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Ahmed R, Mao Y. An Intersectional Approach to Understanding Beliefs and Attitudes Toward Mental Health Issues Among Muslim Immigrant Women in Canada. HEALTH COMMUNICATION 2024; 39:2014-2025. [PMID: 37670409 DOI: 10.1080/10410236.2023.2252644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Although addressing cultural and religious practices is important in providing mental health care, little research exists on understanding mental health issues of minority groups such as Muslim immigrant women. We employed an intersectional approach to examine beliefs and attitudes toward mental health issues among Muslim immigrant women in Canada. Four focus groups (21 participants) were conducted, and 101 surveys were collected in Ottawa, Canada. Three core themes emerged from thematic content analysis of focus group data that relate to participants' communication about: 1) stressors, 2) mental health care seeking, and 3) utilizing coping strategies. The survey data were analyzed using independent samples t-test and One-Way ANOVA, the results of which supported the qualitative findings that social stigma was an important obstacle preventing those women from seeking professional mental health services. Muslim women with South and Southeast Asian cultural/ethnic backgrounds were more likely to get help from professionals than those with African cultural/ethnic backgrounds. No group differences were found in age, family income, and employment status. Broadly, the findings underscore the importance of developing knowledge about the intersections among gender, religion, cultural identity, immigration status, and social stigma that influence beliefs and attitudes toward mental health issues. Specifically, the findings point to the need for an intersectional approach that offers a more nuanced understanding for tailoring mental health care to Muslim immigrant women's needs.
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Affiliation(s)
- Rukhsana Ahmed
- Department of Communication, University at Albany, State University of New York
| | - Yuping Mao
- Department of Communication Studies, California State University, Long Beach
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Saunders E, Pevie NW, Bedford S, Gosselin J, Harris N, Rash JA. Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador. PLoS One 2024; 19:e0304815. [PMID: 38980863 PMCID: PMC11233017 DOI: 10.1371/journal.pone.0304815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/18/2024] [Indexed: 07/11/2024] Open
Abstract
Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.
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Affiliation(s)
- Emily Saunders
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Noah W. Pevie
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Shannon Bedford
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Julie Gosselin
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Nick Harris
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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Zou P, Alam A, Shao J, Luo Y, Huang Y, Zhang H, Wang W, Sidani S. Midlife Transition Experiences of South Asian Immigrant Women in Canada: A Qualitative Exploration. Can J Nurs Res 2023; 55:305-318. [PMID: 36775893 PMCID: PMC10416550 DOI: 10.1177/08445621231153525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND South Asians make up a significant portion of the immigrant population in Canada, and a large portion of them are in their midlife. To improve the midlife transition of South Asian immigrant women, it is necessary to understand their lived experiences. PURPOSE Guided by the transition theory, this study investigates the midlife experiences of South Asian immigrant women in Canada. METHODS Twenty-two South Asian midlife, immigrant women were recruited to participate in this study from the Greater Toronto Area, Ontario, Canada. This study consisted of one asynchronous online focus group with 12 participants and ten one-on-one telephone interviews. Qualitative content analysis was guided by transition theory. RESULTS South Asian immigrant women experienced many different transitions in their midlife in Canada. These transitions included changes in their (a) lifestyle, (b) career, (c) family, (d) physical health, (e) mental health, (f) social, (g) environment, and (h) personal development. Women actively managed their transitions using strategies such as exercise, socialization, counseling, and religion. Women expressed the need for social, community, and governmental support to facilitate their midlife transitions. CONCLUSION To promote healthy midlife transition, governments need to create better employment policies to facilitate immigrant women settlement, transferring skills, and re-employment in Canada. In addition, health care and community services to promote physical and mental health should be emphasized.
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Affiliation(s)
- Ping Zou
- School of Nursing, Nipissing University, Toronto, Ontario, Canada
| | - Arzoo Alam
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jing Shao
- Institute of Nursing Research, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yan Luo
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China
| | - Yanjin Huang
- School of Nursing, University of South China, Hengyang, Hunan, P. R. China
| | - Hui Zhang
- Department of Cardiology, Guizhou provincial people's Hospital, Guiyang, Guizhou, China
| | - Wei Wang
- Toronto Western Hospital Bariatric Surgical Program, University of Health Network, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e203-e216. [PMID: 36841561 DOI: 10.1016/s2468-2667(22)00342-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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Nwoke CN, Awosoga OA, McDonald S, Bonifacio GT, Leung BMY. Prevalence and Associated Factors of Maternal Depression and Anxiety Among African Immigrant Women in Alberta, Canada: Quantitative Cross-sectional Survey Study. JMIR Form Res 2023; 7:e43800. [PMID: 36808093 PMCID: PMC9989913 DOI: 10.2196/43800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Although there is a significant body of evidence on maternal mental health, an inadequate focus has been placed on African immigrant women. This is a significant limitation given the rapidly changing demographics in Canada. The prevalence of maternal depression and anxiety among African immigrant women in Alberta and Canada, as well as the associated risk factors, are not well understood and remain largely unknown. OBJECTIVE The purpose of this study was to investigate the prevalence and associated factors of maternal depression and anxiety among African immigrant women living in Alberta, Canada up to 2 years postpartum. METHODS This cross-sectional study surveyed 120 African immigrant women within 2 years of delivery in Alberta, Canada from January 2020 to December 2020. The English version of the Edinburgh Postnatal Depression Scale-10 (EPDS-10), the Generalized Anxiety Disorder-7 (GAD-7) scale, and a structured questionnaire regarding associated factors were administered to all participants. A cutoff score of 13 on the EPDS-10 was indicative of depression, while a cutoff score of 10 on the GAD-7 scale was indicative of anxiety. Multivariable logistic regression was used to determine the factors significantly associated with maternal depression and anxiety. RESULTS Among the 120 African immigrant women, 27.5% (33/120) met the EPDS-10 cutoff score for depression and 12.1% (14/116) met the GAD-7 cutoff score for anxiety. The majority of respondents with maternal depression were younger (18/33, 56%), had a total household income of CAD $60,000 or more (US $45,000 or more; 21/32, 66%), rented their homes (24/33, 73%), had an advanced degree (19/33, 58%), were married (26/31, 84%), were recent immigrants (19/30, 63%), had friends in the city (21/31, 68%), had a weak sense of belonging in the local community (26/31, 84%), were satisfied with their settlement process (17/28, 61%), and had access to a regular medical doctor (20/29, 69%). In addition, the majority of respondents with maternal anxiety were nonrecent immigrants (9/14, 64%), had friends in the city (8/13, 62%), had a weak sense of belonging in the local community (12/13, 92%), and had access to a regular medical doctor (7/12, 58%). The multivariable logistic regression model identified demographic and social factors significantly associated with maternal depression (maternal age, working status, presence of friends in the city, and access to a regular medical doctor) and maternal anxiety (access to a regular medical doctor and sense of belonging in the local community). CONCLUSIONS Social support and community belonging initiatives may improve the maternal mental health outcomes of African immigrant women. Given the complexities immigrant women face, more research is needed on a comprehensive approach for public health and preventive strategies regarding maternal mental health after migration, including increasing access to family doctors.
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Affiliation(s)
| | | | - Sheila McDonald
- Department of Pediatrics and Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glenda T Bonifacio
- Department of Women and Gender Studies, University of Lethbridge, Lethbridge, AB, Canada
| | - Brenda M Y Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
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Nwoke CN, Awosoga OA, McDonald S, Bonifacio GT, Leung BMY. African Immigrant Mothers' Views of Perinatal Mental Health and Acceptability of Perinatal Mental Health Screening: Quantitative Cross-sectional Survey Study. JMIR Form Res 2023; 7:e40008. [PMID: 36705944 PMCID: PMC9886220 DOI: 10.2196/40008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mental health disorders are the most common perinatal conditions. They affect mothers, babies, partners, and support networks. However, <15% of pregnant and postpartum women seek timely help for their mental health care. Low perinatal mental health knowledge and universal screening unacceptability are cited as important deterrents to obtaining timely mental health care. OBJECTIVE The purpose of this quantitative cross-sectional study was 2-fold: (1) to determine African immigrant mothers' views of perinatal mental health and to identify predictors of those views and (2) to identify African immigrant mothers' views regarding perinatal mental health screening and to determine factors associated with those views. METHODS A cross-sectional survey was conducted using a convenience sample of African immigrant women from the province of Alberta, Canada. Respondents were eligible to participate if they were aged ≥18 years, had a live birth, and the infant was aged ≤2 years. Questions were drawn from the Edinburgh Postnatal Depression Scale, the Generalized Anxiety Disorder-7 scale, and additional questions were developed using the Alberta Maternal Mental Health 2012 survey as a guide and tested to reflect the immigrant context. Descriptive and multivariable regression analyses were conducted. RESULTS Among the 120 respondents, 46.5% (53/114) were aged 31-35 years, 76.1% (89/117) were employed or on maternity leave, 92.5% (111/120) were married, and 55.6% (65/117) had younger infants aged 0 to 12 months. Significantly more respondents had higher levels of knowledge of postnatal (109/115, 94.8%) than prenatal (57/110, 51.2%) mental health (P<.001). Only 25.4% (28/110) of the respondents accurately identified that prenatal anxiety or depression could negatively impact child development. Personal knowledge of postpartum anxiety and depression was a significant predictor of prenatal and postnatal mental health knowledge. Most respondents strongly agreed or agreed that all women should be screened in the prenatal (82/109, 75.2%) and postnatal (91/110, 82.7%) periods. Respondents reported that their partner would be their first choice when seeking help and support. The acceptability of postnatal screening was a significant predictor of prenatal mental health knowledge (P<.001), whereas the acceptability of prenatal screening was a significant predictor of postnatal mental health knowledge (P=.03). Prenatal mental health knowledge was a significant predictor of both prenatal (P<.001) and postnatal (P=.001) screening acceptability. CONCLUSIONS Although African mothers' knowledge of postnatal mental health is high, their prenatal mental health knowledge and its influence on child development are limited. Perinatal mental health interventions for African immigrant mothers in Alberta should target these knowledge gaps. The high acceptability of universal perinatal mental health screening among African mothers provides a promising strategy for perinatal mental health literacy initiatives to achieve optimal perinatal mental health.
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Affiliation(s)
| | | | - Sheila McDonald
- Department of Pediatrics and Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glenda T Bonifacio
- Department of Women and Gender Studies, University of Lethbridge, Lethbridge, AB, Canada
| | - Brenda M Y Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
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Vaillancourt M, Lane V, Ditto B, Da Costa D. Parity and Psychosocial Risk Factors Increase the Risk of Depression During Pregnancy Among Recent Immigrant Women in Canada. J Immigr Minor Health 2022; 24:570-579. [PMID: 34595614 DOI: 10.1007/s10903-021-01284-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
Prior investigations have examined risk factors associated to postpartum depression in immigrant women, but depression during pregnancy has received less attention. This study describes the prevalence and early determinants of antenatal depression among recent (≤ 5 years) and long-term immigrants (> 5 years), compared to Canadian-born women. 503 women completed standardized self-report questionnaires measuring sociodemographics and psychosocial factors. Multivariate logistic regressions identified first trimester risk factors for depression in each immigrant group. The prevalence of depressive symptoms was highest for recent immigrant (25.3-30.8%) compared to long-term immigrant (16.9-19.2%) and Canadian-born women (11.7-13.8%). Among recent immigrants, multiparity, higher stress and pregnancy-specific anxiety in early pregnancy increased the risk of antenatal depression. Among long-term immigrants, stress in the first trimester was significantly associated with antenatal depressive symptoms. Knowledge of modifiable risk factors (pregnancy-specific anxiety and stress) may help improve antenatal screening and inform the development of tailored interventions to meet the mental health needs of immigrant women during the perinatal period.
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Affiliation(s)
| | - Victoria Lane
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Blaine Ditto
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Deborah Da Costa
- Department of Medicine, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research & Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), 5252 de Maisonneuve Boulevard W., Montreal, QC, H4A 3S9, Canada.
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Stirling Cameron E, Ramos H, Aston M, Kuri M, Jackson L. "COVID affected us all:" the birth and postnatal health experiences of resettled Syrian refugee women during COVID-19 in Canada. Reprod Health 2021; 18:256. [PMID: 34952615 PMCID: PMC8709538 DOI: 10.1186/s12978-021-01309-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prior to COVID-19, postnatal resettled refugee women in Canada reported barriers to healthcare and low levels of social support, contributing to maternal health morbidities. The COVID-19 pandemic appears to be further exacerbating health inequities for marginalized populations. The experiences of resettled refugee women are not fully known. AIM To understand Syrian refugee women's experiences accessing postnatal healthcare services and supports during the COVID-19 pandemic. METHODS Semi-structured, virtual interviews were conducted with eight resettled Syrian refugee women living in Nova Scotia (Canada) who were postnatal between March and August 2020. Data analysis was informed by constructivist grounded theory. FINDINGS Three themes emerged: "the impacts of COVID-19 on postnatal healthcare;" "loss of informal support;" and "grief and anxiety." Women experienced difficult healthcare interactions, including socially and physically isolated deliveries, challenges accessing in-person interpreters, and cancelled or unavailable in-home services (e.g., public health nurse and doula visits). Increased childcare responsibilities and limited informal supports due to pandemic restrictions left women feeling overwhelmed and exhausted. Stay-at-home orders resulted in some women reporting feelings of isolation and loss, as they were unable to share in person postnatal moments with friends and family, ultimately impacting their mental wellness. CONCLUSIONS COVID-19 and associated public health restrictions had significant impacts on postnatal Syrian refugee women. Data presented in this study demonstrated the ways in which the pandemic environment and related restrictions amplified pre-existing barriers to care and postnatal health inequalities for resettled refugee women-particularly a lack of postnatal informal supports and systemic barriers to care.
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Affiliation(s)
- Emma Stirling Cameron
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.
- School of Nursing, Dalhousie University, Halifax, NS, Canada.
| | - Howard Ramos
- Department of Sociology, University of Western Ontario, London, ON, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Marwa Kuri
- School of Social Work, Dalhousie University, Halifax, NS, Canada
| | - Lois Jackson
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
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Bonakdar Tehrani M, Kemp L, Baird K. Culturally and linguistically diverse mothers accessing public health nursing: A narrative review. Public Health Nurs 2021; 39:82-88. [PMID: 34811798 DOI: 10.1111/phn.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/01/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Culturally and linguistically diverse (CALD) families with young children are less likely to seek out healthcare services in comparison with the mainstream population. A lack of appropriate access and engagement with public health nursing (PHN) service contributes to major health disparities for CALD mothers. AIM To describe and synthesize the available literature on the factors that promote or hinder CALD mothers' access to and engagement with PHN services and in particular sustained nurse home-visiting (SNHV) programs. This paper identifies gaps and new areas of needed research inquiry to support best provision of PHN for CALD mothers. METHOD A narrative review of the literature was conducted. Databases searched included PubMed, CINAHL, MEDLINE, Cochrane, and Scopus with year of publication between 2000 and 2020. RESULTS Of 463 total articles, 12 met inclusion criteria. The key barriers and facilitators identified were grouped in three major themes. These include mother-related issues, experiences with interpreters, and program and program delivery related issues. DISCUSSION The review demonstrates that CALD mothers with limited English proficiency (LEP) are experiencing multiple challenges in accessing and engaging with PHN and SNHV services. More research is needed to understand nurse-mother-interpreter relationships and policy and practice issues.
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Affiliation(s)
- Mehrnoush Bonakdar Tehrani
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Ingham Institute for Applied Medical Research, Western Sydney University, Liverpool, New South Wales, Australia
| | - Lynn Kemp
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Ingham Institute for Applied Medical Research, Western Sydney University, Liverpool, New South Wales, Australia
| | - Kelly Baird
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Ingham Institute for Applied Medical Research, Western Sydney University, Liverpool, New South Wales, Australia
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Turin TC, Haque S, Chowdhury N, Yeasmin F, Ferdous M, Rashid R, Rumana N, Rahman N, Rahman A, Lasker M, Chowdhury M. Community-Driven Prioritization of Primary Health Care Access Issues by Bangladeshi-Canadians to Guide Program of Research and Practice. FAMILY & COMMUNITY HEALTH 2021; 44:292-298. [PMID: 34292226 DOI: 10.1097/fch.0000000000000308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Research around probable solutions to immigrants accessing health care in Canada is not extensive, and the perspective of immigrant communities on priorities and potential solutions has not been captured effectively. The purpose of this article is to describe a research initiative that involved grassroots community members as producers of research priorities on primary care access issues. This study aimed to seek input from an immigrant community in Calgary, Canada. Members of the Bangladeshi community of Calgary were asked through a survey to rank 10 predefined primary care access topics as to what they felt constituted priorities for solution-oriented research (1, highest; 10, lowest). We used frequencies and percentages to describe the participant demographics. Ratings of preferred research themes were analyzed on the basis of relative weighted priority rank. We received 432 responses: 51.2% female; 58.9% aged 36 to 55 years; 90.5% had university-level education; 46.2% immigrated to Canada between 10 and 19 years ago; 82.5% employed full/part-time or self-employed. Lack of resources, lack of knowledge, health care cost, and workplace-related barriers were among the top-ranked topics identified as solution-oriented research priorities. Through partnerships and reciprocal learning, public input can increase insider perspectives to help develop interventions that align with the needs of community members.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine (Dr Turin, N. Chowdhury, Yeasmin, and Ferdous and Mss Haque and Rashid), Department of Community Health Sciences (Drs Turin and M. Chowdhury), and Sleep Center, Foothills Medical Centre (Dr Rumana), University of Calgary, Calgary, Alberta, Canada. Ms N. Rahman and Drs A. Rahman and Lasker are community scholars and citizen researchers, Bangladeshi-Canadian community, Calgary, Alberta, Canada
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Turin TC, Rashid R, Ferdous M, Chowdhury N, Naeem I, Rumana N, Rahman A, Rahman N, Lasker M. Perceived Challenges and Unmet Primary Care Access Needs among Bangladeshi Immigrant Women in Canada. J Prim Care Community Health 2021; 11:2150132720952618. [PMID: 32865103 PMCID: PMC7457633 DOI: 10.1177/2150132720952618] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Understanding barriers in primary health care access faced by Canadian
immigrants, especially among women, is important for developing mitigation
strategies. The aim of this study was to gain an in-depth understanding of
perceived challenges and unmet primary health care access needs of
Bangladeshi immigrant women in Canada. Methods: In this qualitative study, we conducted 7 focus groups among a sample of 42
first-generation immigrant women on their experiences in primary health care
access in their preferred language, Bangla. Descriptive analysis was used
for their socio-demographic characteristics and inductive thematic analysis
was applied to the qualitative data. Results: The hurdles reported included long wait time at emergency service points,
frustration from slow treatment process, economic losses resulting from
absence at work, communication gap between physicians and immigrant
patients, and transportation problem to go to the health care centers. No
access to medical records for walk-in doctors, lack of urgent care, and lack
of knowledge about Canadian health care systems are a few of other barriers
emerged from the focus group discussions. Conclusions: The community perception about lack of primary health care resources is quite
prevalent and is considered as one of the most important barriers by the
grassroots community members.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ruksana Rashid
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nashit Chowdhury
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Iffat Naeem
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nahid Rumana
- Sleep Center, Foothils Medical Center, Calgary, AB, Canada
| | - Afsana Rahman
- Community-based citizen researcher, Calgary, AB, Canada
| | - Nafiza Rahman
- Community-based citizen researcher, Calgary, AB, Canada
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Hamwi S, Lorthe E, Barros H. Language Proficiency and Migrant-Native Disparities in Postpartum Depressive Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094782. [PMID: 33947149 PMCID: PMC8125143 DOI: 10.3390/ijerph18094782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.
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Affiliation(s)
- Sousan Hamwi
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal;
- Correspondence: ; Tel.: +351-22-206-1820
| | - Elsa Lorthe
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, 1205 Geneva, Switzerland;
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, F-75004 Paris, France
| | - Henrique Barros
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal;
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-450 Porto, Portugal
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Baiden D, Evans M. Black African Newcomer Women's Perception of Postpartum Mental Health Services in Canada. Can J Nurs Res 2020; 53:202-210. [PMID: 32551939 DOI: 10.1177/0844562120934273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY BACKGROUND The stress of immigrating, settling into Canada, and being a new mother, may place newcomer women at risk of mental health challenges. However, little is known on Black African newcomer women's perspectives of postpartum mental health care after experiencing childbirth in Canada. PURPOSE To explore sociocultural factors that impact Black African newcomer women's perception of mental health and mental health service utilization within a year after childbirth in Canada. METHODS This qualitative study, set in Southern Ontario, purposively sampled 10 African newcomer women who birthed a baby in Canada within the past year. Open-ended, semistructured interviews were conducted individually, transcribed and analyzed using thematic analysis. RESULTS Black African newcomer women rely on mental strength, nonmedical treatment preferences, spirituality, and spousal support for fostering postpartum mental health. Furthermore, cultural beliefs, racial discrimination, and temporary immigration status impact their decision making around postpartum mental health services utilization. CONCLUSION Our findings suggest that Black African newcomer women use mental strength to minimize maternal mental illness. Also, the spouses of Black African newcomer women are crucial in their postpartum mental health support. There is an urgent need for culturally safe interventions to meet the postpartum mental health needs of Black African newcomer mothers.
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Affiliation(s)
- Deborah Baiden
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Marilyn Evans
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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14
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Dol J, Tomblin Murphy G, Aston M, McMillan D, Campbell-Yeo M. Design, development and usability testing of Essential Coaching for Every Mother: A postnatal text message educational intervention. Women Birth 2020; 34:e228-e236. [PMID: 32475782 DOI: 10.1016/j.wombi.2020.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 04/10/2020] [Accepted: 05/18/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The transition to motherhood is an exciting yet challenging period that requires physical, emotional, and social adjustment. During the postpartum period, mothers require support and information to ensure a smooth transition and adjustment to motherhood. One innovative strategy to provide mothers with this information is mobile health (mHealth), and specifically, text messaging. OBJECTIVE To describe the design, development and usability testing of a postnatal text message intervention called Essential Coaching for Every Mother. METHODS First time mothers (n=11) and postpartum healthcare providers (n=18) were involved in iterative interviewing in Halifax, Canada. Adaption of content occurred through three rounds of user testing using semi-structured interviews. The Information Assessment Method (IAM) Parents survey was also completed by mothers. RESULTS Three cycles of iterative testing were conducted with eight participants (3 mothers, 5 healthcare providers), thirteen participants (8 mothers, 5 healthcare providers) and 8 participants (8 healthcare providers), respectively. Messages evolved from risk-focused to prevention and education focused. Mothers felt the messages addressed their needs and healthcare providers ensured the content was consistent with the messaging currently provided to postpartum mothers. CONCLUSION Essential Coaching for Every Mother is the first postnatal educational text message intervention developed for mothers in Halifax, Canada. We sought to involve first time mothers (end-users) and postpartum healthcare providers (experts) in the development and usability evaluation to ensure the intervention adequately met needs and was consistent with current practices related to postpartum education.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | | | - Megan Aston
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Douglas McMillan
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada; Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
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Abstract
Acculturation has been related to risk of postpartum depression (PPD) among immigrant women globally. The purpose of this study was to examine the relationship between acculturation and PPD symptoms among U.S. immigrant women of Arabic descent. A cross-sectional study was conducted with 115 postpartum immigrant women of Arabic descent. Women completed questionnaires including measures of acculturation [attraction to Arabic culture (AArC), attraction to American culture (AAmC), marginalization] and PPD symptoms (Edinburgh Postnatal Depression Scale-EPDS) between 1 and 12 months postpartum. Twenty-five percent of women (n = 29) had EPDS scores ≥ 10 that represent PPD symptoms. Women with higher marginalization reported more PPD symptoms (r = .25, p = .008). None of the acculturation factors correlated with PPD symptoms after adjustment for maternal sociodemographic and health characteristics. Higher education (p = .001), lower gestational age at birth (p < .05), and antenatal anxiety (p < .05) were correlated with PPD symptoms in multivariate analyses. Health care providers should identify and assess immigrant women of Arabic descent for antenatal anxiety as this may identify women at risk for development of PPD symptoms. Future studies need to examine acculturation in relation to mental health among immigrant women of Arabic descent.
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Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B, Salt K. Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.
Objectives
Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.
Review methods
An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.
Results
We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.
Limitations
Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.
Conclusions
Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.
Future work
Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.
Study registration
This study is registered as PROSPERO CRD42015023605.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gina MA Higginbottom
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Karen Salt
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
- Centre for Research into Race and Rights, University of Nottingham, Nottingham, UK
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Hetherington E, McDonald S, Williamson T, Tough S. Trajectories of social support in pregnancy and early postpartum: findings from the All Our Families cohort. Soc Psychiatry Psychiatr Epidemiol 2020; 55:259-267. [PMID: 31256206 DOI: 10.1007/s00127-019-01740-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/24/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Low social support during the perinatal period can increase the risk of postpartum depression and anxiety after giving birth but little is known about women's trajectories of social support during this time. This study will identify trajectories of social support among women from second trimester to 4-month postpartum, and the characteristics associated with different trajectories. METHODS Data from the All Our Families longitudinal birth cohort was used to assess women's perceived social support during their second trimester, third trimester, and at 4-month postpartum (n = 3387). Group-based trajectory modeling was used to determine the number of groups, shape of trajectories, and proportion of women with differing trajectories. Multinomial regression was used to compare probability of group membership. RESULTS Six distinct trajectory groups were identified, with the majority of participants belonging to groups with stable, high social support (60.6%). Only 2.7% of women had consistently low levels of social support, and 2.3% had rising levels. Membership in groups with lower levels of social support was associated with lower incomes and minority ethnicity. Women whose support improved over time may be more likely to be employed in pregnancy than those whose support remained low. CONCLUSION Trajectories of social support are relatively stable in pregnancy and early postpartum. Socio-demographic indicators of vulnerability predict initial levels of support, and participating in the workforce may help improve perception of support over time.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada.
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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Ganann R, Sword W, Newbold KB, Thabane L, Armour L, Kint B. Influences on mental health and health services accessibility in immigrant women with post-partum depression: An interpretive descriptive study. J Psychiatr Ment Health Nurs 2020; 27:87-96. [PMID: 31444918 DOI: 10.1111/jpm.12557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/27/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant women in Canada are at greater risk for post-partum depression (PPD) than native-born women. Immigrant women are less likely to have their care needs met as they face multiple barriers to care at both individual and system levels. To date, most PPD research has focused on individual barriers to care, with limited research examining organizational and system level barriers and the uniqueness of immigrant women's post-partum health experiences. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study provides unique insights into immigrant women's perceptions of what influences their post-partum mental health and ability to access services for PPD. Factors contributing to immigrant women's PPD included several social determinants of health, particularly a lack of social support and limited knowledge about PPD and available services. Most helpful services acknowledge women's concerns, build trust, enact cultural competence and help with system navigation. Assessment approaches and organizational wait times created barriers to accessing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Relationship building by providers is foundational to effective care for immigrant women with PPD. Findings highlight the need for mental health practitioners to improve cultural competence when working with diverse ethno-cultural communities and for more effective assistance with system navigation, service integration and timely, flexible and accessible services. Findings have implications for the development of healthy public policy to address perinatal mental health issues amongst immigrant women. Abstract Introduction Immigrant women in Canada are at greater risk for post-partum depression (PPD) than native-born women yet face multiple barriers to care at individual and system levels. Aim To explore factors that contribute to PPD and health service accessibility, and the role of health services in supporting immigrant women with PPD. Methods A qualitative interpretive descriptive design was used. Individual interviews were conducted with 11 immigrant women who had delivered a baby within the previous year and had experienced PPD. Inductive thematic content analysis was conducted. Results Factors contributing to immigrant women's PPD included several social health determinants. Services were most helpful and accessible when providers acknowledged women's concerns, allowed time to build trust, provided culturally competent care and helped with navigating services. Assessment approaches and organizational wait times created barriers to care. Discussion Immigrant women with PPD see relationship building by providers as foundational to providing effective support, enhancing coping and facilitating access to services. Improved communication with diverse ethno-cultural communities and assistance with system navigation, service integration and timely, accessible services are needed. Implications for Practice Findings can inform health service delivery models and the development of healthy public policy to address perinatal mental health issues amongst immigrant women.
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Affiliation(s)
- Rebecca Ganann
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Wendy Sword
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - K Bruce Newbold
- School of Geography & Earth Sciences, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Leigh Armour
- Aisling Discoveries Child and Family Centre, Toronto, ON, Canada
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19
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Kassam S. Understanding Experiences of Social Support as Coping Resources among Immigrant and Refugee Women with Postpartum Depression: An Integrative Literature Review. Issues Ment Health Nurs 2019; 40:999-1011. [PMID: 31070499 DOI: 10.1080/01612840.2019.1585493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lack of social support increases the risk of postpartum depression (PPD), especially among immigrant and refugee women. In this integrative literature review, I aim to synthesize the current state of knowledge on social support experiences among immigrant and refugee women with PPD. Conceptualization of social support as coping resources occurs through Stewart's coping theory. Eleven primary sources were located using Whittemore and Knafl's review methods. These methods are philosophically underpinned by Racine's postcolonial feminist lens. In synthesizing literature located, themes were generated and include the following: maintaining cultural identity, connecting with a community, connecting with spirit (subtheme), relational space imparted by health care providers, and seeking and exchanging knowledge. Co-existing issues emerged from this review and capture broad determinants influential in shaping immigrant and refugee experiences of social support. These included: experience of poverty, connecting to maintain gender-driven roles, and experience of trauma and abuse. Interconnectedness of these themes and issues are depicted in a data display to demonstrate complexity. Drawing on these findings, I propose practice implications for nurses working in psychiatric and public health facilities. I also offer future research ideas and policy development recommendations based on the generated findings of this review.
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Affiliation(s)
- Shahin Kassam
- School of Nursing, University of Victoria, Victoria, Canada
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20
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Gender of Provider-Barrier to Immigrant Women's Obstetrical Care: A Narrative Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019. [PMID: 28625284 DOI: 10.1016/j.jogc.2017.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To explore the preference for female obstetrician/gynaecologists among immigrant women, and providers' understandings of these preferences, to identify challenges and potential solutions. METHODS Five databases (Medline, Embase, CINAHL, Global Health, and Scopus) were searched using combinations of search terms related to immigrant, refugee, or Muslim women and obstetrics or gynaecological provider gender preference. STUDY SELECTION Peer reviewed, English-language articles were included if they discussed either patient or provider perspectives of women's preference for female obstetrics or gynaecological care provider among immigrant women in Western and non-western settings. After screening, 54 met inclusion criteria and were reviewed. DATA EXTRACTION Studies were divided first into those specifically focusing on gender of provider, and those in which it was one variable addressed. Each category was then divided into those describing immigrant women, and those conducted in a non-Western settings. The research question, study population, methods, results, and reasons given for preferences in each article were then examined and recorded. CONCLUSION Preference for female obstetricians/gynaecologists was demonstrated. Although many will accept a male provider, psychological stress, delays, or avoidance in seeking care may result. Providers' views were captured in only eight articles, with conflicting perspectives on responding to preferences and the health system impact.
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Alfayumi-Zeadna S, Froimovici M, Azbarga Z, Grotto I, Daoud N. Barriers to postpartum depression treatment among Indigenous Bedouin women in Israel: A focus group study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:757-766. [PMID: 30488992 DOI: 10.1111/hsc.12693] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/26/2018] [Accepted: 10/27/2018] [Indexed: 06/09/2023]
Abstract
Postpartum depression (PPD), a common mental health problem among mothers worldwide, is higher among minority women. However, little is known about barriers faced by minority women when accessing mental health care services (MHCS) for PPD treatment. Drawing on McLeroy et al (Health Education Quartely 15: 351, 1988) ecological model, the current study explores barriers to mental health services among pregnant and postpartum minority Bedouin women in southern Israel. We conducted eight focus groups (FGs) in Arabic with 75 Bedouin women recruited using snowball sampling. Participants completed a socio-demographic questionnaire at each FG. Discussions were recorded and transcribed verbatim. Next, we conducted simultaneous thematic analysis and coded transcripts into conceptual categories based on the ecological model. We found multiple barriers that manifest at different levels (individual, family, organisational, economic, and public policy) and interact to limit Bedouin women's access to PPD treatment. At the individual level, factors included: women's negative attitudes toward PPD, women's societal status, grand multipara, gender, and limited knowledge about PPD; at the family level: low awareness among husbands and other family members regarding PPD symptoms and treatment, and lack of social support; at the organisational level: lack of culturally appropriate (health care services) HCSs, lack of PPD screening, and lack of PPD detection by family physicians; at the community level: economic barriers and poverty, stigmatisation of mental health problems, polygamy, and multiple births; finally, at the public policy level: residence in unrecognised villages lacking basic infrastructure. Our study thus sheds light on multilevel barriers impacting PPD prevention and treatment among Bedouin women. Policies and intervention programmes should seek to remove these barriers and protect Bedouin women and their children from the consequences of PPD.
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Affiliation(s)
- Samira Alfayumi-Zeadna
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Beer-Sheva, Southern Region, Israel
| | | | - Zoya Azbarga
- Clalit Health Services, Beer-Sheva, Southern Region, Israel
| | - Itmar Grotto
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Determinants of Child Attachment in the Years Postpartum in a High-Risk Sample of Immigrant Women. J Immigr Minor Health 2019; 20:1166-1172. [PMID: 28988283 DOI: 10.1007/s10903-017-0662-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our goal was to examine maternal mental health and associated stresses in a sample of high-risk immigrant mothers, and its association with child insecure attachment in the years following childbirth. Mothers and their child (Mage = 37 months) were recruited through a Health and Social Service organization in the Parc-Extension neighborhood in Montreal, Quebec. Mothers completed the Hopkins Symptoms Checklist (HSCL-25), the Multidimensional Scale of Perceived Social Support (MPSS) and a sociodemographic questionnaire that included questions on premature delivery and birth weight. Attachment behaviors were coded out of a videotaped free play sequence using the Preschool and Early School-Age Attachment Rating Scales (PARS). Analysis revealed high levels of clinical anxiety and depression, low social support and low attachment security. Significant mean differences and associations were found between anxiety, depression, social support, preterm delivery and child attachment. These results underscore the importance of screening for anxiety and depression early in the postnatal years, in order to prevent associated consequences such as child insecure attachment. Results also highlight the importance of building positive social networks, especially with immigrant populations.
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Saad M. Examining the Social Patterning of Postpartum Depression by Immigration Status in Canada: an Exploratory Review of the Literature. J Racial Ethn Health Disparities 2018; 6:312-318. [DOI: 10.1007/s40615-018-0526-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/23/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
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Alhasanat-Khalil D, Fry-McComish J, Dayton C, Benkert R, Yarandi H, Giurgescu C. Acculturative stress and lack of social support predict postpartum depression among U.S. immigrant women of Arabic descent. Arch Psychiatr Nurs 2018; 32:530-535. [PMID: 30029744 DOI: 10.1016/j.apnu.2018.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/25/2017] [Accepted: 02/11/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine the relationships among acculturative stress, social support, and postpartum depression (PPD) symptoms among U.S. immigrant women of Arabic descent; and to examine if social support moderates the associations between acculturative stress and PPD symptoms. METHODS Using a cross-sectional design, a sample of 115 U.S. immigrant women of Arabic descent, all between 1 and 12 months postpartum, were enrolled from clinics in Dearborn, MI. Data were analyzed using correlational and multiple linear regression. RESULTS Women had a mean age of 29 ± 5 years and were 5 ± 4 months postpartum. Women had been in the U.S. for 7 ± 6 years and had a mean education of 12 ± 4 years. The majority had an annual household income of <$40,000 (88%), were unemployed (80%), and preferred Arabic language for interview (68%). Higher levels of acculturative stress, higher levels of education, antenatal anxiety, and lower levels of social support predicted PPD symptoms (all significant at p < .05). The moderating effect of social support on the association between acculturative stress and PPD symptoms was not supported. CONCLUSIONS Acculturative stress, lack of social support, higher level of education, and antenatal anxiety predicted PPD symptoms. Future research is needed to examine acculturative stress among immigrant women in different U.S. SETTINGS Longitudinal studies and utilizing diagnostic assessments of PPD is highly recommended. Nurses need to screen immigrant women of Arabic descent for anxiety and depression during antenatal visits and develop evidence-based interventions targeted to improve mental health during pregnancy and postpartum.
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Affiliation(s)
- Dalia Alhasanat-Khalil
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, MI 48202, United States.
| | - Judith Fry-McComish
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, MI 48202, United States
| | - Carolyn Dayton
- Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI 48202, United States
| | - Ramona Benkert
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, MI 48202, United States
| | - Hossein Yarandi
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, MI 48202, United States
| | - Carmen Giurgescu
- The Ohio State University, College of Nursing, Center for Women, Children, and Youth, 236 Newton Hall, 1585 Neil Ave, Columbus, OH 43210, United States
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Katz A, Chateau D, Enns JE, Valdivia J, Taylor C, Walld R, McCulloch S. Association of the Social Determinants of Health With Quality of Primary Care. Ann Fam Med 2018; 16:217-224. [PMID: 29760025 PMCID: PMC5951250 DOI: 10.1370/afm.2236] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/22/2018] [Accepted: 03/06/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In primary care, there is increasing recognition of the difficulty of treating patients' immediate health concerns when their overall well-being is shaped by underlying social determinants of health. We assessed the association of social complexity factors with the quality of care patients received in primary care settings. METHODS Eleven social complexity factors were defined using administrative data on poverty, mental health, newcomer status, and justice system involvement from the Manitoba Population Research Data Repository. We measured the distribution of these factors among primary care patients who made at least 3 visits during 2010-2013 to clinicians in Manitoba, Canada. Using generalized linear mixed modeling, we measured 26 primary care indicators to compare the quality of care received by patients with 0 to 5 or more social complexity factors. RESULTS Among 626,264 primary care patients, 54% were living with at least 1 social complexity factor, and 4% were living with 5 or more. Social complexity factors were strongly associated with poorer outcomes with respect to primary care indicators for prevention (eg, breast cancer screening; odds ratio [OR] = 0.77; 99% CI, 0.73-0.81), chronic disease management (eg, diabetes management; OR = 0.86; 99% CI, 0.79-0.92), geriatric care (eg, benzodiazepine prescriptions; OR = 1.63; 99% CI, 1.48-1.80), and use of health services (eg, ambulatory visits; OR = 1.09; 99% CI, 1.08-1.09). CONCLUSIONS Linking health and social data demonstrates how social determinants are associated with primary care service provision. Our findings provide insight into the social needs of primary care populations, and may support the development of focused interventions to address social complexity in primary care.
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Affiliation(s)
- Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada .,Departments of Family Medicine, University of Manitoba, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Manitoba, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Manitoba, Canada
| | - Jeff Valdivia
- Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Scott McCulloch
- Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
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Acculturation and Postpartum Depressive Symptoms among Hispanic Women in the United States: Systematic Review. MCN Am J Matern Child Nurs 2018; 42:21-28. [PMID: 27926598 DOI: 10.1097/nmc.0000000000000298] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this review was to evaluate studies that examined the relationship between acculturation and postpartum depression (PPD) among immigrant and/or refugee women in the United States. METHODS A systematic, computer-assisted search of quantitative, English-language, peer-reviewed, published research articles was conducted in the Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Maternity and Infant Care databases using the keyword terms of "postpartum depression" and "perinatal depression" in combination with "acculturation." Studies were included if they were conducted in the United States. RESULTS Seven studies met inclusion criteria. Three studies used longitudinal designs and four used cross-sectional designs. All were conducted with Hispanic women. Only one study used a diagnostic tool to measure PPD; the remaining studies used screening tools to measure postpartum depressive symptoms. Most studies used country of birth, country of residence, and language preferences to measure acculturation. Five studies reported acculturation was positively related to risk of postpartum depressive symptoms, and two studies reported no relationship. CLINICAL IMPLICATIONS Higher levels of acculturation were related to higher risk of postpartum depressive symptoms in Hispanic women living in the United States. Nurses should have an understanding of stressors of immigrant women to guide their assessment and screening for postpartum depressive symptoms and make appropriate referrals. More research is needed to confirm the relationship between acculturation and PPD among immigrant women from different cultural backgrounds.
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Shaban IA, Al-Awamreh K, Mohammad K, Gharaibeh H. Postnatal women's perspectives on the feasibility of introducing postpartum home visits: a Jordanian study. Home Health Care Serv Q 2018; 37:247-258. [PMID: 29558322 DOI: 10.1080/01621424.2018.1454865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In Jordan, there is a deficiency in postnatal care provided to women and their newborns. This study investigated the feasibility of initiating postnatal home visits in Jordan. Thirty Jordanian mothers who had recently given birth were recruited from two governmental hospitals in the northern region of Jordan to participate in a qualitative study through face-to-face, voice-recorded interviews. The findings revealed that initiating postnatal home visits as part of postnatal care was well-received by the participants. Mothers' views and perceptions regarding postpartum home visits play an integral role in finding areas to improve postnatal services.
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Affiliation(s)
- Insaf A Shaban
- a Faculty of Nursing , Al al-Bayt University , Marfraq , Jordan
| | | | - Khitam Mohammad
- b Faculty of Nursing , Jordan University of Science and Technology , Irbid , Jordan
| | - Huda Gharaibeh
- b Faculty of Nursing , Jordan University of Science and Technology , Irbid , Jordan
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The Access to Antenatal and Postpartum Care Services of Migrant Workers in the Greater Mekong Subregion: The Role of Acculturative Stress and Social Support. J Pregnancy 2018; 2018:9241923. [PMID: 29686905 PMCID: PMC5852849 DOI: 10.1155/2018/9241923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 11/20/2022] Open
Abstract
The objective of this paper is to determine whether social support and acculturative stress were related to obtaining antenatal and postpartum care for pregnant female migrants, as well as access to health care for migrant children. The study utilized data of 987 migrant workers in Thailand who originated from hill tribes and mountain communities in Myanmar and Cambodia. Regression analysis showed that the language barrier, a crucial factor behind acculturative stress, adversely influenced access to maternal care. Social support reduced the impact of acculturative stress. Migrants with support are more likely to access health care. Based on the Multidimensional Scale of Perceived Social Support, more sources of support either from friends, family members, or other supporters who are significant could increase health care access. Besides friends and family, the support from the Migrant Health Worker Program and Migrant Health Volunteer Program allowed the formal health sector to utilize the informal social networks to improve care for migrants.
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Mahon A, Merry L, Lu O, Gagnon AJ. Postpartum Pain in the Community Among Migrant and Non-migrant Women in Canada. J Immigr Minor Health 2018; 19:407-414. [PMID: 26883029 DOI: 10.1007/s10903-016-0364-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
International migrant women of childbearing age represent a large proportion of immigrants to high-income countries, yet research focusing on their postpartum health is limited. We investigated predictive factors for breast and non-breast pain 1 week post-birth in migrant and non-migrant women in Canada. Among migrant women, difficulty accessing health services; being from a middle-or high-income country; poor functionality in English and French; living with the father of their infant; and having no regular care provider were predictive of breast pain. Among non-migrant women, difficulties accessing health services, multiparity and prenatal education were predictive of breast pain, while receiving an epidural and having no regular care provider were predictive of non-breast pain. Among both groups, difficulties accessing health services and having no regular care provider were predictive of breast pain, while second degree or higher perineal tearing was predictive of non-breast pain. Migration-specific indicators should be considered in postpartum care planning.
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Affiliation(s)
- Abbey Mahon
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Lisa Merry
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Olivia Lu
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada.
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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30
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Dennis CL, Brown HK, Wanigaratne S, Fung K, Vigod SN, Grigoriadis S, Marini F, Brennenstuhl S. Prevalence, Incidence, and Persistence of Postpartum Depression, Anxiety, and Comorbidity among Chinese Immigrant and Nonimmigrant Women: A Longitudinal Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:44-53. [PMID: 28748744 PMCID: PMC5788121 DOI: 10.1177/0706743717720689] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our objectives were to examine the prevalence and incidence of postpartum depressive, anxiety, and comorbid symptoms over the first postpartum year; the persistence of these symptoms; and the prevalence stratified by immigration status. METHOD We conducted a longitudinal cohort study in Ontario, Canada. Participants were 571 Chinese recent immigrant, nonrecent immigrant, and Canadian-born women with live births in 2011 to 2014. Participants were assessed at 4, 12, and 52 weeks postpartum for the presence of possible and high depressive symptomatology (Edinburgh Postnatal Depression Scale [EPDS] >9 and >12, respectively), anxiety symptomatology (State-Trait Anxiety Inventory [STAI] >40), and comorbid symptomatology (EPDS >9 and STAI >40). Prevalence and incidence with 95% confidence intervals were calculated. RESULTS Prevalence rates were highest at 4 weeks and decreased across time, with possible depressive symptomatology most prevalent at most time points. Incidence rates at 12 and 52 weeks were generally similar. Of those with possible symptomatology at 4 weeks, 42.0% or less continued to have symptomatology at 12 weeks and 17.4% or less at 52 weeks. There were no differences in prevalence of any type of symptomatology between immigrant and Canadian-born Chinese women at 4 weeks, but at 12 and 52 weeks, most types of symptomatology were more common among recent and nonrecent immigrants. CONCLUSION Our findings suggest that Chinese immigrant women are a high-risk group for postpartum depressive and anxiety symptomatology. Future research should identify cultural and psychosocial factors associated with immigration that could be addressed in the system of care for postpartum immigrant women.
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Affiliation(s)
- Cindy-Lee Dennis
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario.,2 Department of Psychiatry, University of Toronto, Toronto, Ontario.,3 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario
| | - Hilary K Brown
- 2 Department of Psychiatry, University of Toronto, Toronto, Ontario.,4 Department of Anthropology (Health Studies Program), University of Toronto Scarborough, Toronto, Ontario.,5 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,6 Women's College Research Institute, Women's College Hospital, Toronto, Ontario
| | | | - Kenneth Fung
- 2 Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Simone N Vigod
- 2 Department of Psychiatry, University of Toronto, Toronto, Ontario.,6 Women's College Research Institute, Women's College Hospital, Toronto, Ontario
| | - Sophie Grigoriadis
- 2 Department of Psychiatry, University of Toronto, Toronto, Ontario.,7 Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Flavia Marini
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Sarah Brennenstuhl
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario
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Kalich A, Heinemann L, Ghahari S. A Scoping Review of Immigrant Experience of Health Care Access Barriers in Canada. J Immigr Minor Health 2017; 18:697-709. [PMID: 26093784 DOI: 10.1007/s10903-015-0237-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Canadian population-based surveys report comparable access to health care services between immigrant and non-immigrant populations, yet other research reports immigrant-specific access barriers. A scoping review was conducted to explore research regarding Canadian immigrants' unique experiences in accessing health care, and was guided by the research question: "What is currently known about the barriers that adult immigrants face when accessing Canadian health care services?" The findings of this study suggest that there are unmet health care access needs specific to immigrants to Canada. In reviewing research of immigrants' health care experiences, the most common access barriers were found to be language barriers, barriers to information, and cultural differences. These findings, in addition to low cultural competency reported by interviewed health care workers in the reviewed articles, indicate inequities in access to Canadian health care services for immigrant populations. Suggestions for future research and programming are discussed.
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Affiliation(s)
- Angela Kalich
- School of Rehabilitation Therapy, Queen's University, 31 George St., Kingston, ON, K7L 3N6, Canada
| | - Lyn Heinemann
- School of Rehabilitation Therapy, Queen's University, 31 George St., Kingston, ON, K7L 3N6, Canada
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, 31 George St., Kingston, ON, K7L 3N6, Canada.
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Affiliation(s)
- Lisa Merry
- School of Nursing, University of Ottawa, Ottawa, ON, Canada.
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33
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Aydın R, Körükcü Ö, Kabukcuoğlu K. Bir Göçmen Olarak Anneliğe Geçiş: Riskler ve Engeller. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2017. [DOI: 10.18863/pgy.285927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Anderson FM, Hatch SL, Comacchio C, Howard LM. Prevalence and risk of mental disorders in the perinatal period among migrant women: a systematic review and meta-analysis. Arch Womens Ment Health 2017; 20:449-462. [PMID: 28389934 PMCID: PMC5423996 DOI: 10.1007/s00737-017-0723-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/28/2017] [Indexed: 11/16/2022]
Abstract
This study was conducted in order to evaluate the prevalence and risk of mental disorders in the perinatal period among migrant women. Six databases (including MEDLINE) were searched from inception to October 19th, 2015, in addition to citation tracking. Studies were eligible if mental disorders were assessed with validated tools during pregnancy and up to 1 year postpartum among women born outside of the study country. Of 3241 abstracts screened, 53 met the inclusion criteria for the review. Only three studies investigated a mental disorder other than depression. Unadjusted odds ratios were pooled using random effects meta-analysis for elevated depression symptoms during pregnancy (n = 12) and the postpartum (n = 24), stratified by study country due to heterogeneity. Studies from Canada found an increased risk for antenatal (OR = 1.86, 95% CIs 1.32-2.62) and postnatal elevated depression symptoms (OR = 1.98, 95% CIs 1.57-2.49) associated with migrant status. Studies from the USA found a decreased risk of antenatal elevated depression symptoms (OR = 0.71, 95% CIs 0.51-0.99), and studies from the USA and Australia found no association between migrant status and postnatal elevated depression symptoms. Low social support, minority ethnicity, low socioeconomic status, lack of proficiency in host country language and refugee or asylum-seeking status all put migrant populations at increased risk of perinatal mental disorders.
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Affiliation(s)
- Fraser M Anderson
- Section of Women's Mental Health, IOPPN, King's College London, Box P031, David Goldberg Centre, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Stephani L Hatch
- Department of Psychological Medicine, IOPPN, King's College London, London, UK
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Louise M Howard
- Section of Women's Mental Health, IOPPN, King's College London, Box P031, David Goldberg Centre, 16 De Crespigny Park, London, SE5 8AF, UK
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Quay TAW, Frimer L, Janssen PA, Lamers Y. Barriers and facilitators to recruitment of South Asians to health research: a scoping review. BMJ Open 2017; 7:e014889. [PMID: 28576896 PMCID: PMC5541387 DOI: 10.1136/bmjopen-2016-014889] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/17/2017] [Accepted: 03/31/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES People of South Asian ethnicity are under-represented in health research studies. The objectives of this scoping review were to examine the barriers and facilitators to recruitment of South Asians to health research studies and to describe strategies for improving recruitment. DESIGN Scoping review METHODS: Using the Arksey and O'Malley framework for scoping reviews, we comprehensively searched electronic databases (MEDLINE via PubMed, Cochrane Library, CINAHL and PsycINFO). Studies that identified barriers and facilitators to recruitment, or recruitment strategies for South Asian populations were included. Recruitment barriers, facilitators and strategies were grouped thematically and summarised narratively. SYNTHESIS Of 1846 potentially relevant articles, 15 met the inclusion criteria and were included in the thematic synthesis. Multiple facilitators and barriers to enrolment of South Asians in health research studies were identified; these most commonly related to logistical challenges, language and cultural barriers, concerns about adverse consequences of participating and mistrust of research. Several actionable strategies were discussed, the most common being engagement of South Asian communities, demonstration of cultural competency, provision of incentives and benefits, language sensitivity through the use of translators and translated materials and the development of trust and personal relationships. CONCLUSION There is a growing awareness of the barriers and facilitators to recruitment of South Asian participants to health research studies. Knowledge of effective recruitment strategies and implementation during the grant funding stages may reduce the risk of poor recruitment and representation of South Asians.
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Affiliation(s)
- Teo AW Quay
- The Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
- Food Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Leora Frimer
- Departments of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Patricia A Janssen
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
| | - Yvonne Lamers
- Food Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
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Dennis CL, Merry L, Gagnon AJ. Postpartum depression risk factors among recent refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:411-422. [PMID: 28220215 DOI: 10.1007/s00127-017-1353-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective was to examine and compare risk factors for postpartum depression among: (1) recent (≤5 years) migrant and Canadian-born women, and (2) refugee, asylum-seeking, and non-refugee immigrant women. METHODS A sample of 1536 women (1024 migrant and 512 Canadian-born) were recruited from 12 hospitals. Women completed questionnaires at 1-2 and 16 weeks postpartum including questions on socio-demographics, biomedical history, health services, and migration and resettlement factors. Bivariate analyses and multivariate logistic regression were performed to examine and compare risk factors for postpartum depressive symptoms at 16 weeks postpartum. RESULTS Recent migrant women had significantly higher rates (6%) of depressive symptoms at 16 weeks postpartum than Canadian-born women (2.9%). Asylum-seekers had the highest rate (14.3%), followed by refugee (11.5%) and non-refugee immigrant women (5.1%). Migrant women at greatest risk to develop depressive symptoms were those who experienced abuse, had pain post-birth, worried about family members left behind, had food insecurity, and had reduced access to healthcare (limited insurance and/or no regular care-provider). Conversely, those with higher levels of social support and who felt they belonged to a community had a lower risk of developing depressive symptoms. CONCLUSION All childbearing recent migrant women should be considered at risk for postpartum depression. To prevent and support migrant women suffering postpartum depressive symptoms, barriers to healthcare need to be addressed and interventions should include assessments and support/programmes for abuse/violence, lack of social support, food insecurity, and stress/poor mental health. Treatment of pain during the postpartum period is also critical.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada
| | - Lisa Merry
- School of Nursing, University of Ottawa, 1 Stewart Street, Rm 127, Ottawa, ON, K1N 6N5, Canada. .,Ingram School of Nursing, McGill University, Montreal, Canada.
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Research Institute, McGill University Health Centre, Montreal, Canada
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Abstract
PURPOSE To explore the experience of childbirth and becoming a new mother for Arab migrant women in the United Kingdom. STUDY DESIGN & METHODS Hermeneutic phenomenology design was used to investigate the childbirth and early mothering experience of migrant Arab Muslim women from several countries to United Kingdom. Purposive sampling was chosen. Data collection was conducted through in-depth interviews. RESULTS The emerging theme "displacement and reformation of the self" includes four subthemes from analyses of participants' interviews. These were the emerging dominance of the nuclear family over the extended family: self-contained/self-worth; moving from dependence: self-governing/self-reliance; freedom from cultural constraints: self-determination; and achieving peace of mind: self-satisfaction. CONCLUSION Exploring the perception of migrant Muslim women's childbirth and new mother experiences in a foreign land may help caregivers better understand their healthcare needs.
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Woodgate RL, Busolo DS, Crockett M, Dean RA, Amaladas MR, Plourde PJ. A qualitative study on African immigrant and refugee families' experiences of accessing primary health care services in Manitoba, Canada: it's not easy! Int J Equity Health 2017; 16:5. [PMID: 28068998 PMCID: PMC5223444 DOI: 10.1186/s12939-016-0510-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Immigrant and refugee families form a growing proportion of the Canadian population and experience barriers in accessing primary health care services. The aim of this study was to examine the experiences of access to primary health care by African immigrant and refugee families. Methods Eighty-three families originating from 15 African countries took part in multiple open ended interviews in western Canada. Qualitative data was collected in six different languages between 2013 and 2015. Data analysis involved delineating units of meaning from the data, clustering units of meaning to form thematic statements, and extracting themes. Results African immigrant and refugee families experienced challenges in their quest to access primary health care that were represented by three themes: Expectations not quite met, facing a new life, and let’s buddy up to improve access. On the theme of expectations not quite met, families struggled to understand and become familiar with a new health system that presented with a number of barriers including lengthy wait times, a shortage of health care providers, high cost of medication and non-basic health care, and less than ideal care. On the theme of facing a new life, immigrant and refugee families talked of the difficulties of getting used to their new and unfamiliar environments and the barriers that impact their access to health care services. They talked of challenges related to transportation, weather, employment, language and cultural differences, and lack of social support in their quest to access health care services. Additionally, families expressed their lack of social support in accessing care. Privately sponsored families and families with children experienced even less social support. Importantly, in the theme of let’s buddy up to improve access, families recommended utilizing networking approaches to engage and improve their access to primary health care services. Conclusions African immigrant and refugee families experience barriers to accessing primary health care. To improve access, culturally relevant programs, collaborative networking approaches, and policies that focus on addressing social determinants of health are needed.
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Affiliation(s)
- Roberta Lynn Woodgate
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada.
| | - David Shiyokha Busolo
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Maryanne Crockett
- Departments of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada
| | - Ruth Anne Dean
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Miriam R Amaladas
- Nor-West Co-op Access Center, 785 Keewatin Street, Winnipeg, MB, Canada
| | - Pierre J Plourde
- Medical Officer of Health, Winnipeg Regional Health Authority, 490 Hargrave Street, Winnipeg, MB, R3A 0X7, Canada
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Jörgensdotter Wegnelius C, Petersson EL. Cultural Background and Societal Influence on Coping Strategies for Physical Activity Among Immigrant Women. J Transcult Nurs 2016; 29:54-63. [PMID: 27815551 DOI: 10.1177/1043659616676317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of the study was to examine, from an intersectional perspective, how immigrant women with prolonged illness experience the conditions for physical activity. METHOD Focus groups were used. Twenty-two women from primary care representing 14 countries were included. Systematic text condensation was applied for analysis. RESULTS Five conditions were identified: Dual cultures to relate to, Isolation an invisible danger, Keys to physical activity, Physical activity for whom, The power to decide the agenda. DISCUSSION AND CONCLUSION This study shows the importance of raising the intersectional perspective for immigrant women's possibilities to perform physical activity. Immigrant women's vulnerability to power relations and their adjustment to society's expectations are significant considerations to be aware of. IMPLICATIONS FOR PRACTICE Our findings emphasize the significance of collaborating in biomedical and psychosocial issues, considering that the obstacles are more comprehensive than society assumes regarding prior knowledge, isolation, and cultural rules.
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Robinson AM, Benzies KM, Cairns SL, Fung T, Tough SC. Who is distressed? A comparison of psychosocial stress in pregnancy across seven ethnicities. BMC Pregnancy Childbirth 2016; 16:215. [PMID: 27514674 PMCID: PMC4982239 DOI: 10.1186/s12884-016-1015-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 08/01/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Calgary, Alberta has the fourth highest immigrant population in Canada and ethnic minorities comprise 28 % of its total population. Previous studies have found correlations between minority status and poor pregnancy outcomes. One explanation for this phenomenon is that minority status increases the levels of stress experienced during pregnancy. The aim of the present study was to identify specific types of maternal psychosocial stress experienced by women of an ethnic minority (Asian, Arab, Other Asian, African, First Nations and Latin American). METHODS A secondary analysis of variables that may contribute to maternal psychosocial stress was conducted using data from the All Our Babies prospective pregnancy cohort (N = 3,552) where questionnaires were completed at < 24 weeks of gestation and between 34 and 36 weeks of gestation. Questionnaires included standardized measures of perceived stress, anxiety, depression, physical and emotional health, and social support. Socio-demographic data included immigration status, language proficiency in English, ethnicity, age, and socio-economic status. RESULTS Findings from this study indicate that women who identify with an ethnic minority were more likely to report symptoms of depression, anxiety, inadequate social support, and problems with emotional and physical health during pregnancy than women who identified with the White reference group. CONCLUSIONS This study has identified that women of an ethic minority experience greater psychosocial stress in pregnancy compared to the White reference group.
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Affiliation(s)
- Alexandra M. Robinson
- Faculty of Education, Counselling Psychology, University of Calgary, Calgary, AB Canada
| | - Karen M. Benzies
- Faculty of Nursing, and Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Sharon L. Cairns
- Faculty of Education, Counselling Psychology, University of Calgary, Calgary, AB Canada
| | - Tak Fung
- Information Technologies, University of Calgary, Calgary, AB Canada
| | - Suzanne C. Tough
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, Calgary, AB Canada
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Hannan J, Brooten D, Youngblut JM, Galindo AM. Comparing mothers' postpartum concerns in two clinical trials 18 years apart. J Am Assoc Nurse Pract 2016; 28:604-611. [PMID: 27273192 DOI: 10.1002/2327-6924.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 04/05/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE To determine if U.S. women's postpartum concerns have changed over time. METHODS Mothers' postpartum concerns were compared in two clinical trials: 1997 (high-risk pregnancy) and 2015 (first-time mothers). Advanced practice nurses (APNs) provided care through 8 weeks postpartum and recorded interactions in clinical logs. Content analysis of logs was used for identifying concerns. RESULTS Ninety-five percent of 58 1997 mothers were African American; 64% of 62 2015 mothers were Hispanic. The number of infant concerns (129 vs. 144) was similar to four of the top five infant concerns; infant feeding was the top concern for both groups. The 1997 mothers were concerned with body changes, birth control, breastfeeding, maternal health problems, and had more concerns about their health (142 vs. 43); the 2015 mothers were concerned with not having help, fatigue, finding things hard. Both groups had postpartum pain concerns and problems accessing mother/infant governmental programs. CONCLUSIONS Mothers' concerns regarding infant care were essentially the same over the two time periods with infant feeding as the top concern. Maternal concerns in common were postpartum pain and needing help accessing government programs. Women who had high-risk pregnancies had more health concerns. IMPLICATIONS FOR PRACTICE Results provide guidance for helping minority mothers in the postpartum period.
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Affiliation(s)
- Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
| | - Dorothy Brooten
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
| | | | - Ali Marie Galindo
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
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Depression and Social Support Trajectories During 1 Year Postpartum Among Marriage-Based Immigrant Mothers in Taiwan. Arch Psychiatr Nurs 2016; 30:350-5. [PMID: 27256940 DOI: 10.1016/j.apnu.2015.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/17/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This panel study examined the trajectories of depression and social support during the first year postpartum among marriage-based immigrant mothers in Taiwan, and the effect of social support on depression. METHODS This panel study recruited South-Asia immigrant mothers (mean age: 27years) to complete structured questionnaire at 1month, 6month, and 1year postpartum. A total of 203 immigrant mothers completed structured questionnaires at 1 and 6months, and 163 completed the questionnaires at 1year postpartum. Postpartum depression was measured using the Edinburgh Postpartum Depression Scale. Social support was composed of 3 subscales, emotional, instrumental, and informational support. Hierarchical linear modeling was used to examine the relationships between trajectories and factors associated with depression. RESULTS Depression and instrumental support followed downward curvilinear trajectories, while emotional and informational support followed upward curvilinear trajectories. Depression was highest at 1month, decreased sharply until 6months, and then leveled off between 6 and 12months. Emotional and instrumental support negatively covaried with postpartum depression over time. When the three-dimensional supports were considered together, only emotional support retained its significance. CONCLUSIONS Our results demonstrated that depression was highest at 1month, then decreased, and then leveled off during 1year postpartum, though further study may be needed to confirm the trajectory. The 3 types of social support differed in postpartum trajectory, suggesting the needs to consider them separately in future studies. To decrease postpartum depression among immigrant mothers, strategies should be developed to increase emotional and instrumental support during postpartum period.
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Lum ID, Swartz RH, Kwan MYW. Accessibility and use of primary healthcare for immigrants living in the Niagara Region. Soc Sci Med 2016; 156:73-9. [PMID: 27017093 DOI: 10.1016/j.socscimed.2016.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/19/2016] [Accepted: 03/16/2016] [Indexed: 11/26/2022]
Abstract
Although the challenges of accessing and using primary healthcare for new immigrants to Canada have been fairly well documented, the focus has primarily been on large cities with significant immigrant populations. The experiences of immigrants living in smaller, less diverse urban centres remain largely unknown. The purpose of this study was to examine the lived experiences of immigrants living in a small urban centre with regards to the primary healthcare system. A total of 13 immigrants living in the Greater Niagara Region participated in semi-structured interviews. All interviews were recorded, transcribed, and then coded and analyzed for emergent themes using NVivo. Five factors were found to impact primary care access and use: lack of social contacts, lack of universal healthcare coverage during their initial arrival, language as a barrier, treatment preferences, and geographic distance to primary care. Overall findings suggest that immigrants moving to smaller areas such as the Niagara Region face similar barriers to primary care as those moving into large cities. Some barriers, however, appear to be specific to the context of smaller urban centres, further exacerbated by living in a small city due to a smaller immigrant population, fewer services for immigrants, and less diversity in practicing physicians. More research is required to understand the contextual factors inhibiting primary care access and use among immigrants moving to smaller urban centres, and determine effective strategies to overcome these barriers.
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Affiliation(s)
- Irene D Lum
- McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, 500 Glenridge Avenue, St. Catharines, Ontario L2S 3A1, Canada.
| | - Rebecca H Swartz
- McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, 500 Glenridge Avenue, St. Catharines, Ontario L2S 3A1, Canada.
| | - Matthew Y W Kwan
- McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, 500 Glenridge Avenue, St. Catharines, Ontario L2S 3A1, Canada; McMaster University, Department of Family Medicine, 5th Floor - 100 Main Street West, Hamilton, Ontario L8P 1H6, Canada.
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Eastwood JG, Kemp LA, Jalaludin BB. Being alone and expectations lost: a critical realist study of maternal depression in South Western Sydney. SPRINGERPLUS 2015; 4:700. [PMID: 26609502 PMCID: PMC4646882 DOI: 10.1186/s40064-015-1492-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
Abstract
The study reported here is part of a critical realist multilevel study. It seeks to identify and explain complex perinatal contextual social and psychosocial mechanisms that may influence the developmental origins of health and disease, with a focus on the role of postnatal depression. The aims of the greater study are to: (1) describe the phenomenon of postnatal depression in South Western Sydney; and (2) identify mechanisms that would add to our understanding of the psycho-social causes of maternal depression. This paper will move beyond our previous quantitative descriptions of individual-level predictors of depressive symptoms by seeking the views of local mothers and practitioners, to explain the mechanisms that might be involved. The study was set in South Western Sydney, New South Wales, Australia. An Explanatory Theory Building Method was used. The previously reported quantitative study was a non-linear principal component analysis and logistic regression study of 15,389 months delivering in 2002 and 2003. This intensive qualitative study used open coding of interviews, of seven practitioners and three naturally occurring mothers groups, to enable maximum emergence. The theoretical concepts identified were: attachment and nurturing, infant temperament, unplanned pregnancy and sole parenthood, support for mothers, access to services, stress, financial hardship, isolation and marginalisation, mothers' "loss of control" and "power", and expectations and dreams. Being alone and expectations lost emerged as possible triggers of stress and depression for mothers. These findings might also apply to others who have their dreams shattered during life's transitions. In these situations social and cultural context can either nurture and support or marginalise and isolate. The challenge for policy and practice is to support mothers and their partners during the transition to parenthood within a challenging social and material context.
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Affiliation(s)
- John G. Eastwood
- />Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
- />School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia
| | - Lynn A. Kemp
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Bin B. Jalaludin
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
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Falah-Hassani K, Shiri R, Vigod S, Dennis CL. Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis. J Psychiatr Res 2015; 70:67-82. [PMID: 26424425 DOI: 10.1016/j.jpsychires.2015.08.010] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/03/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.
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Affiliation(s)
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Simone Vigod
- Women's College Hospital and Research Institute, Toronto, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
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Guruge S, Thomson MS, George U, Chaze F. Social support, social conflict, and immigrant women's mental health in a Canadian context: a scoping review. J Psychiatr Ment Health Nurs 2015; 22:655-67. [PMID: 26031541 DOI: 10.1111/jpm.12216] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
Abstract
ACCESSIBLE SUMMARY Social support has positive and negative dimensions, each of which has been associated with mental health outcomes. Social networks can also serve as sources of distress and conflict. This paper reviews journal articles published during the last 24 years to provide a consolidated summary of the role of social support and social conflict on immigrant women's mental health. The review reveals that social support can help immigrant women adjust to the new country, prevent depression and psychological distress, and access care and services. When social support is lacking or social networks act as a source of conflict, it can have negative effects on immigrant women's mental health. It is crucial that interventions, programmes, and services incorporate strategies to both enhance social support as well as reduce social conflict, in order to improve mental health and well-being of immigrant women. ABSTRACT Researchers have documented the protective role of social support and the harmful consequences of social conflict on physical and mental health. However, consolidated information about social support, social conflict, and mental health of immigrant women in Canada is not available. This scoping review examined literature from the last 24 years to understand how social support and social conflict affect the mental health of immigrant women in Canada. We searched MEDLINE, PsycINFO, CINAHL, Healthstar, and EMBASE for peer-reviewed publications focusing on mental health among immigrant women in Canada. Thirty-four articles that met our inclusion criteria were reviewed, and are summarized under the following four headings: settlement challenges and the need for social support; social support and mental health outcomes; social conflict and reciprocity; and social support, social conflict, and mental health service use. The results revealed that social support can have a positive effect on immigrant women's mental health and well-being, and facilitate social inclusion and the use of health services. When social support is lacking or social networks act as a source of conflict, it can have negative effects on immigrant women's mental health. The results also highlighted the need for health services to be linguistically-appropriate and culturally-safe, and provide appropriate types of care and support in a timely manner in order to be helpful to immigrant women.
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Affiliation(s)
- S Guruge
- School of Nursing, Ryerson University, Toronto, ON, Canada
| | - M S Thomson
- Office of the Dean, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - U George
- Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - F Chaze
- School of Social Work, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
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Ganann R, Sword W, Thabane L, Newbold B, Black M. Predictors of Postpartum Depression Among Immigrant Women in the Year After Childbirth. J Womens Health (Larchmt) 2015; 25:155-65. [PMID: 26447838 DOI: 10.1089/jwh.2015.5292] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immigrant women are at increased risk for postpartum depression (PPD). The factors that influence PPD among immigrant women are poorly understood. The purpose of this study was to identify individual- and community-level factors predictive of PPD among immigrant women living in a large Ontario city at 6 weeks, 6 months, and 1 year postpartum. METHODS The study involved a secondary analysis of a prospective cohort study, The Ontario Mother and Infant Study 3. This study included 519 immigrant women who were recruited from two hospitals in one urban city and delivered full-term singleton infants. Women completed a written questionnaire in hospital, followed by structured telephone interviews at 6 weeks, 6 months, and 1 year after hospital discharge. Generalized estimating equations were used to explore factors associated with PPD, measured using the Edinburgh Postnatal Depression Scale (EPDS) and two thresholds for depression (≥12 and ≥9). RESULTS Rates of PPD at all time points were 8%-10% for EPDS scores of ≥12. For EPDS scores of ≥9, rates of PPD more than doubled at all time points. A lack of social support was strongly associated with PPD in all analyses. Living in Canada for ≤2 years, poor perceptions of health, and lower mental health functioning were other important predictors of PPD. Living in communities with a high prevalence of immigrants and low income also was associated with PPD. CONCLUSIONS Complex individual and community-level factors are associated with PPD in immigrant women. Understanding these contextual factors can inform a multifaceted approach to addressing PPD.
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Affiliation(s)
- Rebecca Ganann
- 1 School of Nursing, McMaster University , Hamilton, Canada
| | - Wendy Sword
- 2 School of Nursing, University of Ottawa , Ottawa, Canada
| | - Lehana Thabane
- 3 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Canada
| | - Bruce Newbold
- 4 School of Geography and Earth Sciences, McMaster University , Hamilton, Canada
| | - Margaret Black
- 1 School of Nursing, McMaster University , Hamilton, Canada
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Sanghera R, Wong ST, Brown H. A cross-sectional analysis of perinatal depressive symptoms among Punjabi-speaking women: are they at risk? BMC Pregnancy Childbirth 2015. [PMID: 26197818 PMCID: PMC4510901 DOI: 10.1186/s12884-015-0568-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Depression is the leading cause of disability for childbearing women. We examined three specific research questions among Punjabi-speaking women residing in the Fraser Health Authority: 1) What are the prevalence rates of prenatal depressive symptoms? 2) Do Punjabi-speaking women have a higher likelihood of reporting depressive symptoms compared to English-speaking women after controlling for age, level of education and financial worries, and 3) Given the same level of exposure to level of education and financial worries, do Punjabi-speaking women have the same likelihood of reporting depressive symptoms? Methods Data originated from the Fraser Health Authority prenatal registration database consisting of pregnant women (n = 9684) who completed a prenatal registration form between June 2009 and August 2010; 9.1 % indicated speaking Punjabi. The Whooley Depression Screen measured depressive symptoms. Chi-square tests and logistic multiple regression were used to examine the rates of reporting depressive symptoms among Punjabi-speaking women compared to English-speaking women. Results Punjabi-speaking women are at a higher risk for perinatal depressive symptoms. Women needing an interpreter were more likely to report prenatal depressive symptoms compared to English-speaking women. All registrants who reported financial worries had four and a half times the odds of reporting depressive symptoms. The impact of financial worries was significantly greater in the English-speaking women compared to the Punjabi-speaking women needing an interpreter. Conclusion Using an established screening device, Punjabi-speaking women were found to be at higher risk for prenatal depressive symptoms.
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Affiliation(s)
- Raman Sanghera
- Fraser Health Authority, Public Health Nurse, Newton Public Health Unit, #200 7337 137th Street, Surrey, BC, V3W 1A4, Canada.
| | - Sabrina T Wong
- University of British Columbia School of Nursing and Centre for Health Services and Policy Research, Co-Director of BC node of the Canadian Primary Care Sentinel Surveillance Network, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Helen Brown
- University of British Columbia School of Nursing, T149-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Yelland J, Riggs E, Small R, Brown S. Maternity services are not meeting the needs of immigrant women of non-English speaking background: Results of two consecutive Australian population based studies. Midwifery 2015; 31:664-70. [DOI: 10.1016/j.midw.2015.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 02/17/2015] [Accepted: 03/02/2015] [Indexed: 11/17/2022]
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Kaur M, Singh S, Gupta M, Bahuguna P, Rani S. Inequity in access to health services between migrants and natives of Chandigarh, India. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2015. [DOI: 10.1108/ijmhsc-03-2014-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– People often migrate from rural to urban areas within a country or from less developed to more developed countries for better life opportunities but may remain outside the range of health services. The purpose of this paper was to find out the socio-economic and health system factors that may affect the utilization of health services by the migrants.
Design/methodology/approach
– Five villages and three slums were randomly selected from 23 villages and 18 slums of Chandigarh, a northwest Indian city. Using stratified random sampling, 145 migrants and 63 native women, who were pregnant or had delivered a baby from April 1, 2009 to March 31, 2012 were interviewed using semi-structured interview schedule. χ2 was used for testing statistical significance of the differences, and logistic regression was utilized to evaluate the “independent effect” of migration on Maternal and Child Health (MCH) service utilization.
Findings
– The level of education was higher among migrants than the natives but their income was less than that of natives. Majority of the migrant women had registered themselves for antenatal care (ANC) in the first trimester of pregnancy (55 percent) compared to the natives (21 percent), but only few had availed more than three ANC check-ups (18 percent) as compared to the natives (44 percent). Knowledge about danger signs of childhood diarrhea and pneumonia was low among migrants compared to the natives (p
<
0.0001). Health workers interacted less often with migrants (29 percent) than the natives (67 percent). After controlling the effect of socio-economic and -demographic variables, utilization of MCH care services were significantly higher among natives than the migrants. Inadequate community support among migrants led to the lower utilization of MCH care.
Research limitations/implications
– Present study reflects early ANC registration among migrants but the number of ANC visits much less than the natives. This could be further be investigated using qualitative methods.
Practical implications
– Specific strategies are required to address the health needs of migrants such as formation of community-based support groups. Health services and health workers need to be oriented to support migrants to the special needs of migrants.
Social implications
– Reduction in inequality in accessing health between natives and migrants can be addressed with social support.
Originality/value
– The study supports the fact that migration is one of the social determinants of health. Lack of community support to migrants is the major barrier in accessing the health services.
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