Villadsen Sarah Fredsted, Johnsen Helle, Damsted Rasmussen Trine, Ekstrøm Claus Thorn, Sørensen Janne, Azria Elie, Rich-Edwards Janet, Essén Birgitta, Christensen Ulla, Smith Jervelund Signe, Nybo Andersen Anne-Marie
Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Copenhagen, Denmark.
Front Health Serv. 2024 Feb 16;4:1233069. doi: 10.3389/frhs.2024.1233069. eCollection 2024.
Ethnic disparities in stillbirth exist in Europe and suboptimal care due to miscommunication is one contributing cause. The MAMAACT intervention aimed to reduce ethnic disparity in stillbirth and newborns' health through improved management of pregnancy complications. The intervention encompassed training of antenatal care midwives in cultural competencies and intercultural communication combined with health education materials for the expecting parents about symptoms of pregnancy complications. The evaluation consisted of a qualitative in-depth implementation analysis and a process evaluation embedded in a cluster randomized trial including 19 of 20 maternity wards in Denmark. In this article, the findings from the different evaluation perspectives are integrated. The integration follows the principles of realist evaluation by analyzing to what extent the MAMAACT activities were generating mechanisms of change in interaction with the context. The integration analysis shows that the health education materials in the MAMAACT intervention contributed to heightened health literacy concerning pregnancy complications among pregnant women. Additionally, the training of midwives in cultural competency and intercultural communication raised awareness among midwives. Nonetheless, the exclusive emphasis on midwives and the inflexibility in care provision hindered them from changing their communication practices. To enhance the cultural competence in maternity care, it is essential to implement more comprehensive initiatives involving healthcare professionals in maternity care at all levels, from pregraduate to postgraduate. Adequate interpreter services and management support should also be ensured. Currently, the Danish antenatal care system faces challenges including inadequate information transfer between healthcare sectors, insufficient differentiation of care, and inflexibility in midwife scheduling. This results in a lack of responsiveness to the individual needs of women with immigrant backgrounds, potentially reproducing health inequities.
欧洲存在死产方面的种族差异，因沟通不畅导致的护理不佳是一个促成因素。MAMAACT干预旨在通过改善妊娠并发症的管理来减少死产和新生儿健康方面的种族差异。该干预包括对产前护理助产士进行文化能力和跨文化沟通培训，以及为准父母提供有关妊娠并发症症状的健康教育材料。评估包括定性的深入实施分析和纳入丹麦20个产科病房中19个的整群随机试验中的过程评估。在本文中，整合了来自不同评估视角的结果。整合遵循现实主义评估原则，分析MAMAACT活动在与背景互动中产生变化机制的程度。整合分析表明，MAMAACT干预中的健康教育材料有助于提高孕妇对妊娠并发症的健康素养。此外，对助产士进行文化能力和跨文化沟通培训提高了助产士的意识。尽管如此，对助产士的过度强调以及护理提供的僵化阻碍了他们改变沟通方式。为了提高产科护理中的文化能力，必须实施更全面的举措，让各级产科护理的医疗专业人员参与其中，从研究生前到研究生阶段。还应确保提供足够的口译服务和管理支持。目前，丹麦的产前护理系统面临挑战，包括医疗保健部门之间信息传递不足、护理区分不够以及助产士排班僵化。这导致对有移民背景女性的个人需求缺乏响应，可能会延续健康不平等现象。
