Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project

Feasibility, acceptability, and effectiveness of group antenatal care on the continuum of care and perinatal outcomes in Sub-Saharan Africa: A systematic review and meta-analysis protocol

INTRODUCTION

Women with adequate antenatal care (ANC) experience more reduction in adverse maternal and perinatal outcomes compared to those with insufficient care. However, the conventional individualized ANC models have not significantly improved perinatal outcomes. Comprehensive, woman-centered group ANC (G-ANC) interventions, integrating medical care with education, demonstrate positive effects on maternal and newborn health. While promising evidence exists in sub-Saharan Africa, the feasibility, acceptability, and effectiveness of G-ANC in resource-limited settings require further investigation. The variability in current studies further indicated the need for meta-analyses and systematic reviews to consolidate findings and clarify the overall effectiveness of G-ANC interventions. This synthesis aims to provide comprehensive evidence supporting the implementation of group prenatal care models in low-resource settings. Ultimately, it seeks to establish robust evidence to guide policy and practice, contributing to reduced maternal and perinatal mortality in the region.

METHODS AND ANALYSIS

This systematic review and meta-analysis protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. A comprehensive literature search will be conducted across multiple electronic databases, including PubMed/MEDLINE, Web of Science, EMBASE, and CINHAL, to identify pertinent articles published from January 1, 2016, to June 30, 2024. Experimental studies (pre-post, quasi-experimental study, cluster randomized controlled trial), prospective cohort design, prospective comparative study, and qualitative and mixed method designs will be included in the review. The Abstract and full-text screening will be conducted by three reviewers using Covidence, according to the eligibility criteria set. The Joanna Briggs Institute (JBI) Critical Appraisal Tools, specifically designed for JBI Systematic Reviews, will be utilized to assess the methodological quality of the included studies. Statistical heterogeneity will be assessed using the Higgins test. Meta-analysis will be conducted using R statistical software version 4.4.2, which will implement random effects models to determine the weights. Pre-specified subgroup analysis and sensitivity analysis will be performed as needed. The study results will be reported in order, starting with primary outcomes and then secondary outcomes and important subgroup outcomes analyses.

ETHICS AND DISSEMINATION

Ethical approval is not applicable as no original data will be collected. The findings of this review will be disseminated through publication and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42024565501.

Proactive approaches to preventing postpartum depression in non-depressive pregnant women: a comprehensive scoping review

Introduction

Postpartum depression is a significant global health challenge that affects mothers, infants, and families. Although various preventive strategies show promise, comprehensive reviews evaluating interventions among pregnant women without a clinical diagnosis of depression remain limited. This scoping review aims to identify and synthesize the existing evidence on proactive postpartum depression prevention programs initiated during pregnancy.

Methods

Following PRISMA guidelines for scoping reviews, we systematically searched PubMed and Scopus, supplemented by manual reference reviews. Our search strategy combined terms related to postpartum depression, pregnancy, and preventive interventions. Studies were included if they evaluated interventions conducted during pregnancy, targeting women without a clinical diagnosis of depression, and assessed PPD outcomes using established diagnostic criteria or validated screening tools. Only English-language articles published between 2013 and 2023 were considered.

Results

A total of 49 studies met the inclusion criteria. Interventions were categorized into nine themes: psychoeducation (n = 18), home visits (n = 6), cognitive behavioral therapy (CBT) (n = 6), mindfulness (n = 6), exercise (n = 4), dietary supplements (n = 3), interpersonal therapy (IPT) (n = 4), consultation (n = 1), and inhalation aromatherapy (n = 1). Psychoeducational and mindfulness-based interventions consistently reduce PPD risk, particularly when delivered in structured, theory-driven formats and incorporating family support. Digital CBT interventions demonstrated limited effectiveness due to lower engagement, while home-visit and consultation-based interventions were effective when integrated into existing maternal healthcare despite scalability challenges. Exercise and dietary supplement interventions yielded inconsistent outcomes, indicating that factors such as adherence, duration, and intensity are crucial determinants of effectiveness.

Conclusion

Various proactive interventions are available to prevent PPD, and this scoping review systematically maps the different strategies used and their outcomes. Proactive, theory-based, and multi-component interventions, particularly psychoeducational and mindfulness programs, demonstrate promising potential. Future research should emphasize evaluating long-term outcomes, optimizing digital engagement strategies, and developing culturally tailored models to enhance scalability and accessibility across diverse populations, including low-resource settings.

Midwives' perceptions of communication at antenatal care using a bilingual digital dialog support tool- a qualitative study

BACKGROUND

Sweden has a large population of migrant women, which contributes to communication challenges and, consequently, suboptimal maternity care. Compared with native-born women, migrant women have an increased prevalence of adverse pregnancy outcomes. Miscommunication and language barriers are among the reasons for these results. Thus, language barriers can also lead to providing less information to migrant women. A digital Swedish-Arabic dialog support tool was developed and tested at antenatal care, to facilitate communication between midwives and Arabic-speaking women. This study aimed to describe midwives' perceptions of communication via Swedish-Arabic dialog support (Sadima) in antenatal care.

METHODS

A qualitative study was conducted with 14 midwives in antenatal care with experience communicating using a Swedish-Arabic dialog support tool. The data were collected via semi structured individual interviews and were analyzed via phenomenographic analysis.

RESULTS

The analysis resulted in three categories: (1) Dialog support - the skill of constructing bridges, comprised the main finding that dialog support facilitated communication by providing a multimodal way of communication including intercultural evidence-based content;(2) Dialog support - challengingly implementing adaptive efficiency, represented the implementation of dialog support to be time-consuming and, eventually, time-efficient when midwives gained digital skills; and (3) Women and their partners - the ability to be empowered, included the main finding of increased women's empowerment and control over their lives by being less dependent on interpreters.

CONCLUSIONS

The findings contribute to the understanding of communication via dialog support based on midwives' experiences. This study highlights that communication via dialog support facilitates communication between midwives and Arabic-speaking women and enhances midwives' working conditions. Within our increasingly heterogeneous societies, health care could provide support for communication via digital dialog support that is women-centered and culturally sensitive to avoid misunderstandings and delayed or incorrect treatment of migrant women.

Public health, policy, and clinical interventions to improve perinatal care for migrant women and infants in high-income countries: a systematic review

Background

Migrant women who are pregnant or postpartum and their infants are often at increased risk of poorer perinatal outcomes compared to host country populations. This review aimed to identify public health, policy, and clinical interventions to improve maternity care for migrant women and their infants in high-income countries (HICs).

Methods

In this systematic review we searched EMBASE, EMCARE, MEDLINE and PsycINFO, CENTRAL, Scopus, CINAHL Plus, Web of Science, and grey literature from inception to 13th March 2024, with no language or date restrictions (PROSPERO: CRD42022380678). Interventional and observational studies assessing the effectiveness of any intervention to improve perinatal care for migrant women and their infants in HICs delivered in the pregnancy, peripartum, or postpartum period (up to one year after birth) were included. Quantitative outcomes were extracted. Qualitative studies were excluded. The main outcomes of interest were preterm birth, birthweight, and appointment attendance. Quantitative synthesis was conducted using Harvest plots and binomial exact calculations.

Findings

15,689 records were retrieved, 29 studies comprising data from 16,763,837 women were included. 22 studies (75.9%) included multiple interventions. Five interventions had strong evidence of effectiveness. Two clinical interventions: 100.0% of studies including specialist multidisciplinary teams improved one or more of the main outcomes of interest, namely preterm birth, birthweight, and appointment attendance (95% confidence interval 73.5-100.0%; p < 0.001); and 90.9% of studies including specialist in-person interpreting improved one or more of the main outcomes of interest (58.7-100.0%; p = 0.012). Three public health or policy interventions: 100.0% of social welfare interventions (75.3%-100.0%; p < 0.001) improved one or more of the main outcomes of interest; 100.0% of maternal education interventions (71.5-100.0%. p < 0.001), and 83.3% of studies assessing access to free healthcare (51.6-97.9%; p = 0.039).

Interpretation

The findings suggest that multicomponent interventions comprising multidisciplinary teams, in-person interpreting, maternal education, and social welfare support can improve perinatal outcomes for migrant women and their infants. Removing financial barriers to care may improve perinatal outcomes and be cost saving to healthcare systems. However, these findings should be interpreted with caution given that most included studies were of poor quality and that sensitivity analysis restricting to interventional studies only did not demonstrate any effect on the main outcomes of interest.

Funding

KS is supported by a National Institute for Health Research (NIHR) Doctoral Fellowship (NIHR302577). HRJ is supported by an NIHR Advanced Fellowship (NIHR303183). HRJ is supported by NIHR Applied Research Collaboration (ARC) South London. MM is supported by a Medical Research Council Clinical Research Training Fellowship (Grant number MR/W01498X/1). GF is supported by a Nuffield Department of Population Health Clinical Research Fellowship. MK is an NIHR Senior Investigator (NIHR303806). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Maternal Perspectives on and Preferences for an Enhanced Neonatal Jaundice Education Program: An Evaluation Using the Consolidated Framework for Implementation Research

Introduction

Neonatal mortality is a major contributor to under-five deaths yet the main causes of these deaths are preventable. Postnatal health education programs can improve timely detection and care seeking for newborn morbidities such as neonatal jaundice (NNJ). Being a common occurrence in low-income countries, it is surprising that women do not have sufficient knowledge about NNJ. Although the knowledge can be improved through routine education programs, healthcare providers rarely engage women in evaluating such programs, which limits their uptake and sustainability.

Methods

This was a qualitative study evaluating a postnatal neonatal jaundice health education program conducted at Jinja Regional Referral Hospital (JRRH). Narrative data on the structure, design, and delivery of the program was recorded from 12 postnatal women through unstructured interviews. The participants were those who had taken part in an enhanced NNJ education program. Qualitative content analysis, guided by the Consolidated Framework for Implementation Research (CFIR) was performed.

Results

Using the CFIR, two themes were identified; the intervention characteristics domain and the individual domains. The constructs under these domains were intervention design quality and packaging, relative advantage, and maternal knowledge needs. The augmented nature of the intervention, sorting individual needs, ability to promote continuity of care, and care-seeking were identified as key facilitators. Lack of group interaction was identified by some women as a possible barrier.

Conclusion

Overall, the education program was positively perceived by women and preferred compared to the conventional method of health education. In low-resource settings where maternal health education can contribute to a reduction in newborn mortality, the design, implementation, and evaluation of maternal education programs should be informed by women's preferences. Healthcare providers should utilize multiple sources of information and routinely practice patient-centered evaluation to meet the changing knowledge demands of postnatal women.

Women's use of Swedish health care during the postpartum period in relation to maternal country of birth-A population-based study

INTRODUCTION

Migrant women are a heterogenous group with both higher and lower risk for pregnancy complications and adverse birth outcomes compared with women in the receiving countries. This study aimed to investigate women's use of Swedish healthcare postpartum, in terms of hospital stay >48 h, readmission to hospital, and specialized out-patient clinic visits, in relation to maternal country of birth.

MATERIAL AND METHODS

A population-based register study including 278 219 primiparous and 367 776 multiparous women in Sweden (2014-2019) using data from Swedish Pregnancy Register, National Patient Register and Statistics Sweden. Multivariable logistic regression analyses were used to estimate associations between maternal country of birth and outcomes, adjusting for year of birth, maternal age, education, pre-gestational hypertension and diabetes, and healthcare region, presented as crude and adjusted odds ratios (aOR) with 95% confidence interval (CI) with Swedish-born women as reference.

RESULTS

Subgroups of migrant women had higher odds of postpartum hospital stays > 48 h, particularly women from Eritrea (primiparous aOR 2.80, CI 2.49-3.15; multiparous aOR 2.78, CI 2.59-2.98), Somalia (primiparous aOR 2.61, CI 2.34-2.92; multiparous aOR 1.87, CI 1.79-1.97), and India (primiparous aOR 2.52, CI 2.14-2.97; multiparous aOR 2.61, CI 2.33-2.93), compared to Swedish-born women. Primiparous women from Afghanistan (aOR 1.32, CI 1.08-1.6), Iraq (aOR 1.30, CI 1.16-1.46), and Iran (aOR 1.23, CI 1.04-1.45) had slightly higher odds of hospital readmission, along with multiparous women from India (aOR 1.34, CI 1.02-1.76) and Somalia (aOR 1.24, CI 1.11-1.38). Specialized out-patient clinic visits were most common in primiparous women from Somalia (aOR 1.47, CI 1.35-1.59), Iran (aOR 1.31, CI 1.22-1.42) and Afghanistan (aOR 1.31, CI 1.18-1.46), and in multiparous women from Iran (aOR 1.30, CI 1.20-1.41) and Iraq (aOR 1.15, CI 1.11-1.20), however less common in women from some other countries.

CONCLUSIONS

The use of Swedish health care during the postpartum period varied among women, depending on their country of birth. Women from certain countries had particularly high odds of postpartum hospital stays exceeding 48 h, compared to Swedish-born women, regardless of parity and pre-gestational medical disorders. Further studies are needed to determine whether the individual needs of migrant women are being met during the postpartum period or not.

Couples' perceptions and experience of smartphone-assisted CenteringPregnancy model in southeast of China: a dyadic analysis of qualitative study

OBJECTIVES

The objectives of this study are to describe couples' experiences and perceived barriers to participation in the CenteringPregnancy model in southeast of China and to understand whether smartphones could play a potential role in this model.

DESIGN

This study employed a descriptive phenomenological qualitative study using semistructured dyadic interviews with women and their partners. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis.

SETTING

This study was conducted in two pilot prenatal clinics in southern China.

PARTICIPANTS

A purposive sample of 13 couples who underwent smartphone-assisted CenteringPregnancy were recruited. Data were collected until saturation through semistructured dyadic interviews between December 2022 and March 2023.

RESULTS

The study yielded four primary themes: (1) motivation for participation, (2) acceptance of CenteringPregnancy, (3) barriers and suggestions and (4) support for smartphone use of CenteringPregnancy.

CONCLUSIONS

CenteringPregnancy was well received by couples. Couples can access additional medical care and engage in intensive social interactions assisted by smartphones. However, certain objective challenges need to be acknowledged, including inadequate activity space, high demand for knowledge by couples and inflexible time for employed partners. Moreover, the risk that smartphones can lead to false expectations among couples needs to be noted.

Unlocking the mechanisms of change in the MAMAACT intervention to reduce ethnic disparity in stillbirth and newborns' health: integration of evaluation findings

Ethnic disparities in stillbirth exist in Europe and suboptimal care due to miscommunication is one contributing cause. The MAMAACT intervention aimed to reduce ethnic disparity in stillbirth and newborns' health through improved management of pregnancy complications. The intervention encompassed training of antenatal care midwives in cultural competencies and intercultural communication combined with health education materials for the expecting parents about symptoms of pregnancy complications. The evaluation consisted of a qualitative in-depth implementation analysis and a process evaluation embedded in a cluster randomized trial including 19 of 20 maternity wards in Denmark. In this article, the findings from the different evaluation perspectives are integrated. The integration follows the principles of realist evaluation by analyzing to what extent the MAMAACT activities were generating mechanisms of change in interaction with the context. The integration analysis shows that the health education materials in the MAMAACT intervention contributed to heightened health literacy concerning pregnancy complications among pregnant women. Additionally, the training of midwives in cultural competency and intercultural communication raised awareness among midwives. Nonetheless, the exclusive emphasis on midwives and the inflexibility in care provision hindered them from changing their communication practices. To enhance the cultural competence in maternity care, it is essential to implement more comprehensive initiatives involving healthcare professionals in maternity care at all levels, from pregraduate to postgraduate. Adequate interpreter services and management support should also be ensured. Currently, the Danish antenatal care system faces challenges including inadequate information transfer between healthcare sectors, insufficient differentiation of care, and inflexibility in midwife scheduling. This results in a lack of responsiveness to the individual needs of women with immigrant backgrounds, potentially reproducing health inequities.

Migrant women's experiences of an individual language-assisted information and support visit to the labor ward before giving birth - A qualitative study from Sweden

BACKGROUND

Migrant women are less likely to receive an individualized maternal care where they feel safe, informed and supported but few measures have been undertaken to meet their needs. In Södertälje municipality in Sweden, community-based antenatal care midwives identify migrant women and offer them and their partners language-assisted information and support through an individual two-hour-visit to the labor ward. The aim of the present study was to explore migrant women's experiences of antenatal care including receiving language-assisted information and support during pregnancy through a two-hour INFOR-visit to the labor ward.

METHODS

Semi-structured interviews were conducted with 10 non-Swedish speaking migrant women, using an interpreter. Interview analysis was conducted using reflexive thematic analysis.

RESULTS

The individualized support, including thorough information given with language support available, sufficient time for questions and discussion, and a caring approach - did appear to inform and reassure the women. Overall, they felt that they were seen and treated as individuals during both pregnancy and birth and that their specific needs were listened to and met by the health care providers. Having professional interpreters was seen as essential for receiving the right information, something achieved at the individual visit.

CONCLUSIONS

The findings from this study provide evidence that a two-hour-visit to the labor ward during pregnancy has potential to empower migrant women during pregnancy and birth and to improve their experiences of maternity care. The two-hour-visit is a relatively simple intervention with the potential of not only improving migrant women's experiences of pregnancy and birth, but also their medical outcomes.

Finding our own ways of working together: reflections on implementing and facilitating a multidisciplinary and equity-oriented model of Group Pregnancy Care for women of refugee background

OBJECTIVE

This paper explores professional staff experiences of implementing and facilitating a multidisciplinary equity-oriented model of Group Pregnancy Care for women of refugee background. This model was the first of its kind in Australia and one of the first worldwide.

DESIGN AND SETTING

This exploratory descriptive qualitative study reports the process evaluation findings from the formative evaluation of Group Pregnancy Care for women of refugee background. Data were collected in Melbourne, Australia between January and March 2021 via semi-structured interviews, and analysed using reflexive thematic analysis.

PARTICIPANTS

Purposive sampling was used to recruit twenty-three professional staff involved in the implementation, facilitation, or oversight of Group Pregnancy Care.

FINDINGS

This paper reports five themes: knowledge sharing, bicultural family mentors - the critical link, finding our own ways of working together, power dynamics at the intersection of community and clinical knowledge, and system capacity for change.

KEY CONCLUSIONS

The bicultural family mentor role contributes to the cultural safety of the group, and increases the confidence and competence of professional staff through cultural bridging. Multidisciplinary cross-sector teams that collaborate well can provide cohesive care. It is possible for hospital and community-based services to establish cross-sector equity-oriented partnerships. However, there are challenges sustaining partnerships in the absence of explicit funding to support collaboration, and in context of organisational and professional inflexibility.

IMPLICATIONS FOR PRACTICE

Investing in change is necessary to achieve health equity. Creating explicit funding pathways for the bicultural family mentor workforce, multidisciplinary collaboration, and cross-sector partnerships would strengthen service capacity to provide equity-oriented care. Working towards health equity also requires a commitment to continuing professional development for professional staff and organisations to increase knowledge and capacity.