Midwifery Programme, Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark; Department of Public Health, Section of Social Medicine, Copenhagen University, Gothersgade 160, 1123 København K., Denmark.
Department of Public Health, Section of Social Medicine, Copenhagen University, Gothersgade 160, 1123 København K., Denmark.
Int J Nurs Stud. 2020 Nov;111:103742. doi: 10.1016/j.ijnurstu.2020.103742. Epub 2020 Aug 8.
In Europe, the number of children born by non-Western immigrant women is rising and these women have an increased risk of negative pregnancy and birth outcomes, compared to the host populations. Several individual and system barriers are associated with immigrant women's access to maternity care. Scientific evaluations of interventions to enhance the health of immigrant women in the maternity setting are lacking, and there is a need for further development of the evidence base on how health care system initiatives may mitigate ethnic inequities in reproductive health. In Denmark, the MAMAACT intervention was developed to improve midwives' as well as non-Western immigrant women's response to pregnancy complications and to promote midwives' intercultural communication and cultural competence. The intervention included a training course for midwives as well as a leaflet and a mobile application. This study focuses on the significance of the antenatal care context surrounding the implementation of the MAMAACT intervention (Id. No: SUND-2018-01).
To explore the main organisational barriers, which impacted the intended mechanisms of the MAMAACT intervention in Danish antenatal care.
A qualitative study design was used for data collection and analysis.
Midwifery visits at ten antenatal facilities affiliated to five Danish maternity wards formed the setting of the study.
Data consisted of nine focus group interviews with midwives (n = 27), twenty-one in-depth interviews with non-Western immigrant women, forty observations of midwifery visits, and informal conversations with midwives at antenatal care facilities (50 h). Data were initially analysed using systematic text condensation. The candidacy framework was applied for further interpretation of data.
Analysis of data revealed three main categories: 'Permeability of antenatal care services', 'The interpreter as an aid to candidacy´, and 'Local conditions influencing the production of candidacy'.
Several organisational barriers impacted the intended mechanisms of the MAMAACT intervention. Major barriers were incomplete antenatal records, insufficient referrals to specialist care, inadequate interpreter assistance, and lack of local time resources for initiating a needs-based dialogue with the women. Immigrant targeted interventions must be understood as events within complex systems, and training midwives in intercultural communication and cultural competence cannot alone improve system responses to pregnancy complications among immigrant women. Changes in the legal, social, and political context of the health care system are needed to support organisational readiness for the MAMAACT intervention.
在欧洲，非西方移民妇女所生的儿童数量不断增加，与东道国人口相比，她们在妊娠和分娩结果方面面临更大的风险。一些个人和系统障碍与移民妇女获得产妇保健服务的机会有关。科学评估干预措施以增强产妇环境中移民妇女的健康状况的工作还很缺乏，需要进一步制定关于医疗保健系统举措如何减轻生殖健康方面的族裔不平等现象的证据基础。在丹麦，MAMAACT 干预措施的制定是为了改善助产士以及非西方移民妇女对妊娠并发症的反应，并促进助产士的跨文化交流和文化能力。该干预措施包括为助产士提供培训课程以及宣传册和移动应用程序。本研究重点关注 MAMAACT 干预措施在丹麦产前保健环境中实施的背景下的主要组织障碍（编号：SUND-2018-01）。
探讨影响 MAMAACT 干预措施在丹麦产前保健中预期机制的主要组织障碍。
数据收集和分析采用定性研究设计。
十个产前设施的助产士访问构成了研究的背景，这些设施隶属于五个丹麦产科病房。
数据包括九次助产士焦点小组访谈（n=27）、二十一次非西方移民妇女深入访谈、四十次助产士访问观察以及产前保健设施与助产士的非正式对话（50 小时）。数据最初使用系统文本浓缩法进行分析。候选框架用于进一步解释数据。
数据分析揭示了三个主要类别：“产前保健服务的渗透性”、“口译员作为候选资格的辅助手段”和“影响候选资格产生的当地条件”。
几个组织障碍影响了 MAMAACT 干预措施的预期机制。主要障碍是产前记录不完整、向专科护理的转诊不足、口译员协助不足以及缺乏当地时间资源与妇女进行基于需求的对话。针对移民的干预措施必须被理解为复杂系统中的事件，而仅对助产士进行跨文化交流和文化能力培训并不能改善系统对移民妇女妊娠并发症的反应。需要改变医疗保健系统的法律、社会和政治背景，以支持 MAMAACT 干预措施的组织准备。
