De Freitas Cláudia, Massag Janka, Amorim Mariana, Fraga Sílvia
1EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal.
2Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
Public Health Rev. 2020 Apr 7;41:5. doi: 10.1186/s40985-020-00121-w. eCollection 2020.
Guidelines for improving the quality of maternal health services emphasise women's involvement in care. However, evidence about migrant and ethnic minorities' preferences for participation in maternal care remains unsystematised. Understanding these populations' experiences with and preferred forms of involvement in care provision is crucial for imbuing policies and guidelines with sensitivity to diversity and for implementing people-centred care. This paper presents a narrative synthesis of empirical studies of involvement in maternal health care by migrants and ethnic minorities based on four key dimensions: information, communication, expression of preferences and decision-making.
Studies indexed in PubMed and Scopus published until December 2019 were searched. Original quantitative, qualitative and mixed methods studies written in English and reporting on migrant and ethnic minority involvement in maternal care were included. Backward reference tracking was carried out. Three researchers conducted full-text review of selected publications.
In total, 22 studies met the inclusion criteria. The majority of studies were comparative and addressed only one or two dimensions of involvement, with an emphasis on the information and communication dimensions. Compared to natives, migrants and ethnic minorities were more likely to (1) lack access to adequate information as a result of health care staff's limited time, knowledge and misconceptions about women's needs and preferences; (2) report suboptimal communication with care staff caused by language barriers and inadequate interpreting services; (3) be offered fewer opportunities to express preferences and to have preferences be taken less into account; and (4) be less involved in decisions about their care due to difficulties in understanding information, socio-cultural beliefs and previous experiences with care provision less attuned with playing an active role in decision-making and care staff detracting attitudes.
Constraints to adequate and inclusive involvement in maternal care can hinder access to quality care and result in severe negative health outcomes for migrant and ethnic minority women. More research is needed into how to tailor the dimensions of involvement to migrant and ethnic minorities' needs and preferences, followed by provision of the resources necessary for effective implementation (e.g. sufficient time for consultations, optimal interpreter systems, health care staff training).
改善孕产妇保健服务质量的指南强调妇女参与护理。然而，关于移民和少数民族对参与孕产妇护理的偏好的证据仍未系统化。了解这些人群在护理提供方面的经历以及他们偏好的参与形式，对于使政策和指南具有对多样性的敏感性以及实施以人为本的护理至关重要。本文基于信息、沟通、偏好表达和决策这四个关键维度，对移民和少数民族参与孕产妇保健的实证研究进行了叙述性综合分析。
检索了截至2019年12月在PubMed和Scopus上索引的研究。纳入了以英文撰写的、报告移民和少数民族参与孕产妇护理情况的原始定量、定性和混合方法研究。进行了向后参考文献追踪。三位研究人员对选定的出版物进行了全文审查。
共有22项研究符合纳入标准。大多数研究是比较性的，仅涉及参与的一两个维度，重点是信息和沟通维度。与本地人相比，移民和少数民族更有可能：(1) 由于医护人员时间有限、知识不足以及对妇女需求和偏好的误解，而无法获得足够的信息；(2) 报告由于语言障碍和口译服务不足而与护理人员的沟通不理想；(3) 表达偏好的机会较少，且偏好较少被考虑；(4) 由于理解信息困难、社会文化信仰以及以往护理经历与在决策中发挥积极作用不太协调，且护理人员态度不友好，而较少参与有关其护理的决策。
在孕产妇护理中充分和包容性参与的限制可能会阻碍获得高质量护理，并给移民和少数民族妇女带来严重的负面健康后果。需要更多研究如何根据移民和少数民族的需求和偏好调整参与维度，随后提供有效实施所需的资源（例如充足的咨询时间、最佳口译系统、医护人员培训）。
