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Zhi X, McKenzie-McHarg K, Mai DL. Investigating cultural conflicts in everyday self-care among Chinese first-time pregnant migrants in Australia. Midwifery 2024; 135:104038. [PMID: 38823211 DOI: 10.1016/j.midw.2024.104038] [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: 04/02/2024] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Given the fast-growing migration and globalisation trends in the last decades, women increasingly experienced pregnancy as migrants and often faced complex and unique challenges related to both migration and pregnancy in a foreign land, affecting their psychological wellbeing during pregnancy. Cultural conflicts between pregnant migrants' home and host cultures could play a critical role affecting their pregnancy experiences and psychological wellbeing. AIMS This study aimed to explore cultural conflicts that challenge Chinese first-time expectant mothers living in Australia regarding their pregnancy self-care and their psychological wellbeing. METHOD A qualitative methodology was adopted utilising interpretative phenomenological analysis. Participants were 18 Chinese-born first-time pregnant migrants in Australia. A semi-structured interview schedule focused on their pregnancy self-care and psychological wellbeing and any effects of Chinese-Western/Australian cultural conflicts. FINDINGS Two psychosocial approaches were identified to explain how all the participants were psychologically challenged by self-care cultural conflicts to some extent: 1) challenging decision-making processes about self-care cultural conflicts and 2) interpersonal tension if the decisions conflicted with someone's advice/beliefs/opinions. CONCLUSION Emotional, cognitive, and social factors were relevant in shaping the participants' engagement with and their experiences of various pregnancy self-care activities.
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Affiliation(s)
- Xiaojuan Zhi
- Department of Psychology, Counselling and Therapy, La Trobe University, Australia
| | | | - Dac L Mai
- Department of Psychology, Counselling and Therapy, La Trobe University, Australia.
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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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Shenton EK, Carter AG, Gabriel L, Slavin V. Improving maternal and neonatal outcomes for women with gestational diabetes through continuity of midwifery care: A cross-sectional study. Women Birth 2024; 37:101597. [PMID: 38547549 DOI: 10.1016/j.wombi.2024.101597] [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: 10/24/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
PROBLEM Gestational Diabetes Mellitus (GDM) is a complication of pregnancy which may exclude women from midwife-led models of care. BACKGROUND There is a paucity of research evaluating the safety and feasibility of continuity of midwifery care (CoMC) for women with GDM. AIM To investigate the impact of CoMC on maternal and neonatal outcomes, for otherwise low-risk women with GDM. METHODS This exploratory cross-sectional study observed maternal and neonatal outcomes including onset of labour, augmentation, labour analgesia, mode of birth, perineal trauma, gestation at birth, shoulder dystocia, infant birth weight, neonatal feeding at discharge. FINDINGS Participants were 287 otherwise low-risk pregnant women, who developed GDM, and either received CoMC (n=36) or standard hospital maternity care (non-CoMC) (n=251). Women with GDM who received CoMC were significantly more likely to experience an spontaneous onset of labour (OR 6.3; 95% CI 2.7-14.5; p<.001), labour without an epidural (OR 4.2; 95% CI 2.0 - 9.2,<0.001) and exclusively breastfeed (OR 4.3; 95% CI 1.26 - 14.32; p=0.02). DISCUSSION Receiving CoMC may be a public health initiative which not only improves maternal and neonatal outcomes, but also long-term morbidity associated with GDM. CONCLUSION Findings provide preliminary evidence suggesting CoMC improves maternal and neonatal outcomes and is likely a safe and viable option for otherwise low-risk women with GDM. Larger studies are recommended to confirm findings and explore the full impact of CoMC for women with GDM.
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Affiliation(s)
- Eleanor K Shenton
- Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6153, Australia.
| | - Amanda G Carter
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia
| | - Laura Gabriel
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia
| | - Valerie Slavin
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD 4131, Australia; Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
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Dube M, Ireland S, Bromley A, Steel M, Gao Y, Kildea S. "It's all about cultural understanding": A reflexive thematic analysis of women's experiences at a dedicated refugee midwifery group practice service. Women Birth 2024; 37:410-418. [PMID: 38158322 DOI: 10.1016/j.wombi.2023.12.006] [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: 10/11/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Inequitable maternity care provision in high-income countries contributes to ongoing poor outcomes for women of refugee backgrounds. To address barriers to quality maternity care and improve health equity, a co-designed maternity service incorporating community-based group antenatal care, onsite social worker and interpreters, continuity of midwifery carer through a caseload design with 24/7 phone access was implemented for women of refugee background. OBJECTIVE To explore and describe women's experiences and perceptions of care from a dedicated Refugee Midwifery Group Practice service. DESIGN Qualitative exploratory descriptive study using focus group discussions and interpreters. SETTING The study was conducted at a community-based Refugee Midwifery Group Practice service in a tertiary maternity hospital in Brisbane, Australia. METHODS We conducted three focus group discussions (June - December 2020) with 16 women, born in six different countries, in three language groups: Sudanese Arabic, Somali, and English. We used reflexive thematic analysis to interpret women's perspectives and generate informed meanings of experiences of care. RESULTS We generated four themes 1) accessibility of care, 2) women feeling accepted, 3) value of relationality, and 4), service expansion and promotion. Results demonstrate positive experiences and acceptability due to easy access, strong woman-midwife relationships, and culturally safe care. CONCLUSION The service addressed concerns raised in an early evaluation and provides evidence that redesigning maternity services to meet the needs of women with a refugee background speaking multiple languages from many countries is possible and promotes access, use, and satisfaction with care, contributing to improved health equity and perinatal outcomes.
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Affiliation(s)
- Mpho Dube
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sarah Ireland
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Angela Bromley
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Michelle Steel
- Mater Mothers Hospital, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Faculty of Health, Charles Darwin University, Brisbane City, Queensland 4000, Australia.
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Barrio-Ruiz C, Ruiz de Viñaspre-Hernandez R, Colaceci S, Juarez-Vela R, Santolalla-Arnedo I, Durante A, Di Nitto M. Language and Cultural Barriers and Facilitators of Sexual and Reproductive Health Care for Migrant Women in High-Income European Countries: An Integrative Review. J Midwifery Womens Health 2024; 69:71-90. [PMID: 37531180 DOI: 10.1111/jmwh.13545] [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] [Revised: 04/26/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Dealing with intercultural communicative barriers in European countries' national health services is an increasing and necessary challenge to guarantee migrant women's right to health care. This integrative review describes the communication barriers and facilitators that migrant women encounter to access and use sexual and reproductive health (SRH) services in Europe. METHODS A literature search was performed to identify original studies in PubMed, CINAHL, PsycINFO, Web of Science, and Scopus, using keywords associated with migrant women and SRH services. This was supplemented by scanning the reference lists from relevant studies and similar reviews. Studies exploring the perspective of migrant women about communication barriers and facilitators to the access and use of SRH services were included, whereas those that solely explored health professional's experiences were excluded. Findings were organized into 4 themes: (1) verbal-linguistic barriers, (2) nonverbal language barriers, (3) cultural barriers, and (4) communication facilitators. RESULTS Nineteen studies met the inclusion criteria. Results showed that when women had problems understanding or being understood by health professionals, they experienced feelings of anxiety, fear, insecurity, and discrimination that discouraged them from using SRH services. The most requested facilitators by women were health education, access to professional interpreters and translation of written information, and increasing the practitioners' cultural competence. DISCUSSION Communication barriers undermine migrant women's right to benefit from preventive SRH programs and to make informed decisions concerning their health. It is necessary to establish tailored plans in each health care center to improve intercultural communication that integrate facilitators proposed by women. Future research should provide solid evidence on the effectiveness of each facilitator implemented.
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Affiliation(s)
| | | | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Raul Juarez-Vela
- GRUPAC, Predepartment Unit of Nursing, University of La Rioja, La Rioja, Spain
| | | | - Angela Durante
- GRUPAC, Predepartment Unit of Nursing, University of La Rioja, La Rioja, Spain
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro,", Novara, Italy
| | - Marco Di Nitto
- Azienda Usl Di Bologna, Bologna, Italy
- Center for Clinical Excellence and Quality of Care, Istituto Superiore Di Sanità, Rome, Italy
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Obionu IM, Onyedinma CA, Mielewczyk F, Boyle E. UK maternity care experiences of ethnic minority and migrant women: Systematic review. Public Health Nurs 2023; 40:846-856. [PMID: 37548036 DOI: 10.1111/phn.13240] [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: 03/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The increasing population of immigrant and migrant women in the United Kingdom has implications to the provision of healthcare and for healthcare experiences. Eliciting women's experiences and perceptions of maternity care received is an important way of monitoring and evaluating the quality of maternity services. This study was designed to explore the maternity care experiences of ethnic minority and migrant women in the United Kingdom. METHODS A literature search for relevant studies was carried across seven databases. We included nine studies carried out between 2015 and February 2022 that met the inclusion criteria. Data were analyzed using a thematic analysis approach. RESULTS Findings showed that ethnic minority women and migrant women have had mixed experiences while utilizing maternity services in the United Kingdom. However, most of the experiences were negative and included issues related to communication, discrimination, culture, access to care, physical comfort, and continuity of care. Only one of the studies reported that the respondents had a wholly positive communication experience, one found that a few women felt the staff were respectful and one reported that the midwives gave the women treatment options that would respect their cultural and religious beliefs. CONCLUSION This study has highlighted some important gaps in the maternity care experiences specific to ethnic minority and migrant women in the United Kingdom which provides useful insights to future policy and clinical practice.
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Affiliation(s)
- Ifeoma Maureen Obionu
- College of Public Health and Social Justice, Saint Louis University, St Louis, Missouri
| | - Chioma Amarachi Onyedinma
- Department of Community Medicine University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Frances Mielewczyk
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Elaine Boyle
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Shan H, Saharso S, van Kroonenburg N, Henrichs J. Understanding the relationship between maternity care providers and middle-class Chinese migrant women in the Netherlands: A qualitative study. Midwifery 2023; 125:103775. [PMID: 37480628 DOI: 10.1016/j.midw.2023.103775] [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: 03/21/2023] [Revised: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE This study aims to provide insights into the formation and the quality of the maternity care provider-woman relationship between midwives, maternity care assistants and middle-class Chinese migrant women in the Netherlands. DESIGN online in-depth interviews addressing interpersonal trust, women's autonomy in shared decision making and culturally sensitive care PARTICIPANTS: 46 middle-class Chinese migrant women, 13 midwives and 12 maternity care assistants in the Netherlands FINDINGS: Midwives and maternity care assistants reported challenges interpreting the needs of middle-class Chinese migrant women in care practices while Chinese migrant women experienced receiving insufficient emotional support. Midwives and maternity care assistant tended to attribute women's different preferences for care to culture which reinforced difficulties of addressing women's needs. Middle-class Chinese migrant women experienced a lack of responsive care, feelings of being overlooked, being uncomfortable to express different opinions and challenges in developing autonomy in the shared decision-making process. CONCLUSIONS A trusting relationship, effective communication with maternity care providers, and a culturally sensitive and safe environment could be beneficial for middle-class migrant mothers. Chinese migrant women held ambivalent attitudes towards both traditional Chinese health beliefs and Dutch maternity care values. Each individual woman adopted the practice of the "doing the month" tradition to a different extent. This indicated the need for maternity care providers to recognize women's various needs for more responsive and individualized care, especially for first-time migrant mothers to negotiate their ways through the new healthcare system. IMPLICATIONS FOR PRACTICE We suggest a more proactive role for maternity care providers addressing the individual's subjectivity and preferences. Our findings are relevant and applicable for maternity care professionals conducting shared decision making with middle-class and highly educated migrant women living in Western contexts.
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Affiliation(s)
- Haiyue Shan
- Department of Sociology, Vrije University Amsterdam, De Boelelaan 1105 HV, Amsterdam 1081, the Netherlands.
| | - Sawitri Saharso
- Department of Sociology, Vrije University Amsterdam, De Boelelaan 1105 HV, Amsterdam 1081, the Netherlands
| | - Nandy van Kroonenburg
- Department of Sociology, Vrije University Amsterdam, De Boelelaan 1105 HV, Amsterdam 1081, the Netherlands
| | - Jens Henrichs
- Department of Midwifery Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1118 HZ, Amsterdam 1081, the Netherlands
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Hearn MF, Biggs DL, Brown PS, Krastev MA, Szwarc MJ, Riggs APE. Finding our own ways of working together: reflections on implementing and facilitating a multidisciplinary and equity-oriented model of Group Pregnancy Care for women of refugee background. Midwifery 2023; 123:103709. [PMID: 37209583 DOI: 10.1016/j.midw.2023.103709] [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: 12/13/2022] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This paper explores professional staff experiences of implementing and facilitating a multidisciplinary equity-oriented model of Group Pregnancy Care for women of refugee background. This model was the first of its kind in Australia and one of the first worldwide. DESIGN AND SETTING This exploratory descriptive qualitative study reports the process evaluation findings from the formative evaluation of Group Pregnancy Care for women of refugee background. Data were collected in Melbourne, Australia between January and March 2021 via semi-structured interviews, and analysed using reflexive thematic analysis. PARTICIPANTS Purposive sampling was used to recruit twenty-three professional staff involved in the implementation, facilitation, or oversight of Group Pregnancy Care. FINDINGS This paper reports five themes: knowledge sharing, bicultural family mentors - the critical link, finding our own ways of working together, power dynamics at the intersection of community and clinical knowledge, and system capacity for change. KEY CONCLUSIONS The bicultural family mentor role contributes to the cultural safety of the group, and increases the confidence and competence of professional staff through cultural bridging. Multidisciplinary cross-sector teams that collaborate well can provide cohesive care. It is possible for hospital and community-based services to establish cross-sector equity-oriented partnerships. However, there are challenges sustaining partnerships in the absence of explicit funding to support collaboration, and in context of organisational and professional inflexibility. IMPLICATIONS FOR PRACTICE Investing in change is necessary to achieve health equity. Creating explicit funding pathways for the bicultural family mentor workforce, multidisciplinary collaboration, and cross-sector partnerships would strengthen service capacity to provide equity-oriented care. Working towards health equity also requires a commitment to continuing professional development for professional staff and organisations to increase knowledge and capacity.
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Affiliation(s)
- Ms Fran Hearn
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Dr Laura Biggs
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Professor Stephanie Brown
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia; University of Melbourne, Department of General Practice, Swanston St, Parkville, VIC, 3052, Australia; University of Melbourne, Department of Paediatrics, Swanston St, Parkville, VIC, 3052, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Ms Ann Krastev
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Mr Josef Szwarc
- The Victorian Foundation for Survivors of Torture Inc., Brunswick, VIC, 3056, Australia
| | - Associate Professor Elisha Riggs
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia; University of Melbourne, Department of General Practice, Swanston St, Parkville, VIC, 3052, Australia
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Lakin K, Kane S. A critical interpretive synthesis of migrants' experiences of the Australian health system. Int J Equity Health 2023; 22:7. [PMID: 36624465 PMCID: PMC9827657 DOI: 10.1186/s12939-022-01821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/25/2022] [Indexed: 01/10/2023] Open
Abstract
While the health of and healthcare use by migrants has received significant scholarly and policy attention in Australia, current debates highlight that a critical examination of the theoretical underpinnings of these inquiries and responses is needed. We conducted a systematic review and critical interpretive synthesis (CIS) to critically examine how the policy and scholarly literature conceptualises migrants' interactions with and experiences of the Australian health system. Guided by PRISMA, we searched for literature without imposing any limits. We also searched key State and Federal Government websites for relevant policy documents. Our initially broad inclusion criteria became refined as the CIS progressed. We prioritised the likely relevance and theoretical contribution of the papers to our inquiry over methodological quality. The CIS of 104 papers revealed that the Australian scholarly literature and policy documents consistently homogenise and reduce migrants according to an assumed, (1) cultural identity, (2) linguistic affiliation, and/or (3) broad geographic origin. Based on these three critiques and drawing on the theoretical literature, we propose a synthesising argument on how the Australian literature could better conceptualise migrants' experiences of the Australian health system. We contend that both research and policy should explicitly recognise and engage with the multifaceted and shifting ways that migrants define themselves, generally, and during their encounters with destination country health systems. Engagement with this notion is necessary for also understanding how aspects of migrants' identities are dynamically co-constructed during their interactions with the health system. These understandings have implications for improving the design and implementation of policies and programs directed at improving the responsiveness of Australia's health system to the needs and expectations of migrant communities specifically, and destination countries broadly.
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Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 2, 32 Lincoln Square, Melbourne, 3010, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 2, 32 Lincoln Square, Melbourne, 3010, Australia.
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Gonçalves AQ, Sequeira-Aymar E, Aguilar Martín C, Dalmau RM, Cruz A, Evangelidou S, Hargreaves S, Requena-Mendez A, Jacques-Aviñó C. Usefulness and practicality of a multidisease screening programme targeting migrant patients in primary care in Spain: a qualitative study of general practitioners. BMJ Open 2022; 12:e065645. [PMID: 36385020 PMCID: PMC9670956 DOI: 10.1136/bmjopen-2022-065645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Some migrant groups are disproportionately affected by key infectious diseases in European countries. These pose a challenge for healthcare systems providing care to these groups. We aimed to explore the views of general practitioners (GPs) on the acceptability, adaptability and feasibility of a multidisease screening programme based on an innovative clinical decision-support system for migrants (the ISMiHealth tool), by examining the current gaps in healthcare provision and areas of good practice and the usefulness and limitations of training in the health needs of migrants. METHODS We undertook a qualitative descriptive study and carried out a series of focus groups (FGs) taking a pragmatic utilitarian approach. Participants were GPs from the four primary healthcare (PHC) centres in Catalonia, Spain, that piloted an intervention of the ISMiHealth tool. GPs were recruited using purposive and convenience sampling. FG discussions were transcribed and analysed using thematic content analysis. RESULTS A total of 29 GPs participated in four FGs. Key themes identified were: (1) GPs found the ISMiHealth tool to be very useful for helping to identify specific health problems in migrants, although there are several additional barriers to screening as part of PHC, (2) the importance of considering cultural perspectives when caring for migrants, and of the impact of migration on mental health, (3) the important role of PHC in healthcare provision for migrants and (4) key proposals to improve screening of migrant populations. GPs also highlighted the urgent need, to shift to a more holistic and adequately resourced approach to healthcare in PHC. CONCLUSIONS GPs supported a multidisease screening programme for migrant populations using the ISMiHealth tool, which aided clinical decision-making. However, intercultural participatory approaches will need to be adopted to address linguistic and cultural barriers to healthcare access that exist in migrant communities.
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Affiliation(s)
- Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, Tortosa, Spain
| | - Ethel Sequeira-Aymar
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain
| | - Rosa Maria Dalmau
- Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, Tortosa, Spain
- Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Stella Evangelidou
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease, Karolinska University Hospital, Solna, Stockholm, Sweden
- CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Madrid, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Barcelona, Spain
- Campus Bellaterra, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
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Dube M, Gao Y, Steel M, Bromley A, Ireland S, Kildea S. Effect of an Australian community-based caseload midwifery group practice service on maternal and neonatal outcomes for women from a refugee background. Women Birth 2022; 36:e353-e360. [PMID: 36344389 DOI: 10.1016/j.wombi.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Women from a refugee background who resettle in high-income countries experience poorer perinatal outcomes in comparison to women from host countries. There is a paucity of research on how best to improve these outcomes. AIM To report on the effectiveness of an Australian Refugee Midwifery Group Practice service on perinatal outcomes. METHODS We used inverse probability of treatment weighting to balance confounders and calculate treatment effect and compare maternal and neonatal outcomes for women from a refugee background who received Refugee Midwifery Group Practice care (n = 625), to those receiving standard care (n = 634) at a large tertiary hospital (1 January 2016-31 December 2019). Prespecified primary outcomes included: proportion of women attending ≥ 5 antenatal visits, preterm birth (<37 weeks), spontaneous onset of labour, epidural analgesia in the first stage of labour, normal birth (term, spontaneous onset, vertex, spontaneous vaginal birth, no epidural, no episiotomy), and exclusively breast-feeding at discharge. FINDINGS Women who received Refugee Midwifery Group Practice care were more likely to have spontaneous onset of labour (adjusted odds ratio 2·20, 95% CI 1·71-2·82; p < 0·0001), normal birth (1·55, 1·23-1·95; p < 0·0001), and less likely to use epidural analgesia (0·67, 0·50-0·89; p = 0·0067) and have a preterm baby (0·60, 0·36-0·99; p = 0·047). There was no difference between groups in women attending ≥ 5 antenatal visits and exclusive breastfeeding at discharge from hospital. DISCUSSION A Refugee Midwifery Group Practice is feasible and clinically effective. CONCLUSION Similar services could potentially improve outcomes for women from a refugee background who resettle in high-income countries.
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Affiliation(s)
- Mpho Dube
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Michelle Steel
- Mater Mothers Hospital, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Angela Bromley
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sarah Ireland
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane City, Queensland 4000, Australia.
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Buultjens M, Gill J, Fielding J, Lambert KA, Vondeling K, Mastwyk SE, Sloane S, Fedele W, Karimi L, Milgrom J, von Treuer K, Erbas B. Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health? Women Birth 2022; 36:305-313. [PMID: 36184532 PMCID: PMC9551992 DOI: 10.1016/j.wombi.2022.09.007] [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: 01/04/2022] [Revised: 07/21/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
Background The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman’s experience – with likely adverse effects on mental health and wellbeing. Aim To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. Methods Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. Findings Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (−1.17, 95% CI: −1.81, −0.53) and the EPDS (−0.83, 95% CI: −1.5, −0.15). Discussion The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. Conclusion This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.
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Affiliation(s)
- Melissa Buultjens
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Jessica Gill
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jennifer Fielding
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Katrina A Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kirsty Vondeling
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sally E Mastwyk
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Sarita Sloane
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Wendy Fedele
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Applied Health, Psychology Department, RMIT University, Melbourne, Australia.
| | - Jeannette Milgrom
- Parent-Infant Research Institute (PIRI), Australia and Melbourne School of Psychological Science, University of Melbourne, Australia
| | | | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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13
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Khaw SML, Zahroh RI, O'Rourke K, Dearnley R, Homer C, Bohren MA. Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis. BMJ Glob Health 2022; 7:e009098. [PMID: 35902203 PMCID: PMC9341177 DOI: 10.1136/bmjgh-2022-009098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Community-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women in maternity settings in high-income countries (HICs). The aim of this review was to explore key stakeholders' perceptions and experiences of community-based doula programmes for migrant and refugee women during labour and birth in HICs, and identify factors affecting implementation and sustainability of such programmes. METHODS We conducted a mixed-method systematic review, searching MEDLINE, CINAHL, Web of Science, Embase and grey literature databases from inception to 20th January 2022. Primary qualitative, quantitative and mixed-methods studies focusing on stakeholders' perspectives and experiences of community-based doula support during labour and birth in any HIC and any type of health facility were eligible for inclusion. We used a narrative synthesis approach to analysis and GRADE-CERQual approach to assess confidence in qualitative findings. RESULTS Twelve included studies were from four countries (USA, Sweden, England and Australia). There were 26 findings categorised under three domains: (1) community-based doulas' role in increasing capacity of existing maternity services; (2) impact on migrant and refugee women's experiences and health; and (3) factors associated with implementing and sustaining a community-based doula programme. CONCLUSION Community-based doula programmes can provide culturally-responsive care to migrant and refugee women in HICs. These findings can inform community-based doula organisations, maternity healthcare services and policymakers. Further exploration of the factors that impact programme implementation, sustainability, strategic partnership potential and possible wider-reaching benefits is needed.
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Affiliation(s)
- Sarah Min-Lee Khaw
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Rana Islamiah Zahroh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Kerryn O'Rourke
- School of Nursing and Midwifery, Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- College of Indigenous Futures, Education and the Arts, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Red Dearnley
- Birth for Humankind, North Melbourne, Victoria, Australia
| | - Caroline Homer
- Child and Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Meghan A Bohren
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Having a Say in Research Directions: The Role of Community Researchers in Participatory Research with Communities of Refugee and Migrant Background. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084844. [PMID: 35457711 PMCID: PMC9024418 DOI: 10.3390/ijerph19084844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/10/2022]
Abstract
Research teams in high-income countries often fail to acknowledge the capacity and contributions of Community Researchers. This qualitative exploratory study used decolonising methodology and the Foundation House ‘Refugee Recovery Framework’ to understand Community Researchers’ perceptions and experiences of their role, and how research teams can integrate the knowledge they bring into research. Purposive sampling was used to facilitate the recruitment of eight Community Researchers from five different community groups working in Melbourne, Victoria. Semi-structured interviews lasting forty to sixty minutes occurred between December 2020 and January 2021. Data were analysed using reflexive thematic analysis. Findings reported in this paper include eight themes: ‘nothing about us without us’; ‘open the door’; a safe space to share; every step of the way; this does not translate; finding the right way to ask; a trauma-informed approach; and support within the workplace. The knowledge obtained demonstrates that Community Researchers facilitate meaningful participation in research for women, families, and communities of refugee or migrant background. Community Researchers’ presence, knowledge, and skills are vital in establishing culturally safe research practices and developing accessible language to facilitate conversations about sensitive research topics across multiple languages. Community Researchers can make important contributions at all stages of research, including data collection and interpretation.
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