Developing a culturally appropriate preconception health promotion strategy for newly immigrated Latinos through a community-based program in South Carolina

Perspectives of women and partners from migrant and refugee backgrounds accessing the Cross Cultural Worker Service in maternity and early childhood services-a survey study

BACKGROUND

Women from migrant and refugee backgrounds living in high-income countries have increased risk of adverse perinatal outcomes and report lower satisfaction with perinatal healthcare. In Sydney, Australia, a new service known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service) was implemented to support such women and families from pregnancy to the early parenting period. This study aimed to ascertain the experiences of women and their partners engaging with the CCW Service.

METHODS

A survey study was undertaken. Women accessing the CCW Service were recruited during pregnancy and were asked to complete surveys at three time points: in the third trimester of pregnancy, at 6 and 12 months postpartum. Their partners were invited to complete a survey at 6 months postpartum. Survey data were analysed to compare satisfaction, usefulness, number of CCW interactions, cultural sensitivity, and service improvement recommendations across all three survey timepoints.

RESULTS

A total of 231 surveys were received: 113 during pregnancy, 50 at 6-months postpartum, 44 at 12-months postpartum, and 24 partner surveys. Participants in all surveys reported the CCW Service to be useful (84-94%), stating that it increased their understanding of pregnancy, birth and parenting (95-100%), and that they would recommend the CCW Service (92-98%). Participants experienced a high level of satisfaction (88-95%) irrespective of the number of CCW interactions (p = 0.42). Thoughts on becoming a mother or parent were more positive after meeting the CCW than before for both women (p = 0.01) and partners (p = 0.12). Suggestions for CCW Service improvement were to 1) increase the provision of information, specifically financial entitlements, postnatal depression, and support services, 2) increase involvement of partners in care, 3) increase the CCW workforce/or number of CCWs.

CONCLUSION

The CCW Service was associated with positive experiences and high rates of satisfaction at all timepoints. This service has the potential to inform the implementation of similar models of care that improve accessibility, the perinatal experience, and respond to the unique needs of women and families from migrant and refugee backgrounds.

Effects of COVID-19, Discrimination, and Social Support on Latinx Adult Mental Health

We investigated the role of COVID-19 exposure and discrimination on depressive and posttraumatic stress symptoms among Latinx adults residing in the southeastern United States. Survey data were collected from 264 Latinx adults. Using structural equation modeling (SEM) procedures, we estimated a structural model for hypothesized direct and indirect relationships between the risk factors of COVID-19 exposure and discrimination, social support, and two mental health conditions: depression and posttraumatic stress. COVID-19 exposure and discrimination each had a significant and positive relationship with both depression and posttraumatic stress. Social support was found to have a significant and inverse relationship with depression and posttraumatic stress, as well as to mediate the relationship between discrimination and both mental health symptoms. Implications for service provision and program design are presented. Future studies should examine variation between southeastern states and consider the influence of documentation status among an immigrant-only sample.

Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions

Background

Women from migrant and refugee backgrounds who live in high-income countries are at increased risk of adverse perinatal outcomes, including mental health issues, preterm birth and maternal and infant mortality. There is a need to implement and evaluate models of care to meet their specific needs in order to improve health outcomes, their experiences of care, and overcome barriers to access. In Sydney, Australia, a unique model of care was implemented to support women and families from migrant and refugee backgrounds to access health and community-based services through the continuum of pregnancy to the early parenting period. This model of care is known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service). The aim of this study was to explore the perceptions of service providers regarding the CCW Service and identify recommendations for improvement.

Methods

A mixed-methods study was conducted consisting of surveys and face to face semi-structured interviews. Service providers were recruited from hospital-based maternity and community-based services. Survey data were analysed descriptively. Interviews were analysed using qualitative content analysis.

Results

Sixty-nine service providers completed surveys and 19 were interviewed. The CCW Service was highly regarded by service providers who perceived it to be critical in improving care for women from migrant and refugee backgrounds. The overarching theme from the interviews was the ability of the CCW Service to act as a ‘bridge to health’ through the provision of culturally responsive care. There were three main categories; supporting access to health and community-based services, improving the healthcare experience, and organisational factors, including part-time hours, capacity, heavy workloads and confusion/lack of clarity regarding the CCW role, which affected CCWs’ capacity to optimally support service providers in providing culturally responsive care. These limitations meant CCWs were not able to meet demand, and fully operationalise the model.

Conclusion

Service providers perceived the CCW model to be a culturally responsive model of care tailored to the needs of women and families from migrant and refugee backgrounds, that reduces barriers to access, and has the potential to improve perinatal outcomes, and women's experience and satisfaction with care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01368-4.

Responding to the health needs of women from migrant and refugee backgrounds-Models of maternity and postpartum care in high-income countries: A systematic scoping review

Pregnant women from migrant and refugee backgrounds living in high-income countries (HIC) are at increased risk of adverse perinatal outcomes compared with women born in the host country. Women from migrant and refugee background have perinatal healthcare needs that are recognised internationally as a public health priority. The aim of this study was to identify, appraise and synthesise available evidence on the effectiveness of models of care in pregnancy or first 12 months postpartum for women from migrant and refugee backgrounds living in HIC. Care models were mapped in terms of (a) effectiveness at improving service access, (b) effectiveness at improving maternal and infant health outcomes, (c) acceptability and appropriateness from the perspective of women and (d) acceptability and appropriateness from the perspective of service providers. Using systematic scoping review methodology, qualitative, quantitative, and mixed methods research published in English 2008-2019 were included. The databases MEDLINE, Embase, Emcare, PubMed, Scopus, CINAHL, PsycINFO, Web of Science, Google Scholar, Cochrane Database of Systematic Reviews and Joanna Briggs Institute were searched between 27 February 2019 and updated 27 December 2019. Qualitative and quantitative data were analysed narratively. Seventeen studies, involving 1,499 women and 203 service providers, were included. A diverse range of interventions were identified, including bilingual/bicultural workers, group antenatal care and specialised clinics. All identified interventions were acceptable to women, and improved access, however, few provided evidence of improved perinatal outcomes. Gaps identified for future research include the use of qualitative and quantitative approaches to ascertain the experiences of women, their families, service providers and impact on perinatal outcomes. Synthesis of the included studies indicates the key elements of acceptable and accessible models, which were as follows: culturally responsive care, continuity of care, effective communication, psychosocial and practical support, support to navigate systems, flexible and accessible services.

Men Aged 15-44 in Need of Preconception Care

OBJECTIVES

Preconception care for men focuses on prevention strategies implemented prior to conception of a first or subsequent pregnancy to improve pregnancy and infant outcomes. Little is known about U.S. men in need of preconception care. This analysis describes the proportion of men in need of preconception care and associations of these needs by background characteristics, related health conditions, access to care and receipt of services.

METHODS

Data from men aged 15-44 in the National Survey of Family Growth 2006-2010 were analyzed to describe men in need of preconception care, based on future childbearing intentions and self and partner fecundity status (among sexually experienced only), and associated factors with these needs using weighted bivariate analyses.

RESULTS

About 60 % of men are in need of preconception care. Higher prevalence of being in need was observed among men aged 15-29 than older; living in urban than non-urban settings; in school than not in school regardless of working status; not in a coresidential union than married or cohabiting; who were recent immigrants than U.S. born; and reporting never having had a child than ≥1 child(ren). Men in need were overweight/obese (56 %), ever binge drank in the last year (58 %), and have high STI risk (21 %). The majority of men in need reported access to care in the last year (>70 %), but few reported receipt of services including STD/HIV testing (<20 %) or counseling (<11 %).

CONCLUSIONS FOR PRACTICE

Findings from this analysis have implications for promoting preconception care among U.S. men.