Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Victoria, Australia; School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia; Intergenerational Health, Murdoch Children Research Institute, Parkville, Victoria, Australia.
Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Victoria, Australia.
Soc Sci Med. 2024 Oct;358:117250. doi: 10.1016/j.socscimed.2024.117250. Epub 2024 Aug 23.
Different models of care may be appropriate for various groups of women during their perinatal period, depending on their risk level, location, and accessibility of healthcare practitioners and facilities. Evaluating these models' effectiveness and cost-effectiveness is critical to allocating resources and offering sustained care to women from refugee backgrounds. This systematic review aimed to synthesize evidence on the effectiveness and cost-effectiveness of maternity care models among women from migrant and refugee backgrounds living in high-income countries.
A comprehensive search of major databases for studies published in English between 2000 and 2023 was developed to identify literature using defined keywords and inclusion criteria. Two authors independently screened the search findings and the full texts of eligible studies. The quality of the included studies was appraised, and qualitative and quantitative results were synthesised narratively and presented in tabular form. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Forty-seven research papers from six countries were included in the review. The review highlighted the positive impact of community and stakeholders' involvement in the implementation of models of maternity care for women from migrant and refugee backgrounds. The review summarised the models of care in terms of their effectiveness in improving perinatal health outcomes and minimising medical interventions, continuum of care in maternity services, enhancing health literacy, maternity service use and navigating the healthcare system, social support, and sense of belongingness, and addressing cultural and linguistic barriers. Notably, only one study conducted a partial economic evaluation to determine the cost-effectiveness of the model.
While the reviewed models demonstrated effectiveness in improving perinatal health outcomes, there was considerable variation in outcome measures and assessment tools across the models. Thus, reaching a consensus on prioritised perinatal outcomes and measurement tools is crucial. Researchers and policymakers should collaborate to enhance the quality and quantity of economic evaluations to support evidence-based decision-making. This includes thoroughly comparing costs and outcomes across various health models to determine the most efficient interventions. By emphasizing the importance of comprehensive economic evaluations, healthcare systems can better allocate resources, ultimately leading to more effective and efficient healthcare delivery.
根据风险水平、地理位置以及医疗保健从业者和设施的可及性，不同的照护模式可能适用于围产期的不同女性群体。评估这些模式的有效性和成本效益对于为有难民背景的女性分配资源并提供持续的照护至关重要。本系统评价旨在综合评估高收入国家中具有移民和难民背景的女性所接受的各种围产期照护模式的有效性和成本效益。
制定了全面检索 2000 年至 2023 年间发表的英文文献的策略，以使用定义的关键词和纳入标准搜索文献。两位作者独立筛选了检索结果和符合条件的研究的全文。评估了纳入研究的质量，并以叙述性方式综合了定性和定量结果，并以表格形式呈现。该综述按照系统评价和荟萃分析的首选报告项目进行报告。
综述纳入了来自六个国家的 47 篇研究论文。该综述强调了社区和利益相关者参与实施针对移民和难民背景女性的围产期照护模式的积极影响。该综述总结了这些照护模式在改善围产期健康结局和减少医疗干预、孕产妇服务中连续照护、提高健康素养、使用孕产妇服务和在医疗保健系统中导航、社会支持和归属感以及解决文化和语言障碍方面的有效性。值得注意的是，只有一项研究进行了部分经济评估，以确定该模式的成本效益。
虽然所审查的模式在改善围产期健康结局方面表现出有效性，但这些模式在结局衡量指标和评估工具方面存在很大差异。因此，就优先围产期结局和衡量工具达成共识至关重要。研究人员和政策制定者应合作，提高经济评估的质量和数量，以支持基于证据的决策。这包括通过彻底比较各种卫生模型的成本和结果，来确定最有效的干预措施。通过强调全面经济评估的重要性，医疗保健系统可以更好地分配资源，最终实现更有效和高效的医疗保健服务。
