Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies

OBJECTIVE

Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular.

METHODS

Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status.

RESULTS

In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake.

CONCLUSIONS FOR PRACTICE

Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups.

Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study)

Background

Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR’ health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists’ medication reviews linked with measures to strengthen interprofessional co-operation on NHR’ medication quality, health status and health care use.

Methods

Pragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist’s medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a “toolbox” to facilitate implementation in daily practice. Analysis: primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs.

Discussion

The trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany.

Trial registration

Registered in the German register of clinical studies (DRKS, study ID DRKS00013588, primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.

[Strategies for Recruiting Women with Migration History Using the Example of The BaBi-Birth Cohort Study]

BACKGROUND

Recruitment of participants from all population groups is a known challenge in social epidemiological research. A multitude of potentially useful strategies for the recruitment of ethnic minorities and certain migrant groups have been proposed. However, existing publications have not answered the question whether such strategies are applicable to a birth cohort study in Germany. The aim of the present study was to present recruitment strategies for migrants in a birth cohort using the example of the BaBi study.

METHODS

As a preparatory step, focus group discussions were conducted with pregnant and postpartum women and structured interviews with midwives and gynecologists in order to assess suitability of study information materials, questionnaires and language preferences. The pilot study, conducted from October 2013 to October 2016, tested different recruitment strategies. The entire recruitment period was accompanied by continuous evaluation in order to assess and adapt the process to ensure successful recruitment of migrants.

RESULTS

Of the 980 participants, 390 had a migration background (40%). Both active and passive recruitment strategies were explored in which Turkish language translations and multicultural personnel were used. Passive recruitment via gynecological practices and midwives required pregnant women to have high levels of motivation. Active recruitment in postnatal wards (where women were approached by study nurses after birth) increased the proportion of participants with a migration background from 22 to 49%. Early monitoring of our recruitment strategy thus enabled us to improve participation rates.

CONCLUSION

For recruitment of women with a migration background, it is crucial to use both careful preparation in the form of qualitative measures (focus groups, structured interviews) and a pilot study. Extra resources should be planned from the beginning for diverse recruitment strategies and a higher personnel demand (e. g., for translations and back translations). Efforts for the inclusions of migrants in social epidemiological studies in Germany should be a routine process.

Early childhood health in Bielefeld, Germany (BaBi study): study protocol of a social-epidemiological birth cohort

INTRODUCTION

The heterogeneity among the German population is increasing. Sociodemographic differentials (eg, in education and migrant status) have been associated with health disparities. Life course studies show that a considerable part of these disparities is determined by exposures during pregnancy and early childhood. The BaBi study was established in 2012 to investigate the production of health disparities from foetal life to childhood in the city of Bielefeld, Germany.

METHODS AND ANALYSIS

Between 2013 and 2016, detailed information on socioeconomic characteristics, migration background, lifestyle factors, environmental factors, healthcare use, and health status of 995 newborns, including 24 twins, and their families was collected using standardised instruments. Data collection started during pregnancy or shortly after birth with a computer-assisted personal interview of the pregnant woman/mother. Follow-up data will be collected until 2018 by computer-assisted telephone interviews around the first, second and after the third birthday of the child and by linking routine healthcare data. Blood samples are collected from a small subsample of 50 mothers for a substudy about stress during pregnancy (BaBi-Stress study).

ETHICS AND DISSEMINATION

The study was approved by the ethical committee of the Medical Faculty of Muenster University and the Data Protection Board of Bielefeld University. Results will be published in scientific journals. Data sets and questionnaires will be made accessible for researchers based on access proposals and data usage contracts.