Beliefs Associated with Mexican Immigrant Families’ Practice of La Cuarentena during Postpartum Recovery

The influence of primary language on postoperative stroke outcomes

BACKGROUND

Language barriers have the potential to influence acute stroke outcomes. Thus, we examined postoperative stroke outcomes among non-English primary language speakers.

METHODS

Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2016-2019), we conducted a retrospective cohort study of adults diagnosed with a postoperative stroke in Michigan, Maryland, and New Jersey. Patients were classified by primary language spoken: English (EPL) or non-English (n-EPL). The primary outcome was hospital length-of-stay. Secondary outcomes included stroke intervention, feeding tube, tracheostomy, mortality, cost, disposition, and readmission. Propensity-score matching and post-match regression were used to quantify outcomes.

RESULTS

Among 3078 postoperative stroke patients, 6.2 ​% were n-EPL. There were no differences in length-of-stay or secondary outcomes, except for higher odds of feeding tube placement (OR 1.95, 95 ​% CI 1.10-3.47, p ​= ​0.0227) in n-EPL.

CONCLUSIONS

Postoperative stroke outcomes were comparable by primary language spoken. However, higher odds of feeding tube placement in n-EPL may suggest differences in patient-provider communication.

Utilization of traditional healing practices from Mexico by U. S. women of Mexican origin: A systematic review

Hispanics are 18.7 % of the U.S. population, and people of Mexican origin are 61.4 % of that Hispanic community. National health surveys indicate that utilization of traditional medicine among Hispanics is low compared to non-Hispanic Whites. However, many researchers have described their use in Hispanic populations as commonplace.

OBJECTIVE

This review analyzed studies about traditional healing practices from Mexico (THPM) used by women of Mexican origin in the U.S. for a greater understanding of traditional health practices within U.S. communities of Mexican origin.

DATA SOURCES

Journal databases were searched for studies between January 1, 1990 and December 31, 2020.

STUDY SELECTION

The Whittemore and Knafl and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) methods were used to analyze the studies.

DATA EXTRACTION

Seven themes emerged: A) foundations, B) medical pluralism, C) non-disclosure and patient satisfaction, D) remedies and rituals, E) healers, F) affinity, and G) what clinicians need to know. Four subthemes were identified: G1) cultural sensitivity, G2) communication skills, G3) leveraging the influence of THPM, and G4) scientific inquiry.

DATA SYNTHESIS

U.S. women of Mexican origin reported continued use of THPM for health promotion, influenced by their understanding of health and illness, community ties, and personal experiences. Study authors recommended strategies for improving patient-provider communication and understanding patients' use of traditional health and healing practices.

CONCLUSION

Further explorations of THPM are needed to build awareness of culturally-tied health beliefs and behaviors that improve medical care experiences and quality for Hispanics of Mexican origin.

Immigrant women's and families' views and experiences of routine postnatal care: findings from a qualitative evidence synthesis

BACKGROUND

Uptake of postnatal care (PNC) is low and inequitable in many countries, and immigrant women may experience additional challenges to access and effective use. As part of a larger study examining the views of women, partners, and families on routine PNC, we analysed a subset of data on the specific experiences of immigrant women and families.

METHODS

This is a subanalysis of a larger qualitative evidence synthesis. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews and grey literature for studies published until December 2019 with extractable qualitative data with no language restrictions. For this analysis, we focused on papers related to immigrant women and families. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and quality assessment were carried out using a study-specific extraction form and established quality assessment tools. Study findings were identified using thematic analysis. Findings are presented by confidence in the finding, applying the GRADE-CERQual approach.

FINDINGS

We included 44 papers, out of 602 full-texts, representing 11 countries where women and families sought PNC after immigrating. All but one included immigrants to high-income countries. Four themes were identified: resources and access, differences from home country, support needs, and experiences of care. High confidence study findings included: language and communication challenges; uncertainty about navigating system supports including transportation; high mental health, emotional, and informational needs; the impact of personal resources and social support; and the quality of interaction with healthcare providers. These findings highlight the importance of care experiences beyond clinical care. More research is also needed on the experiences of families migrating between low-income countries.

CONCLUSIONS

Immigrant families experience many challenges in getting routine PNC, especially related to language, culture, and communication. Some challenges may be mitigated by improving comprehensive and accessible information on available services, as well as holistic social support.

TRIAL REGISTRATION NUMBER

CRD42019139183.

"Why would I go if the infant was healthy?": Factors Influencing Postnatal Care Utilization in Chiapas, Mexico

Despite global efforts, postnatal care utilization remains low. There is almost no research on factors influencing postnatal care utilization in Latin America. Chiapas has one of the highest rates of maternal and neonatal mortality in Mexico. In 2014, we conducted 101 interviews with recently delivered women, male partners, traditional birth attendants (TBAs), and health staff, to assess factors influencing postnatal care utilization. Data underwent content analysis and thematic coding. Travel costs, postnatal seclusion practices, and a low perceived need for postnatal care were found to be disincentives to seek care. Providers ascribed low care adherence to cultural beliefs and low health literacy, while families indicated that their decision to seek facility care was mediated by the TBA's recognition of danger signs and perceived ability to manage complications. TBAs should be leveraged as gatekeepers, health literacy programs should emphasize the importance of primary care, and structural barriers to care should be reduced.

[Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.

Patterns of family negativity in the perinatal period: Implications for mental health among Mexican-origin women

Negativity in the family environment during the perinatal period is likely to have detrimental effects on maternal well-being, especially among low-income ethnic minority mothers who are at increased risk for experiencing postpartum depressive symptoms. With a sample of 322 Mexican and Mexican American families, this study used latent class growth analysis to identify meaningful subgroups of women based on their perceived family negativity reported prenatally and at 6, 12, 18, and 24 weeks postpartum. A 4-trajectory model of family negativity fit the data well: low-stable (58%), moderate-increasing (26%), high-decreasing (8%), and high-increasing (8%). Higher prenatal depressive symptomatology predicted membership in the moderate-increasing, high-decreasing, and high-increasing trajectories, relative to the low-stable trajectory. Findings suggest substantial heterogeneity in family negativity, identifying three significant growth patterns during the perinatal period with differential implications for maternal depressive symptomatology at 24 weeks and 12 months after delivery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Intention to Engage in Maternal and Child Health Home Visiting

Home visiting (HV) programs have the potential to improve maternal and child health. As federal and state initiatives expand the reach of these programs, understanding what factors enhance uptake and retention of the services becomes increasingly important. This qualitative study used a Reasoned Action Model (RAM) and a cultural lens to explore factors influencing the engagement of women with low-income in HV programs. We conducted 21 semi-structured interviews in both English and Spanish in a prenatal clinic in an urban public health department. The constructs most salient for participants were emotions and affect, behavioral beliefs, and self-efficacy. In the context of an urban public health prenatal clinic, HV marketing and outreach should highlight convenience and social support, as well as clearly communicate program content and intent. In practice, HV programs must be flexible to work around work and home schedules; marketing and outreach should emphasize that flexibility.

Perceived Motivators, Barriers and Intervention Strategies Related to Weight Loss After Childbirth Among WIC Participants in Southern California

PURPOSE

To explore perceived motivators and barriers to weight loss after childbirth and ideas for postpartum weight loss interventions among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

APPROACH

Four (2 with English-speaking and 2 with Spanish-speaking participants) focus groups were conducted.

SETTING

A WIC clinic in Southern California.

PARTICIPANTS

Of 22 participants, the majority were Hispanic/Latina. The mean age of the mothers' infants was 6.18 months.

MEASURES

A structured focus group guide was used.

ANALYSIS

Audio-recordings were transcribed verbatim. The Spanish transcriptions were reviewed for discrepancies by a bilingual coinvestigator and translated into English for analysis. Transcriptions of the focus group audio-recordings were organized in ATLAS.ti version 8.0. and analyzed using content analysis.

RESULTS

Participants had a mean age of 30.5 and a mean prepregnancy body mass index of 32.4. Motivators for weight loss after childbirth included modeling healthy behavior for children and a fear of developing chronic illness. Barriers to weight loss included lack of knowledge, self-efficacy, time, child care and support, postpartum depression, the 40-day rule, and having a c-section. Intervention ideas included providing accountability and peer support for weight loss, providing nutrition/exercise weight loss strategies, and integrating mobile phone technologies into weight loss programs.

CONCLUSIONS

Weight loss strategies for postpartum WIC participants should provide knowledge, support, accountability, and preferably integrate technology.

Infants' Biological Sensitivity to the Effects of Maternal Social Support: Evidence Among Mexican American Families

The identification of infants who are most susceptible to both negative and positive social environments is critical for understanding early behavioral development. This study longitudinally assessed the interactive effects of infant vagal tone (respiratory sinus arrhythmia; RSA) and maternal social support on behavioral problems and competence among 322 low-income Mexican American mother-infant dyads (infants: 54.1% female) and explored sex differences. Infant RSA was calculated from resting HR data at 6 weeks of age. Mothers reported on general social support, partner support, and family support at 6 months, and infant behavioral problems and competence at 1 year. Two-way interactions (RSA × support source) were evaluated to predict behavioral problems and competence, adjusting for covariates. Results indicated higher competence among infants with lower RSA whose mothers reported higher general support or higher partner support. Interactive effects on behavior problems of RSA with maternal partner or family support were only found for female infants: Girls with higher RSA showed more behavior problems when mothers reported low support, but fewer problem levels in the context of high support. Our results suggest that infant RSA is an important moderator of the effects of the early social environment on early development.

Family Support and Family Negativity as Mediators of the Relation between Acculturation and Postpartum Weight in Low-Income Mexican-Origin Women

BACKGROUND

Obesity presents a significant health concern among low-income, ethnic minority women of childbearing age.

PURPOSE

The study investigated the influence of maternal acculturation, family negativity, and family support on postpartum weight loss among low-income Mexican-origin women.

METHODS

Low-income Mexican-origin women (N=322; 14% born in the U.S.) were recruited from a prenatal clinic in an urban area of the Southwest U.S. Acculturation was assessed during a prenatal home visit (26-38 weeks gestation), and post-birth family support and general family negativity were assessed at 6 weeks postpartum. Objective maternal weight measures were obtained at five time points across the first postpartum year.

RESULTS

Higher acculturation predicted higher family support and family negativity. Higher family support predicted decreasing weight across the first postpartum year, and higher family negativity predicted higher weight at 6 weeks postpartum and increasing weight across the first postpartum year. In combination, family negativity and support mediated the impact of acculturation on postpartum weight gain.

CONCLUSIONS

Cultural and family-related factors play a significant role in postpartum weight gain and loss for low-income Mexican-origin women.

Quantitative Methodologies Reveal a Diversity of Nutrition, Infection/Illness, and Psychosocial Stressors During Pregnancy and Lactation in Rural Mam-Mayan Mother–Infant Dyads From the Western Highlands of Guatemala

Background:

The nature and severity of 3 categories of maternal stressors (nutritional, infectious, and psychosocial) that may impact maternal health and early infant growth are not often considered together.

Objectives:

To describe quantitative methodologies; assess construct validity of questionnaires; report variability in sociodemographic, obstetric, nutritional, infectious, and psychosocial characteristics; and compare characteristics between pregnancy and lactation and between study cohorts of Mam-Mayan mother–infant dyads.

Methods:

Grounded in participatory action research and a socioecological framework, this observational study enrolled a longitudinal cohort of 155 women, followed during pregnancy (6-9 months), early (0-6 weeks), and later (4-6 months) postpartum, and 2 cross-sectional cohorts (60 early and 56 later postpartum). Household and social factors; obstetric history; nutritional, infectious, and psychosocial stressors; and infant characteristics were explored.

Results:

Diet diversity (3.4 ± 1.3) and adult food security (38%) were low. Urinary and gastrointestinal infections were rare (<5%), whereas experience of local idioms of distress was frequent (20%-50%). Participants reported low maternal autonomy (81%), high paternal support (70%), small social support networks (2.7 ± 1.3 individuals), and high trust in family (88%) and community-based institutions (61%-65%) but low trust in government services (6%). Domestic violence was commonly reported (22%). Infant stunting was common (36% early postpartum and 43% later postpartum) despite frequent antenatal care visits (7.5 ± 3.8). Participant engagement with the research team did not influence study outcomes based on comparisons between longitudinal and cross-sectional cohorts.

Conclusions:

The variability in sociodemographic, nutritional, and psychosocial variables, will allow exploration of factors that promote resilience or increase vulnerability of the mother–infant dyad.

[The effects, beliefs and practices of puerperal women's self-care]

The objective of this exploratory-descriptive study was to identify the beliefs, effects and practices that permeate women's self-care during puerperium. The participants were fifteen puerperal women from Rio Grande/RS. Data collection was performed in September and October of 2010 using semi-structured interviews, performed between fifteen and thirty days postpartum. Thematic analysis was used. Two categories emerged regarding self-care during puerperium, which was performed based on the family guidance received at home. One referred to restrictions, or activities that should be avoided to prevent harm; the other involved encouragement, i.e., practices that promoted benefits to the puerperal woman or newborn. This study shows the importance of professionals being aware of the quarantine period, as it is a cultural heritage that remains in effect today. In conclusion, common knowledge is highly valued by these women, and despite the need for scientific evidence supporting such knowledge it was not a trigger for problems in either the mothers or infants in this study.