. Research suggests that culturally sensitive care can help improve the experiences and outcomes and reduce maternal health disparities for women from diverse cultures. At the same time, the physical environment of the birth setting influences the birthing experience and maternal outcomes such as the progression of labor, the use of interventions, and the type of birth. METHODS The review synthesizes articles from three categories: (a) physical environment of birthing facilities, (b) physical environment and culturally sensitive care, and (c) physical environment and culturally sensitive birthing facilities. RESULTS Fifty-five articles were identified as relevant to this review. The critical environmental design features identified in these articles were categorized into different spatial scales: community, facility, and room levels. CONCLUSIONS Most studies focus on maternal or culturally sensitive care settings outside the United States. Since the maternal care environment is an important aspect of their culturally sensitive care experience, further studies exploring the needs and perspectives of racially and ethnically diverse women within maternal care settings in the United States are necessary. Such research can help future healthcare designers contribute toward addressing the ongoing maternal health crisis within the country.
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Affiliation(s)
- Devi A Soman
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, SC, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, Clemson University, SC, USA
- School of Architecture and Industrial Engineering, Clemson University, SC, USA
| | - Arelis Moore
- Community Health and Spanish, Department of Languages, Clemson University, SC, USA
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Lognos B, Oude Engberink A, Gonzalez L, Leandri J, Charlot Pisoni C, Rachedi N, Clary B, Bourrel G, Bayen S, Million E. Meeting the needs of pregnant women in socially vulnerable situations: A phenomenological qualitative study. Heliyon 2024; 10:e24881. [PMID: 38318039 PMCID: PMC10840009 DOI: 10.1016/j.heliyon.2024.e24881] [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: 04/03/2022] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Objective Vulnerability relates to fragile physical, psychological, and socio-environmental circumstances. Pregnant women's social vulnerability can lead to disruptions in their medical follow-ups, prematurity, and increased infant mortality rates, such that their special needs must be considered. Yet, despite different governments' 'perinatality' plans, international literature suggests their care can be improved. Although quantitative studies regularly evaluate these plans, few studies have assessed vulnerable pregnant women's views. This study explores the needs and expectations of vulnerable women regarding their follow-ups during pregnancy and identified strategies to improve their circumstances. Methods The study was a phenomenological qualitative study involving semi-structured interviews with women who gave birth in the past six months (December 2017 to June 2018) and who fulfilled at least one vulnerability criterion. The women were recruited by French midwives and general practitioners (GPs). Findings Concerning these vulnerable pregnant women, three phenomenological categories emerged: 1) they need to be monitored by a single trusted contact; 2) they seek medical and social support adapted to their situations that addresses their needs; and 3) they expect kind and person-centred communication skills from professionals who provide them appropriate information. Conclusion We identified various international recommendations to screen and care for vulnerable pregnant women, but still these women often experience numerous challenges. Finally, the implementation of recommendations for healthcare professionals based on women's real-life experiences could help optimise the identification of vulnerable pregnant women as well as their follow-up care.
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Affiliation(s)
- Béatrice Lognos
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Agnès Oude Engberink
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluri professionnelle universitaire Avicenne, 2 rue IBN Sinaï dit Avicenne 66 330 Cabestany, France
| | - Lorène Gonzalez
- Centre médical, Rue de la Brèche, 34630 Saint-Thibéry, France
| | - Julia Leandri
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Carla Charlot Pisoni
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Nadia Rachedi
- Département de L’Hérault, Hôtel du Département mas d’Alco, 1977 avenue du mas de Moulin 34087 Montpellier, France
| | - Bernard Clary
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de Santé Professionnelle 20 route Minervois, 11800 Trèbes, France
| | - Gérard Bourrel
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
| | - Sabine Bayen
- Department of General Practice, Pôle formation Faculté médecine H. Warembourg 59045 Lille CEDEX 1, University of Lille, 1, place de Verdun, 59045, France
| | - Elodie Million
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
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Morton Ninomiya ME, Almomani Y, Dunbar Winsor K, Burns N, Harding KD, Ropson M, Chaves D, Wolfson L. Supporting pregnant and parenting women who use alcohol during pregnancy: A scoping review of trauma-informed approaches. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057221148304. [PMID: 36744547 PMCID: PMC9905036 DOI: 10.1177/17455057221148304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alcohol is legalized and used for a variety of reasons, including socially or as self-medication for trauma in the absence of accessible and safe supports. Trauma-informed approaches can help address the root causes of alcohol use, as well as the stigma around women's alcohol use during pregnancy. However, it is unclear how these approaches are used in contexts where pregnant and/or parenting women access care. Our objective was to synthesize existing literature and identify promising trauma-informed approaches to working with pregnant and/or parenting women who use alcohol. A multidisciplinary team of scholars with complementary expertise worked collaboratively to conduct a rigorous scoping review. All screening, extraction, and analysis was independently conducted by at least two authors before any differences were discussed and resolved through team consensus. The Joanna Briggs Institute method was used to map existing evidence from peer-reviewed articles found in PubMed, CINAHL, PsycINFO, Social Work Abstracts, and Web of Science. Data were extracted to describe study demographics, articulate trauma-informed principles in practice, and gather practice recommendations. Thirty-six studies, mostly from the United States and Canada, were included for analysis. Studies reported on findings of trauma-informed practice in different models of care, including live-in treatment centers, case coordination/management, integrated and wraparound supports, and outreach-for pregnant women, mothers, or both. We report on how the following four principles of trauma-informed practices were applied and articulated in the included studies: (1) trauma awareness; (2) safety and trustworthiness; (3) choice, collaboration, and connection; and (4) strengths-based approach and skill building. This review advances and highlights the importance of understanding trauma and applying trauma-informed practice and principles to better support women who use alcohol to reduce the risk of alcohol-exposed pregnancies. Relationships and trust are central to trauma-informed care. Moreover, when applying trauma-informed practices with pregnant and parenting women who use alcohol, we must consider the unique stigma attached to alcohol use.
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Affiliation(s)
- Melody E Morton Ninomiya
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, ON, Canada,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada,Melody E Morton Ninomiya, Department of Health Sciences, Wilfrid Laurier University, Rm. BA0546, 75 University Avenue West, Waterloo, ON N2L 3C5, Canada.
| | - Yasmeen Almomani
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | | | - Nicole Burns
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Kelly D Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada,School of Liberal Arts, Laurentian University, Sudbury, ON, Canada
| | - Megan Ropson
- Memorial University, St. John’s, NL, Canada,Labrador-Grenfell Health, Happy Valley-Goose Bay, NL, Canada
| | - Debbie Chaves
- Library, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Lindsay Wolfson
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada,Centre of Excellence for Women’s Health, Vancouver, BC, Canada
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Ghimire PR, Buck G, Jackson J, Woolley E, Bowman R, Fox L, Gallagher S, Sorrell M, Dubois L. Impact of Antenatal Care on Perinatal Outcomes in New South Wales, Australia: A Decade-Long Regional Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:977. [PMID: 36673735 PMCID: PMC9859161 DOI: 10.3390/ijerph20020977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Low birth weight (LBW) and preterm birth are adverse perinatal outcomes that pose a significant risk to a child's healthy beginning. While antenatal care (ANC) is an established intervention for pregnancy care, little is understood about how the number and timing of ANC visits can impact these adverse health outcomes. This study aimed to examine the impact of the number and timing of ANC visits on LBW and preterm birth in a regional setting. A decade-long perinatal dataset related to singleton live births that took place in the Southern New South Wales Local Health District (SNSWLHD) was utilized. The outcomes of interest were LBW and preterm birth, and the exposure variables were based on the Australian pregnancy guidelines on the number and timing of ANC visits. A multivariable logistic regression was performed to measure the association between outcome and exposure while adjusting for potential confounders. A greater level of protection against LBW and preterm birth was observed among mothers who had an adequate number of visits, with early entry (first trimester) into ANC. The protective effect of an adequate number of ANC visits against LBW and preterm birth among mothers with late entry into ANC (third trimester) was found to be statistically non-significant.
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Affiliation(s)
- Pramesh Raj Ghimire
- Priority Populations, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Gretchen Buck
- Priority Populations, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Jackie Jackson
- Aboriginal Health, Southern New South Wales Local Health District, Batemans Bay, NSW 2536, Australia
| | - Emma Woolley
- Priority Populations, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Rebekah Bowman
- Nursing and Midwifery, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Louise Fox
- Integrated Care and Allied Health, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
| | - Shirlena Gallagher
- People and Wellbeing, Southern New South Wales Local Health District, Batemans Bay, NSW 2536, Australia
| | | | - Lorraine Dubois
- Priority Populations, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia
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Capper TS, Williamson M, Chee R. How is cultural safety understood and translated into midwifery practice? A scoping review and thematic analysis. Nurse Educ Pract 2023; 66:103507. [PMID: 36410133 DOI: 10.1016/j.nepr.2022.103507] [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: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
AIM To identify and understand the scope of the literature published since January 2008 that explored Australian midwives understanding of cultural safety and how this is translated into their practice when caring for First Nations women and families. BACKGROUND Recognition and understanding of First Nations peoples history and culture and the impact this has on the health and wellbeing of women and their families is essential if the midwife is to promote culturally safe and respectful maternity care. The role and responsibilities of the midwife in ensuring that their practice is culturally safe are now reflected in the Australian professional midwifery codes and standards. Whilst midwifery academics' awareness of cultural safety and how it is taught within midwifery education programs have previously been explored, at present, little is known about midwives' understanding of cultural safety, and how this translates into their clinical practice. METHODS A Scoping Review was undertaken following Arksey and O'Malley's five step process. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses - Scoping Review extension checklist. Twelve studies met the criteria for inclusion. Thematic analysis was used to analyse the data and organise the results. RESULTS Thematic analysis, guided by two predetermined review questions led to the identification of six overarching themes: 'Awareness of deficiencies', 'The importance of meeting women's diverse needs', 'Understanding relationships as a foundation for culturally safe care', 'Working in partnership with others', 'Providing individualised care' and 'Fostering effective relationships and communication'. One sub-theme of the first theme was identified, this was named 'Seeking an understanding of culture'. CONCLUSION Australian midwives' level of understanding of cultural safety and how it is translated into their midwifery practice when caring for First Nations women and their families differ widely. Midwives across Australia require increased and equitable access to appropriate opportunities to improve their knowledge and understanding of cultural safety. Whilst theoretical learning on cultural safety has a place in all midwives annual mandatory training requirements, this should ideally be supplemented, where possible, with opportunities for immersive practice in communities. Immersion was considered the optimal way to gain rich knowledge and understanding to strengthen culturally safe midwifery practice. Continuity models of midwifery care which incorporate the principles of cultural safety should be consistently implemented across Australia. These models enable midwives, women, families, communities, and Aboriginal Support Workers to work in collaboration towards achieving optimal outcomes for mothers and babies. STUDY REGISTRATION N/A.
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Affiliation(s)
- Tanya S Capper
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, Level 20, 160 Ann Street, Brisbane, Queensland 4000, Australia.
| | - Moira Williamson
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, Level 21, 160 Ann Street, Brisbane, Queensland 4000, Australia.
| | - Rachelle Chee
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, 160 Ann Street, Brisbane, Queensland 4000, Australia.
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Sivertsen N, Deverix J, Gregoric C, Grant J. A call for culture-centred care: exploring health workers' perspectives of positive care experiences and culturally responsive care provision to Aboriginal women and their infants in mainstream health in South Australia. Health Res Policy Syst 2022; 20:132. [PMID: 36510198 PMCID: PMC9743671 DOI: 10.1186/s12961-022-00936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective, and appropriate maternal and child health care can contribute to reducing these existing health disparities. This research sought to explore factors that contribute to continuity of care for Aboriginal women and their infants living in metropolitan South Australia. This paper reports on the perspectives of health care workers in mainstream health services from the antenatal period to the end of an infants' second birthday. It explores health workers' perspectives of what contributes to positive care experiences and satisfaction with care provided to Aboriginal women and their infants in mainstream health. METHODS Eight focus groups were held with 52 health professionals. Participants included Aboriginal Cultural Child and Family Support Consultants (n = 7), Aboriginal Maternal Infant Care Workers (n = 3), Midwives (n = 3) and Child and Family Nurses (n = 39). Data was inductively coded and thematically analysed. RESULTS Three key themes emerged: the system takes priority, culture is not central in approaches to care, and 'we've got to be allowed to do it in a different way'. CONCLUSIONS This research highlights a lack of continuity of care for Aboriginal families accessing mainstream health services from the antenatal period through to an infants' first 1000 days of life. This research has implications for communities, and it calls for strategies to enhance continuity, and healthcare services to provide appropriate and culturally safe care. Findings will inform and guide future changes to improve continuity of care for Aboriginal families and infants in the first 1000 days.
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Affiliation(s)
- Nina Sivertsen
- grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia ,grid.10919.300000000122595234Department of Health and Care Sciences, UiT Arctic University of Norway, Campus Hammerfest/Kautokeino, Tromsø, Norway
| | - Janiene Deverix
- grid.431036.3Child and Family Health Service, Women’s Children’s Health Network, 295 South Terrace, Adelaide, SA 5000 Australia
| | - Carolyn Gregoric
- grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Julian Grant
- grid.1037.50000 0004 0368 0777School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Panorama Ave, Bathurst, NSW 2795 Australia
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Durowaye TD, Rice AR, Konkle ATM, Phillips KP. Public health perinatal promotion during COVID-19 pandemic: a social media analysis. BMC Public Health 2022; 22:895. [PMID: 35513864 PMCID: PMC9069960 DOI: 10.1186/s12889-022-13324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Canadian public health agencies, both municipal/regional and provincial/territorial, are responsible for promoting population health during pregnancy and the early postnatal period. This study examines how these agencies use web-based and Facebook channels to communicate perinatal health promotion during the emergence of the COVID-19 pandemic. Methods Perinatal health promotion content of websites and Facebook posts from a multijurisdictional and geographically diverse sample of government and non-governmental organizations (NGO) were evaluated using thematic content analysis in 2020. Results Major Facebook perinatal health promotion themes included breastfeeding, infant care, labor/delivery, parenting support and healthy pregnancy. Facebook COVID-19-themed perinatal health promotion peaked in the second quarter of 2020. Websites emphasized COVID-19 transmission routes, disease severity and need for infection control during pregnancy/infant care, whereas Facebook posts focussed on changes to local health services including visitor restrictions. NGO perinatal health promotion reflected organizations’ individual mandates. Conclusions Canadian government use of Facebook to disseminate perinatal health promotion during the COVID-19 pandemic varied in terms of breadth of topics and frequency of posts. There were missed opportunities to nuance transmission/severity risks during pregnancy, thereby proactively countering the spread of misinformation.
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Affiliation(s)
- Toluwanimi D Durowaye
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Alexandra R Rice
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Anne T M Konkle
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.,University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
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Mohamed Shaburdin Z, Bourke L, Mitchell O, Newman T. 'It's a cultural thing': excuses used by health professionals on providing inclusive care. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:1-15. [PMID: 34018893 DOI: 10.1080/14461242.2020.1846581] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals - as holders of organisational power - and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support.
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Affiliation(s)
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
| | - Olivia Mitchell
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
| | - Trudie Newman
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
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Wodtke L, Hayward A, Nychuk A, Doenmez C, Sinclair S, Cidro J. The need for sustainable funding for Indigenous doula services in Canada. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221093928. [PMID: 35438029 PMCID: PMC9021521 DOI: 10.1177/17455057221093928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To interview representatives from Indigenous doulas across Canada in order to document how they manage the logistics of providing community-based doula care and understand their challenges. These objectives inform the development of an Indigenous doula pilot programme as part of the project, 'She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas'. METHODS In 2020, semi-structured interviews were conducted with members of five Indigenous doula collectives across Canada. Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. RESULTS Our article explores one of the main themes that emerged from these interviews: sustainable funding for Indigenous doula services. Within this theme we identified two sub-themes: (1) limitations on and regulations for available funding and (2) negative impacts of limited funding on doula service. CONCLUSION A major challenge to providing Indigenous community-based doula services is sustainable funding. Current models of funding for this work often do not provide livable wages and are bound by limited durations and regulations that are unsustainable and can be culturally inappropriate. Due to this lack of sustainable funding, Indigenous doula service in Canada faces challenges that include high staff turnover and burnout and lack of time and resources to provide culturally safe care, pursue professional development and additional training, and keep their services affordable for the families who need them. Future research is needed to ascertain potential programmes and funding streams for sustainable Indigenous doula support in Canada, including possible integration of doula care into the universal public health care system despite the jurisdictional challenges in providing health care for Indigenous peoples.
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Affiliation(s)
- Larissa Wodtke
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
| | - Ashley Hayward
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
- Department of Peace and Conflict Studies, University of Manitoba, Winnipeg, MB, Canada
| | - Alexandra Nychuk
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
| | - Caroline Doenmez
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
- Department of Anthropology, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Sinclair
- Department of Native Studies, University of Manitoba, Winnipeg, MB, Canada
| | - Jaime Cidro
- Kishaadigeh Collaborative Research Centre, The University of Winnipeg, Winnipeg, MB, Canada
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Ngotie TK, Kaura DKM, Mash B. Awareness of cultural practices by skilled birth attendants during pregnancy and birth in Kenya: An interpretive phenomenological study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jamieson EL, Spry EP, Kirke AB, Griffiths E, Porter C, Roxburgh C, Singleton S, Sterry K, Atkinson DN, Marley JV. Real-world screening for diabetes in early pregnancy: Improved screening uptake using universal glycated haemoglobin. Prim Care Diabetes 2021; 15:995-1001. [PMID: 34696991 DOI: 10.1016/j.pcd.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/10/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Abstract
AIMS To improve perinatal outcomes, screening for hyperglycaemia using 75 g oral glucose tolerance test (OGTT) is recommended for all pregnant women at 24-28 weeks gestation (routine), and earlier if high-risk. Screening coverage for remote and Aboriginal Australian women is less than ideal. This study examined OGTT completion (early and routine) by women from rural and remote Western Australia compared with early glycated haemoglobin (HbA1c). METHODS In 2015-2018, 27 primary health care sites recruited 600 (233 Aboriginal) women aged ≥16-years, without pre-existing diabetes, who delivered >30-weeks gestation. All women presenting <20-weeks gestation (541) were offered an early study HbA1c. Early OGTTs were requested at the discretion of the local clinician, with routine OGTT offered at 24-28 weeks. RESULTS HbA1c uptake was high (85.7% Aboriginal, 86.4% non-Aboriginal); OGTT completion in Aboriginal women was low (early OGTT: 38.6% v 69.6% non-Aboriginal, P < 0.001; routine OGTT: 44.5% v 84.7% non-Aboriginal, P < 0.001). Aboriginal women with both early tests had HbA1c completed 3-weeks prior to OGTT (9.6 ± 3.5 v 12.5 ± 3.5 weeks gestation, P < 0.001). CONCLUSIONS Universal early pregnancy HbA1c appears feasible as an early screening test for women at risk of hyperglycaemia in pregnancy and would expedite and increase screening in Aboriginal women compared to an early OGTT.
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Affiliation(s)
- Emma L Jamieson
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 412, Bunbury, Western Australia 6230, Australia.
| | - Erica P Spry
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, Western Australia 6725, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Andrew B Kirke
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 412, Bunbury, Western Australia 6230, Australia.
| | - Emma Griffiths
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Cynthia Porter
- Geraldton Regional Aboriginal Medical Service, PO Box 5276, Geraldton, Western Australia 6531, Australia.
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, 35 Stirling Terrace, Albany, Western Australia 6330, Australia.
| | - Sally Singleton
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Kylie Sterry
- The Rural Clinical School of Western Australia, The University of Western Australia, St Alban's Road (rear Kalgoorlie Hospital), Kalgoorlie, Western Australia 6433, Australia.
| | - David N Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Julia V Marley
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, Western Australia 6725, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
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MacKay D, Freeman N, Boyle JA, Campbell S, McLean A, Peiris D, Corpus S, Connors C, Moore E, Wenitong M, Silver B, McIntyre HD, Shaw JE, Brown A, Kirkham R, Maple-Brown L. Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation. Int J Gynaecol Obstet 2021; 155:179-194. [PMID: 34331708 DOI: 10.1002/ijgo.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia. METHODS A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff. RESULTS Interviewees (n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor-intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy. CONCLUSION The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy.
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Affiliation(s)
- Diana MacKay
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Natasha Freeman
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Queensland, Australia
| | - Anna McLean
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Diabetes and Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - David Peiris
- Centre for Health Systems Science, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Sumaria Corpus
- Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Christine Connors
- Population & Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Mark Wenitong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - H David McIntyre
- Clinical Unit, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Renae Kirkham
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Louise Maple-Brown
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Longitudinal Follow Up of Early Career Midwives: Insights Related to Racism Show the Need for Increased Commitment to Cultural Safety in Aboriginal Maternity Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031276. [PMID: 33572624 PMCID: PMC7908636 DOI: 10.3390/ijerph18031276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 12/04/2022]
Abstract
Racism in health care undermines equitable service delivery, contributes to poorer health outcomes and has a detrimental effect on the Aboriginal workforce. In maternity care settings, Aboriginal women’s perceptions of discrimination are widespread, with the importance of cultural practices surrounding childbirth often not recognised. Efforts to build midwives’ cultural capabilities and address health disparities have seen Aboriginal content included in training programs but little is known about its application to clinical practice. This study reinterviewed midwives who had previously completed university midwifery training that aimed to increase understanding of Aboriginal people and cultural safety in health care. Participants were 14 non-Indigenous midwives and two Aboriginal midwives. Interviews explored the legacy of program initiatives on cultural capabilities and observations and experiences of racism in maternity care settings. Methods followed qualitative approaches for research rigour, with thematic analysis of transcribed interviews. Findings revealed the positive impact of well-designed content and placements, with non-Indigenous participants cognisant and responsive to casual racism but largely not recognising institutional racism. The Aboriginal midwives had experienced and were attuned to racism in all its guises and suggested initiatives to heighten awareness and dispel stereotypes. It is evident that greater attention must be paid to institutional racism in educational programs to increase its recognition and appropriate actions within health care settings.
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Kelly J, Dowling A, McBride K, Keech W, Brown A. 'We get so task orientated at times that we forget the people': staff communication experiences when caring for Aboriginal cardiac patients. AUST HEALTH REV 2020; 44:1-6. [PMID: 30466504 DOI: 10.1071/ah17290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to describe the experiences of communication for staff providing cardiac care for Aboriginal and Torres Strait Islander patients in hospital and discuss potential improvements. Methods Focus group discussions were performed with 58 multidisciplinary staff who provide care for Aboriginal and Torres Strait Islander cardiac patients in two metropolitan and two regional hospitals in South Australia and Northern Territory. Inductive thematic analysis was undertaken to identify staff perceptions of communication challenges and strategies for improvement. Results There were five key themes: (1) communication is central to good care; (2) communication within busy clinical environments; (3) supporting a strong Aboriginal workforce; (4) a cultural as well as clinical focus; and (5) particular challenges working with patients from remote areas. Conclusions Providing effective communication that is both clinically and culturally appropriate is often challenging within a busy and non-adaptive hospital environment. Moving beyond clinical tasks, increased Aboriginal and Torres Strat Islander health workforce and cultural competency, supporting coordinated care and improved skills are required to meet the communication needs of Aboriginal and Torres Strait Islander patients. What is known about this topic? Communication between patients, their families and hospital staff is crucial for health care quality and safety. There is little understanding of the challenges and opportunities for staff to meet the communication needs of Aboriginal and Torres Strait Islander cardiac patients to address disparities in acute care settings. What does this paper add? This paper discusses the barriers and potential improvements, as identified by hospital staff providing care to Aboriginal and Torres Strait Islander cardiac patients in both metropolitan and regional settings. What are the implications for practitioners? Practitioners should be trained and supported in providing both clinically and culturally safe care for Aboriginal and Torres Strait Islander patients. This requires adequate time, two-way communication and resources to support and facilitate effective communication.
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Affiliation(s)
- Janet Kelly
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, North Terrace, Adelaide, SA 5001, Australia. ;
| | - Anna Dowling
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, North Terrace, Adelaide, SA 5001, Australia. ;
| | - Katharine McBride
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, North Terrace, Adelaide, SA 5001, Australia. ;
| | - Wendy Keech
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, North Terrace, Adelaide, SA 5001, Australia. ;
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, North Terrace, Adelaide, SA 5001, Australia. ;
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Thackrah RD, Wood J, Thompson SC. Cultural respect in midwifery service provision for Aboriginal women: longitudinal follow-up reveals the enduring legacy of targeted program initiatives. Int J Equity Health 2020; 19:210. [PMID: 33238984 PMCID: PMC7689980 DOI: 10.1186/s12939-020-01325-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022] Open
Abstract
Background Culturally competent maternity care provision to Aboriginal and Torres Strait Islander women was identified as a priority area by Australia’s National Maternity Services Plan in 2011. While midwifery programs responded by including core Indigenous content and community placements in curricula, little is known about whether knowledge learned, and insights gained in response to these initiatives have endured and been applied in clinical practice. This follow-up study explores the impact of a compulsory Indigenous unit and a remote clinical placement on two cohorts of non-Indigenous midwives who were participants in an earlier 2012–14 study. Methods Fourteen non-Indigenous participants who were either students or recent graduates in 2012–14 were located and re-interviewed in 2019–20. In-depth interviews based on a semi-structured interview guide were conducted by telephone or face-to face; recordings were transcribed and thematically analysed using standard qualitative procedures. Results Exposure to Indigenous content and settings during training had an enduring impact on participants’ midwifery practice; most felt better prepared to provide culturally safe care, build respectful relationships and advocate for improved services for Aboriginal women. Despite this positive legacy, they also expressed apprehension about causing offence and recognised their own knowledge deficits with regard to Aboriginal cultural practices. Organisational constraints, including restrictions on the number of family members accompanying a birthing mother were identified as barriers to optimal care; some positive organisational initiatives were also described. Conclusions This follow-up study provides encouraging evidence that well-designed and delivered Indigenous content and community placement opportunities in midwifery programs can have a lasting impact on service provision to Aboriginal women, contribute to a more informed, empathetic and culturally competent maternity workforce and help catalyse health service changes towards more culturally safe care.
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Affiliation(s)
- Rosalie D Thackrah
- Western Australian Centre for Rural Health, University of Western Australia, Nedlands, Western Australia.
| | - Jennifer Wood
- King Edward Memorial Hospital, Subiaco, Western Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Nedlands, Western Australia
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Churchill ME, Smylie JK, Wolfe SH, Bourgeois C, Moeller H, Firestone M. Conceptualising cultural safety at an Indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with Indigenous and non-Indigenous clients. BMJ Open 2020; 10:e038168. [PMID: 32994245 PMCID: PMC7526316 DOI: 10.1136/bmjopen-2020-038168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Cultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care. DESIGN AND SETTING Interviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens. PARTICIPANTS Saturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants). RESULTS Three domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and continuous relationships with midwives; and being different from past experiences); Sharing Knowledge and Practice (feeling informed about the basics of pregnancy, birth, and the postpartum period; and having access to Indigenous knowledge and protocols), and Culturally Safe Spaces (feeling at home in practice; and having relationships interconnected with the physical space). While some ideas were shared across groups, the distinctions between the Indigenous and non-Indigenous participants were prominent. CONCLUSION The Indigenous participants conceptualised cultural safety in ways that highlight the survival and resurgence of Indigenous values, understandings, and approaches in cities like Toronto, and affirm the need for Indigenous midwives. The non-Indigenous participants conceptualised cultural safety with both congruence, illuminating Black-Indigenous community solidarities in cultural safety, and divergence, demonstrating the potential of Indigenous spaces and Indigenous-focused midwifery care to also benefit midwifery clients of white European descent. We hope that the positive impacts documented here motivate evaluators and healthcare providers to work towards a future where 'cultural safety' becomes a standard of care.
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Affiliation(s)
- Mackenzie E Churchill
- Well Living House, MAP Centre for Urban Health Solutions (C-UHS), St Michael's Hospital, Toronto, Ontario, Canada
| | - Janet K Smylie
- Well Living House, MAP Centre for Urban Health Solutions (C-UHS), St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara H Wolfe
- Seventh Generation Midwives Toronto (SGMT), Toronto, Ontario, Canada
| | | | - Helle Moeller
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Michelle Firestone
- MAP Centre for Urban Health Solutions (C-UHS), St. Michael's Hospital, Toronto, Ontario, Canada
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Aboriginal and Torres Strait Islander family access to continuity of health care services in the first 1000 days of life: a systematic review of the literature. BMC Health Serv Res 2020; 20:829. [PMID: 32883268 PMCID: PMC7469361 DOI: 10.1186/s12913-020-05673-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/20/2020] [Indexed: 01/07/2023] Open
Abstract
Background Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective and appropriate maternal and child healthcare can contribute to reducing these existing health disparities. However, accessing mainstream healthcare services often results in high levels of fear and anxiety, and low attendance at subsequent appointments among Aboriginal women, due to inefficient communication, poor service coordination and a lack of continuity of care. Methods This integrative literature review sought to explore factors that contribute to continuity of care and consider service features that contribute to positive care experiences and satisfaction with care received by Aboriginal women and their infants. In total, 28 studies were included in the review and were thematically analysed using Braun and Clarke’s six steps of thematic analysis. This was followed by a collaborative, computer-assisted qualitative analysis, which resulted in the emergence of five key themes: lack of continuity of care, impact of lack of continuity of care, continuity of care interventions, impact of continuity of care interventions, and strategies to improve continuity of care. Results Most studies focused on health services in rural or remote Aboriginal communities and there was a lack of documented evidence of continuity of care (or lack thereof) for Aboriginal women living and birthing in regional and metropolitan areas. The majority of studies focused explicitly on continuity of care during the antenatal, birthing and immediate postnatal period, with only two studies considering continuity through to an infant’s first 1000 days. Conclusion The review highlights a lack of studies exploring continuity of care for Aboriginal families from the antenatal period through to an infants’ first 1000 days of life. Included studies identified a lack of continuity in the antenatal, peri- and postnatal periods in both regional and metropolitan settings. This, along with identified strategies for enhancing continuity, have implications for communities, and healthcare services to provide appropriate and culturally safe care. It also marks an urgent need to incorporate and extend continuity of care and carer through to the first 1000 days for successful maternal and infant health outcomes for Aboriginal peoples.
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Chen MM, Cheng BH. Understanding Taiwanese Women's Decisional Experiences Regarding Prenatal Screening Procedures And Diagnostics: A Phenomenological Study. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:231-240. [PMID: 32835863 DOI: 10.1016/j.anr.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study sought to understand Taiwanese women's decisional experiences regarding prenatal screening procedures and diagnostics. METHODS A hermeneutic phenomenological design guided semistructured interviews with 33 women who were 36 weeks pregnant. Data were collected between February and October 2016. Verbatim transcripts were analyzed following hermeneutic circle to cocreate an understanding of Taiwanese women's decision-making in prenatal screening and diagnostics. RESULTS Women's existential experiences were derived from their decision-making process on prenatal screening procedures and diagnostics for chromosomal aneuploidy. These decisional experiences were captured by four theme clusters and eight themes, which were inductively derived from 16 meaning units: (1) accessing health information; (2) considering what was best for my baby; (3) considering family finance; and (4) feeling anxiety posttest. CONCLUSION Participants made informed choices on several prenatal screening procedures, ostensibly, based on their personal values and considerations. During the decision-making process, often-cited benefits of genetic screenings were emphasized, but test limitations were often unheeded. A fundamental need for supportive information in decision making was further identified with recommended strategies. Hence, a revision of traditional genetic counseling approaches is recommended. As genomics technologies are increasingly available during antenatal services, women should be sufficiently educated about them to support decision making.
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Affiliation(s)
- Mei-Man Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - Bi-Hua Cheng
- Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
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Marriott R, Strobel NA, Kendall S, Bowen A, Eades AM, Landes JK, Adams C, Reibel T. Cultural security in the perinatal period for Indigenous women in urban areas: a scoping review. Women Birth 2019; 32:412-426. [DOI: 10.1016/j.wombi.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
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"Our culture, how it is to be us" - Listening to Aboriginal women about on Country urban birthing. Women Birth 2019; 32:391-403. [PMID: 31345660 DOI: 10.1016/j.wombi.2019.06.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Birth on Country is often assumed as relevant to Aboriginal women in rural/remote locations and not usually associated with urban environments. In Western Australia, one third of the Aboriginal population live in the greater metropolitan area. We wanted to know Aboriginal women's experiences of on Country urban births. METHODS Indigenous qualitative data collection and analysis methods were used to learn about Aboriginal women's stories of contemporary and past experiences of maternity care and cultural practices associated with Birth on Country. RESULTS Aboriginal Birthing, Senior and Elder women consistently reported ongoing cultural practices associated with childbirth including knowledge sharing across generations and family support, observance of extended family present at the time of or shortly after birth, and how their cultural security was improved when Aboriginal staff were present. Also noted, were the inflexibility of health systems to meet their needs and midwives lack of cultural awareness and understanding of the importance of Aboriginal kinship. CONCLUSION The Birthing on Noongar Boodjar project Aboriginal women's data represents four generations of women's stories, experiences and expressions of childbearing, which highlighted that maternity care changes across time have failed to acknowledge and support Aboriginal women's cultural needs during childbearing. In terms of on Country urban birth, the women collectively expressed a strong desire to maintain cultural practices associated with childbirth, including birthing close to home (on Country); having family acknowledged and included throughout the perinatal period; and, having access to Aboriginal midwives, nurses, doctors, and other health care workers to support their cultural security.
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Brookfield J. Group antenatal care for Aboriginal and Torres Strait Islander women: An acceptability study. Women Birth 2019; 32:437-448. [PMID: 31326383 DOI: 10.1016/j.wombi.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.
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Affiliation(s)
- Jo Brookfield
- P.O. Box 53, Earlville, Queensland, 4870, Australia.
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Blanc YB, Dietsch E. The Experience of Australia's First Nations Men Supporting Their Partners During Childbirth: A Descriptive, Interpretive Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2019. [DOI: 10.1891/2156-5287.8.4.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This research explored and described the experiences of Australia's First Nations expectant fathers as they supported their partners during childbirth. A descriptive, interpretive approach used purposive recruitment to the point of data saturation. Five participants were interviewed within 4 days of supporting their partners during childbirth. Interview data were thematically analyzed, and five themes emerged. Three themes were consistent with findings from non–First Nations fathers. Two new themes related to changes in childbearing traditions, “we show affection in different way” and staff support strategies, “educate dads by telling stories about birth”; will be closely examined in this article. This research identified the existence of a new generation of First Nations fathers in Central Australia wishing to guide and support their partners in their journey to parenthood. The development of support programs, responsive to their unique ways of knowing and learning style, will ensure that their needs are optimally met.
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Participatory action research opens doors: Mentoring Indigenous researchers to improve midwifery in urban Australia. Women Birth 2018; 31:263-268. [DOI: 10.1016/j.wombi.2017.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/21/2022]
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Kirkham R, Rumbold A, Hoon E, Stuart-Butler D, Moore V. Emotional labour and aboriginal maternal infant care workers: The invisible load. Women Birth 2017; 31:110-116. [PMID: 28716549 DOI: 10.1016/j.wombi.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The term 'emotional labour' has been used to describe the competing demands on midwives to empathize with clients whilst maintaining a level of professional detachment. Previous research indicates that when individuals experience difficulty managing these emotions, burnout may result. Aboriginal health care workers often have roles with large emotional demands, as they are relied upon heavily to engage clients in care. However, the concept of emotional labour has received little attention in relation to this group. AIM To explore potential sources of emotional labour for Aboriginal Maternal Infant Care workers in a maternity care program for Aboriginal women in South Australia. The program involves these workers providing care for women in partnership with midwives. METHODS We employed a phenomenological approach. Thirty in-depth interviews were conducted with staff and clients of the program. Recorded interviews were transcribed and coded and emerging themes identified. FINDINGS This workforce undertakes extensive emotional labour. Key sources include the cultural and family obligations they have to clients, complex social needs of many clients, and potential for community backlash when poor perinatal outcomes occur. A lack of respect for the role within the workplace further contributes to these experiences. CONCLUSION This study found that the responsibilities inherent to the role as both cultural broker and carer create significant emotional labour for workers. Recommendations to address this and enhance the sustainability of this workforce include: recognition and valuing of emotional work by management and other staff, enhancing cultural awareness training, and building stress-relieving activities into the workplace.
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Affiliation(s)
- R Kirkham
- School of Public Health, University of Adelaide, Australia.
| | - A Rumbold
- Robinson Research Institute, University of Adelaide, Australia
| | - E Hoon
- School of Public Health, University of Adelaide, Australia
| | - D Stuart-Butler
- Aboriginal Health Division, Acute Services, Women's and Children's Hospital, Australia
| | - V Moore
- School of Public Health, University of Adelaide, Australia; Robinson Research Institute, University of Adelaide, Australia; Fay Gale Centre for Research on Gender, University of Adelaide, Australia
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