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Coe R, Toke S, Wallace H, Riggs E, Brown SJ, Szwarc J, Biggs LJ. When I can be my whole authentic self, I feel safe and know that I belong: a photovoice study exploring what culturally safe pregnancy care is to Karen women of refugee background in Victoria, Australia. ETHNICITY & HEALTH 2024; 29:720-744. [PMID: 38867355 DOI: 10.1080/13557858.2024.2359388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/20/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. DESIGN A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. RESULTS Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. CONCLUSION When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background.
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Affiliation(s)
- Rowena Coe
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - Shadow Toke
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Heather Wallace
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
- School of Nursing and Midwifery, Institute of Health Transformation, Deakin University, Geelong, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture Inc., Brunswick, Australia
| | - Laura J Biggs
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
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Hirani SAA. Barriers Affecting Breastfeeding Practices of Refugee Mothers: A Critical Ethnography in Saskatchewan, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:398. [PMID: 38673311 PMCID: PMC11050554 DOI: 10.3390/ijerph21040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Refugee mothers are vulnerable to cultural stereotyping and socioeconomic hardships when they migrate to a new country. This vulnerability often has a negative impact on refugee mothers' breastfeeding practices. Saskatchewan is one of the growing provinces in Canada that has a noticeable increase in refugee population with young children and limited availability of healthcare settings with baby-friendly status. Considering existing gaps in knowledge, this critical ethnographic study aimed to explore barriers that impede the breastfeeding practices of refugee mothers in Saskatchewan. After seeking ethics approval, data were collected using multiple methods, including in-depth interviews undertaken with 27 refugee mothers with young children of age range 1 day to 24 months, a review of media communications and field observations of community-based services/facilities available to refugee mothers. Findings suggest that psychosocial barriers, healthcare barriers, environmental barriers, and maternal and child health-related barriers impede the breastfeeding practices of refugee mothers in Saskatchewan. Breastfeeding practices of refugee mothers can be promoted through healthcare support, culturally appropriate services, interpretation services in healthcare settings, implementation of baby-friendly initiatives, hospital and community-based breastfeeding campaigns, and follow-up services. Collaborative efforts by healthcare settings, healthcare providers, policymakers, public health agencies, service providers, and governments are essential to support the breastfeeding practices of refugee mothers.
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Affiliation(s)
- Shela Akbar Ali Hirani
- Faculty of Nursing, University of Regina, 516 RIC, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
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Griffin G, Ali M, Nau SZ, Riggs E, Dantas JAR. Accessing and navigating healthcare: A scoping review of the experiences of women of refugee background from Myanmar. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3459-e3476. [PMID: 35915878 PMCID: PMC10087957 DOI: 10.1111/hsc.13955] [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: 03/30/2022] [Revised: 06/20/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
Despite well-documented health problems, healthcare access by women of refugee background in resettlement countries is typically poor. Suggested reasons include inadequate health literacy and resettlement challenges. A scoping review to explore the experiences of women of refugee background from Myanmar accessing and navigating healthcare was conducted following Arksey and O'Malley's framework, with an intersectional lens. Studies were analysed thematically following Braun and Clark's approach; four themes (eight subthemes) were constructed: Culture (Constructions of health; Navigating cultural tensions); Gender (Shifting gender roles; Sexual and reproductive health); Survivorship (Past health experiences; Strength in collectivism); and Language (The language barrier; Masked communication barriers). Intersectional factors of culture, gender, survivorship and language influenced women's experiences, shaping barriers and facilitators to healthcare. Community networks and bicultural peers are resources which may be enhanced. Research into trauma-informed cultural competency programs, community education and bicultural health navigators is recommended to support women of refugee background from Myanmar.
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Affiliation(s)
- Georgia Griffin
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | - Mohammed Ali
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | - S. Zaung Nau
- School of Management and MarketingCurtin UniversityBentleyWestern AustraliaAustralia
| | - Elisha Riggs
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Jaya A. R. Dantas
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
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Billett H, Vazquez Corona M, Bohren MA. Women from migrant and refugee backgrounds' perceptions and experiences of the continuum of maternity care in Australia: A qualitative evidence synthesis. Women Birth 2021; 35:327-339. [PMID: 34429270 DOI: 10.1016/j.wombi.2021.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women who were born overseas represent an increasing proportion of women giving birth in the Australian healthcare system. PROBLEM Women from migrant and refugee backgrounds have an increased risk of poor pregnancy and birth outcomes, including experiences of care. AIM To understand how women from migrant and refugee backgrounds perceive and experience the continuum of maternity care (pregnancy, birth, postnatal) in Australia. METHODOLOGY We conducted a qualitative evidence synthesis, searching MEDLINE, CIHAHL, and PsycInfo for studies published from inception to 23/05/2020. We included studies that used qualitative methods for data collection and analysis, that explored migrant/refugee women's experiences or perceptions of maternity care in Australia. We used a thematic synthesis approach, assessed the methodological limitations of included studies, and used GRADE-CERQual to assess confidence in qualitative review findings. RESULTS 27 studies met the inclusion criteria, representing women in Australia from 42 countries. Key themes were developed into 24 findings, including access to interpreters, structural barriers to service utilisation, experiences with health workers, trust in healthcare, experiences of discrimination, preferences for care, and conflicts between traditional cultural expectations and the Australian medical system. CONCLUSION This review can help policy makers and organisations who provide care to women from migrant and refugee backgrounds to improve their experiences with maternity care. It highlights factors linked to negative experiences of care as well as factors associated with more positive experiences to identify potential changes to practices and policies that would be well received by this population.
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Affiliation(s)
- Hannah Billett
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia. https://twitter.com/
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Marshall S, Taki S, Love P, Laird Y, Kearney M, Tam N, Baur LA, Rissel C, Wen LM. The process of culturally adapting the Healthy Beginnings early obesity prevention program for Arabic and Chinese mothers in Australia. BMC Public Health 2021; 21:284. [PMID: 33541310 PMCID: PMC7863271 DOI: 10.1186/s12889-021-10270-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/19/2021] [Indexed: 01/25/2023] Open
Abstract
Background Behavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia. Methods The cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program. Results Program structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials). Conclusions This cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10270-5.
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Affiliation(s)
- Sarah Marshall
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia. .,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia. .,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.
| | - Sarah Taki
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia.,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Penny Love
- The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Waurn Ponds, Victoria, 3216, Australia
| | - Yvonne Laird
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Marianne Kearney
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Nancy Tam
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Louise A Baur
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Chris Rissel
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia.,The National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
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SHARMA E, HOWARD N, DUCLOS D. Navigating new lives: A scoping review and thematic synthesis of forced migrant women's perinatal experiences. J Migr Health 2020; 1-2:100014. [PMID: 34405168 PMCID: PMC8352206 DOI: 10.1016/j.jmh.2020.100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND For health systems and maternity services to respond effectively to forced displacement, an understanding of the lived experiences of women seeking protection during childbearing is required. This study aim was to systematically review existing literature on the perinatal experiences of forced migrant women. METHODS We conducted a scoping review including MEDLINE, CINAHL Plus, Web of Science and PsychINFO databases and manual search of references. Included studies were quality-assessed and analysed using inductive thematic synthesis. FINDINGS In total 39 studies were included, involving 624 forced migrant women in 12 countries. Three inductive themes were: (1) "The nature of being a forced migrant," describing multiple liminalities experienced by women; (2) support during the perinatal period, showing women's (re)negotiation of shifting kinship and support networks; and (3) interactions with maternity services, revealing variations in maternity care experiences. CONCLUSION Findings highlight the systemic power structures forced migrant women must (re)negotiate during the perinatal period and the supportive and empowering role maternity services can play through provision of woman-centred care. Further research is needed to understand the lived perinatal experiences of forced migrant in low-income and transit country contexts.
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Affiliation(s)
- Esther SHARMA
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Natasha HOWARD
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
- National University of Singapore, Saw Swee Hock School of Public Health, 12 Science Drive 2, 117549, Singapore
| | - Diane DUCLOS
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
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