Montoya-Williams Diana, Barreto Alejandra, Laguna-Torres Alicia, Worsley Diana, Wallis Kate, Peña Michelle-Marie, Palladino Lauren, Salva Nicole, Levine Lisa, Rivera Angelique, Hernandez Rosalinda, Fuentes-Afflick Elena, Yun Katherine, Lorch Scott, Virudachalam Senbagam
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.
CHOP PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA.
Med Care. 2024 Jun 1;62(6):404-415. doi: 10.1097/MLR.0000000000002002. Epub 2024 Apr 26.
Community-engaged qualitative study using inductive thematic analysis of semistructured interviews.
To understand Latine immigrants' recent prenatal care experiences and develop community-informed strategies to mitigate policy-related chilling effects on prenatal care utilization.
Decreased health care utilization among immigrants due to punitive immigration policies (ie, the "chilling effect") has been well-documented among Latine birthing people both pre and postnatally.
Currently or recently pregnant immigrant Latine people in greater Philadelphia were recruited from an obstetric clinic, 2 pediatric primary care clinics, and 2 community-based organization client pools. Thematic saturation was achieved with 24 people. Participants' pregnancy narratives and their perspectives on how health care providers and systems could make prenatal care feel safer and more comfortable for immigrants.
Participants' recommendations for mitigating the chilling effect during the prenatal period included training prenatal health care providers to sensitively initiate discussions about immigrants' rights and reaffirm confidentiality around immigration status. Participants suggested that health care systems should expand sources of information for pregnant immigrants, either by partnering with community organizations to disseminate information or by increasing access to trusted individuals knowledgeable about immigrants' rights to health care. Participants also suggested training non-medical office staff in the use of interpreters.
Immigrant Latine pregnant and birthing people in greater Philadelphia described ongoing fear and confusion regarding the utilization of prenatal care, as well as experiences of discrimination. Participants' suggestions for mitigating immigration-related chilling effects can be translated into potential policy and programmatic interventions which could be implemented locally and evaluated for broader applicability.
采用半结构化访谈的归纳主题分析方法进行社区参与式定性研究。
了解拉丁裔移民近期的产前护理经历，并制定基于社区的策略，以减轻政策对产前护理利用的相关寒蝉效应。
惩罚性移民政策导致移民医疗保健利用率下降（即“寒蝉效应”），这在拉丁裔产妇产前和产后都有充分记录。
从费城地区的一家产科诊所、两家儿科初级保健诊所和两个社区组织的客户群体中招募目前或近期怀孕的拉丁裔移民。对24人进行访谈后达到主题饱和。参与者讲述了他们的怀孕经历，以及他们对医疗保健提供者和系统如何让移民在接受产前护理时感到更安全、更舒适的看法。
参与者提出的减轻产前寒蝉效应的建议包括：培训产前保健提供者，以敏感地开启关于移民权利的讨论，并再次确认移民身份的保密性。参与者建议，医疗保健系统应扩大为怀孕移民提供信息的来源，要么与社区组织合作传播信息，要么增加接触了解移民医疗保健权利的可靠人员的机会。参与者还建议培训非医疗办公室工作人员如何使用口译员。
费城地区的拉丁裔移民孕妇和产妇描述了在利用产前护理方面持续存在的恐惧和困惑，以及歧视经历。参与者提出的减轻与移民相关的寒蝉效应的建议可转化为潜在的政策和方案干预措施，这些措施可在当地实施并评估其更广泛的适用性。
