Foreign-born women rated medical and emotional aspects of postnatal care higher than women born in Sweden: A quantitative comparative study

INTRODUCTION

Although high-quality postnatal care provides information and recognizes women's personal and cultural contexts, foreign-born women are more exposed to poor health and adverse birth outcomes. The aim of this study was to compare the length and model of postnatal care, along with the content of care, between foreign-born and native-born women living in Sweden. Another aim was to explore factors associated with being very satisfied with various aspects of postnatal care.

METHODS

This was a descriptive cross-sectional study of 483 postnatal women in two Swedish hospitals in 2017. Women completed a questionnaire comprising background data, pregnancy and birth related variables and the Early Postnatal Questionnaire. Data were analyzed using descriptive statistics, analysis of variance and multivariate logistic regression analyses.

RESULTS

Foreign-born women were more likely to have a shorter (<24 h) or longer (>48 h) length of postnatal stay than women born in Sweden. No differences in birth outcomes emerged between the two groups. Foreign-born women rated the medical (OR=1.77; 95% CI: 1.04-3.03) and emotional (OR=2.0; 95% CI: 1.17-3.40) aspects of postnatal care as being more important than Swedish-born women did. The most important aspect of overall satisfaction was the content of care, and the subscale Caring Relationship (AOR=8.15; 95% CI: 4.87-14.62) outscored all other aspects.

CONCLUSIONS

Important factors of satisfactory experiences with postnatal care in a Swedish context were receiving information, professional care, and a hospital environment that facilitates recovery after labor and birth. Culturally sensitive and individualized postnatal care with continuity should therefore be prioritized.

Migrant women's engagement in health-promotive activities through a women's health collaboration

Introduction

Social determinants of health impact health, and migrants are exposed to an inequitable distribution of resources that may impact their health negatively, leading to health inequality and social injustice. Migrant women are difficult to engage in health-promotional activities because of language barriers, socioeconomic circumstances, and other social determinants. Based on the framework of Paulo Freire, a community health promotion program was established in a community-academic partnership with a community-based participatory research approach.

Aim

The aim of this study was to describe how a collaborative women's health initiative contributed to migrant women's engagement in health promotion activities.

Materials and methods

This study was part of a larger program, carried out in a disadvantaged city area in Sweden. It had a qualitative design with a participatory approach, following up on actions taken to promote health. Health-promotional activities were developed in collaboration with a women's health group, facilitated by a lay health promoter. The study population was formed by 17 mainly Middle Eastern migrant women. Data was collected using the story-dialog method and the material was analyzed using thematic analysis.

Result

Three important contributors to engagement in health promotion were identified at an early stage of the analysis process, namely, the group forming a social network, the local facilitator from the community, and the use of social places close to home. Later in the analysis process, a connection was made between these contributors and the rationale behind their importance, that is, how they motivated and supported the women and how the dialog was conducted. This therefore became the designated themes and were connected to all contributors, forming three main themes and nine sub-themes.

Conclusion

The key implication was that the women made use of their health knowledge and put it into practice. Thus, a progression from functional health literacy to a level of critical health literacy may be said to have occurred.

Health-seeking behaviours of immigrants, asylum seekers and refugees in Europe: a systematic review of peer-reviewed articles

Purpose

Immigrants, asylum seekers and refugees living in Europe face a number of challenges in accessing or using health information and healthcare services available in their host countries. To resolve these issues and deliver the necessary services, providers must take a comprehensive approach to better understand the types of health information and healthcare services that these individuals need, seek and use. Therefore, the purpose of this paper is to develop that comprehensive approach.

Design/methodology/approach

In this paper, a systematic literature review of peer-reviewed publications was performed, with 3.013 articles collected from various databases. A total of 57 qualifying papers on studies conducted in Europe were included in the review after applying the predefined inclusion and exclusion requirements, screening processes and eliminating duplicates. The information seeking and communication model (ISCM) was used in the analysis.

Findings

The findings revealed that while many health information and healthcare services are accessible in Europe for immigrants, asylum seekers and refugees, many of these individuals are unaware of their existence or how to access them. While our findings do not specify what health-related information these groups need, use or seek, they do suggest the importance and value of providing mental health, sexual health and HIV, as well as pregnancy and childbirth information and services. Furthermore, according to our results, health information services should be fact-based, easy to understand and raise awareness about healthcare structure and services available in Europe for this vulnerable population.

Practical implications

This study has a range of practical implications, including (1) highlighting the need for mental health and behavioural health services and (2) stressing the value of addressing cultural context and religious values while investigating (health) information seeking of people with foreign background.

Originality/value

This is one of the first studies to systematically review and examine the behaviour of immigrants, asylum seekers and refugees in relation to health information and healthcare services in the European context.

Community-based health promotion about alcohol and other drugs in a multicultural Australia-what works? A review of evidence

Refugee and migrant communities from culturally and linguistically diverse backgrounds in Australia experience dependency, stigma, isolation, mental health issues, family issues and other problems associated with alcohol and other drugs. Yet, refugee and migrant communities also face major linguistic, cultural and technological barriers to health promotion about drug-related problems. The aim of this review is to identify effective techniques and approaches for health promotion that reduces the risk of problems with drugs in culturally and linguistically inclusive ways. To identify what is effective, the Medline/PubMed database was systematically searched for health promotion literature published between 2008 and 2018. Grey literature from relevant agencies was also searched. The review considered both quantitative and qualitative outcome measures, and assessed studies using the Critical Appraisal Skills Programme quality assessment tool. Three studies met inclusion criteria, with weak evaluations. The studies demonstrated effective community engagement, but do not provide conclusive evidence of what is effective drug-related health promotion. The review's findings point to an important knowledge gap. More rigorous research and evaluation are required to identify effective health promotion for reducing drug-related issues with a larger, more diverse range of refugee and migrant communities.

Afghan families and health professionals' access to health information during and after pregnancy

BACKGROUND

Having a baby in a new country can be challenging, especially if unable to communicate in a preferred language. The aim of this paper is to explore the provision of health information for Afghan women and men during pregnancy, childbirth and the first year after birth in Melbourne, Australia.

METHODS

Community engagement underpinned the study design. Qualitative study with bicultural researchers conducting semi-structured interviews. Interviews and focus groups were also conducted with health professionals.

RESULTS

Sixteen Afghan women and 14 Afghan men with a baby aged 4-12 months participated. Thirty four health professionals also participated. Verbal information provided by a health professional with an interpreter was the most common way in which information was exchanged, and was generally viewed favourably by Afghan women and men. Families had limited access to an interpreter during labour and some families reported difficulty accessing an interpreter fluent in their dialect. Availability of translated information was inconsistent and health professionals occasionally used pictures to support explanations. Women and men were unsure of the role of health professionals in providing information about issues other than pregnancy and infant wellbeing.

CONCLUSION

Both individual and health system issues hinder and enable the availability and use of information. Consistent, understandable and 'actionable' information is required to meet the needs of diverse families. Health professionals need to be supported with adequate alternatives to written information and access to appropriate interpreters. Inconsistent provision of information is likely to contribute to low health literacy and poor maternal and child health outcomes.

The significance of gratitude for palliative care professionals: a mixed method protocol

BACKGROUND

In palliative care (PC) patients and relatives (P/R) often show their gratitude to the healthcare professionals (HP) who care for them. HP appreciate these displays of gratitude, although the impact of the same has not been examined in detail. Publications analysed tell personal experiences in which HP say that displays of gratitude create sensations of well-being, pride and increased motivation to carry on caring. No systematic examination in PC was found. These aspects related to gratitude may be important in the field of PC, where there is constant exposure to suffering and the preoccupation which arises from wanting to help HP to go on with their work, but it needs closer study and systemisation. The purpose of this study is to understand the significance and the role of the gratitude received from P/R for palliative care health professionals (PCHP).

METHODS

A suitable mixed method will be used. The first phase will be quantitative and will consist of a survey, piloted by experts, whose goal is to explore the current situation in Spain as regards displays of gratitude received by HP at PC services. It will be sent by e-mail. The results from this part will be incorporated into the second part which will be qualitative and whose goal is to understand the significance of the experience of receiving displays of gratitude from the perspective of PCHP, using a phenomenological approach. Interviews will be undertaken amongst PCHP. The interview guide will be designed after taking the survey results into account. The project has been granted ethical approval.

DISCUSSION

These results are set to provide a key contribution within the context of the growing preoccupation on how to care for HP, how to ensure retention and keep them from resigning, as well as preventing burnout, emotional fatigue and boosting their resilience. In order to do this, it is both interesting and ground breaking, to analyse the repercussion of spontaneous gratitude shown by P/R towards PCHP, to see if this is a useful resource to reduce these problems and to encourage the greater presence of dignity and humanisation, for both those receiving care and for those providing it. This gratitude may be one of these strategies.

A Review of Health Survey Research for People with Refugee Background Resettled from Africa: Research Gaps and Methodological Issues

We reviewed 27 studies on adults with a refugee background resettled from Africa published between 1999 and 2017 to appraise their methodological issues for survey research. Out of 27 studies, eleven used a single sampling method (referral = 1, convenience = 10), and 16 relied on multiple sampling methods, many of which were combinations of referral and convenience. The two most salient recruitment strategies found were building trusted relationships with the community (n = 15), and using recruiters who were culturally and linguistically matched to the refugee communities of interest (n = 14). Fifteen studies used existing data collection instruments, while in 13 studies, researchers developed their own data collection instruments. In-person or phone interviews using bilingual interviewers (n = 21) were the most frequently used mode of data collection, followed by a self-administered survey (n = 7). Our review presents methodological gaps in current refugee health studies, such as limited use of probability sampling approach due to system barriers, lack of information in community engagement and recruitment processes, and insufficient considerations of unique culture and experiences of refugee communities when developing or adapting the instruments. Efforts can be made to guide and facilitate appropriate reporting and development of more scientifically robust survey methodologies for refugee health studies, as well as to improve registration system infrastructure that may help identify these hidden populations more effectively.

Mental health care for adult refugees in high-income countries

Approximately one-third of people who have obtained refugee status live in high-income countries. Over recent years, the number of refugees has been increasing, and there are questions on how many of them need mental health care and which type of interventions are beneficial. Meta-analyses showed highly variable rates of mental disorders in adult refugees. This variability is likely to reflect both real differences between groups and contexts, and methodological inconsistencies across studies. Overall prevalence rates after resettlement are similar to those in host populations. Only post-traumatic stress disorder (PTSD) is more prevalent in refugees. In long-term resettled refugees, rates of anxiety and depressive disorders are higher and linked to poor social integration. Research on mental health care for refugees in high-income countries has been extensive, but often of limited methodological quality and with very context-specific findings. The existing evidence suggests several general principles of good practice: promoting social integration, overcoming barriers to care, facilitating engagement with treatment and, when required, providing specific psychological treatments to deal with traumatic memories. With respect to the treatment of defined disorders, only for the treatment of PTSD there has been substantial refugee-specific research. For other diagnostic categories, the same treatment guidelines apply as to other groups. More systematic research is required to explore how precisely the general principles can be specified and implemented for different groups of refugees and in different societal contexts in host countries, and which specific interventions are beneficial and cost-effective. Such interventions may utilise new communication technologies. Of particular importance are long-term studies to identify when mental health interventions are appropriate and to assess outcomes over several years. Such research would benefit from sufficient funding, wide international collaboration and continuous learning over time and across different refugee groups.

Prevalence of and risk factors for mental disorders in refugees

Given the increasing numbers of refugees worldwide, the prevalence of their mental disorders is relevant for public health. Prevalence studies show that, in the first years of resettlement, only post-traumatic stress disorder (PTSD) rates are clearly higher in refugees than in host countries' populations. Five years after resettlement rates of depressive and anxiety disorders are also increased. Exposure to traumatic events before or during migration may explain high rates of PTSD. Evidence suggests that poor social integration and difficulties in accessing care contribute to higher rates of mental disorders in the long-term. Policy and research implications are discussed.