Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
BMC Health Serv Res. 2024 Oct 31;24(1):1325. doi: 10.1186/s12913-024-11709-2.
Immigrant women in many high-income countries including Sweden, report unmet need of sexual and reproductive health and rights, and face worse pregnancy outcomes and higher risk of unintended pregnancies. Postpartum contraceptive services are often inadequate to meet their needs. Co-design has shown to reduce health inequities, yet little is known about using this method for postpartum contraceptive service development and even less in collaborating with immigrant populations. The aim of this paper is to describe the co-design process and the strategies that were developed to help develop tailored and acceptable postpartum contraceptive services for immigrant women in Sweden.
The paper describes a co-design process that took place during 2022-2023, including the cyclical digital consultations with Arabic and Somali speaking immigrant women, midwives and researchers, as well as the outputs from the process. The theoretical framework for the co-design process was the 'Double Diamond' Design Process Model. Data analysis included qualitative content analysis.
The co-design process led to the joint development of intervention materials and strategies to improve postpartum contraceptive services. Specifically, the process revealed ideas on how to improve contraceptive counseling within three pre-identified areas of change: improve physical access to contraceptive services; improved communication strategies using visual aids and information charts; and empowerment strategies that focus on reflective practice without assumptions about what a group of women might expect. We found that participants contributed actively to the process with ideas and suggestions, and that the co-design process facilitated positive reflections on ongoing counseling practices.
The co-design process resulted in the successful and participative development of innovative tools and activities to improve contraceptive counseling services. This approach is original because it involves both immigrant women, often left behind, and midwives delivering the services. Whilst this interplay allowed for careful refinement of services and tools by using an iterative process, it also facilitated reflective midwifery practice.
包括瑞典在内的许多高收入国家的移民妇女报告称，她们的性健康和生殖健康需求未得到满足，她们面临更糟糕的妊娠结局和更高的意外怀孕风险。产后避孕服务往往无法满足她们的需求。共同设计已被证明可以减少健康不平等，但对于利用这种方法开发产后避孕服务，甚至在与移民群体合作方面，了解甚少。本文旨在描述共同设计过程以及制定的策略，以帮助为瑞典的移民妇女开发量身定制且可接受的产后避孕服务。
本文描述了 2022 年至 2023 年期间进行的共同设计过程，包括与讲阿拉伯语和索马里语的移民妇女、助产士和研究人员进行的周期性数字咨询，以及该过程的产出。共同设计过程的理论框架是“双钻石”设计过程模型。数据分析包括定性内容分析。
共同设计过程导致联合开发干预措施和策略，以改善产后避孕服务。具体而言，该过程揭示了如何在三个预先确定的变革领域改善避孕咨询的想法：改善获得避孕服务的途径；使用视觉辅助工具和信息图表改善沟通策略；以及关注反思实践的赋权策略，而不是对一群女性可能期望的内容做出假设。我们发现，参与者积极参与了该过程，提出了想法和建议，共同设计过程促进了对持续咨询实践的积极反思。
共同设计过程成功地开发了具有创新性的工具和活动，以改善避孕咨询服务。这种方法是原创的，因为它涉及到经常被忽视的移民妇女和提供服务的助产士。虽然这种相互作用允许通过迭代过程仔细改进服务和工具，但它也促进了助产实践的反思。
