Psychosocial health of asylum seeking women living in state-provided accommodation in Germany during pregnancy and early motherhood. A case study exploring the role of social determinants of health

Gewalt SC, Berger S, Ziegler S, Szecsenyi J, Bozorgmehr K. Psychosocial health of asylum seeking women living in state-provided accommodation in Germany during pregnancy and early motherhood. A case study exploring the role of social determinants of health. PLOS ONE. 2018;2018(12): e0208007

“If you can, change this system”. Pregnant asylum seekers‘ perceptions on social determinants and material circumstances affecting their health whilst living in state-provided accommodation in Germany - a prospective, qualitative case study

Gewalt SC, Berger S, Szecsenyi J, Bozorgmehr K. “If you can, change this system”. Pregnant asylum seekers‘ perceptions on social determinants and material circumstances affecting their health whilst living in state-provided accommodation in Germany - a prospective, qualitative case study. BMC Public Health. 2019;19(1): 287

“If you can, change this system” ­­‒ pregnant asylum seekers‘ perceptions on social determinants and material circumstances affecting their health whilst living in state-provided accommodation in Germany : a prospective, qualitative case study

Background: Pregnant women and new mothers seeking asylum are highly vulnerable and have special needs, yet there is dearth of research related to this group in Germany. This paper reports on material circumstances and behavioural factors as social determinants of asylum seekers’ health during pregnancy and early motherhood. The study aim was to gain in-depth insights into these women’s experiences and perceived needs with a focus on material circumstances whilst living in state-provided accommodation in one federal state in Southern Germany. Methods: A qualitative, prospective approach was taken with individual semi-structured interviews of participants during pregnancy and up to the six-week postnatal assessment, aiming at interviewing each woman twice during pregnancy and once after giving birth. Two female interviewers performed interviews assisted by female professional interpreters on the telephone. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to perform content analysis of interview material. Results: 21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Content analysis of women’s perceived health-related needs revealed significant health challenges due to considerable constraints in two major themes each with associated categories: a) material circumstances and b) behavioural factors. Participants’ experiences of living conditions included significant challenges in terms of housing and neighbourhood quality e.g. poor hygiene standards with fear of disease and restless sleep due to threats of violence. Consumption potential was severely limited because of a minimal living allowance. Food was a major preoccupation for all participants. Catering services in state-provided accommodation were perceived as unsatisfactory and neglecting religious practices. Institutional food provided adequate calorific intake but participants reported loss of appetite due to bland food, limited variety, little choice and unfamiliar tastes. Self-catering was prohibited further exacerbating this problem. Conclusions: Pregnant asylum seekers and new mothers living in state-provided accommodation experienced major restrictions related to material circumstances in this study. Key results identified housing and neighbourhood quality, consumption potential and nutrition as social determinants of health which women perceived to adversely affect their health, especially during pregnancy and early motherhood

Quality circles to identify barriers, facilitating factors, and solutions for high-quality primary care for asylum seekers

Straßner C, Gewalt SC, Becker von Rose P, Lorenzen D, Szecsenyi J, Bozorgmehr K. Quality circles to identify barriers, facilitating factors, and solutions for high-quality primary care for asylum seekers. BJGP Open. 2017;1(3):BJGP-2017-0112

Psychosocial health of asylum seeking women living in state-provided accommodation in Germany during pregnancy and early motherhood: A case study exploring the role of social determinants of health.

BackgroundPregnant women and new mothers seeking asylum are subject to major challenges that may affect their health and increase their vulnerability. The study aim was to investigate asylum seeking women's experiences and perceived needs during pregnancy and early motherhood whilst living in state-provided accommodation in one federal state in Southern Germany, with a particular focus on psychosocial factors.MethodsIn this exploratory case study, individual semi-structured interviews were conducted with participants in pregnancy and up to the six-week postnatal assessment. Two female interviewers performed interviews assisted by female professional interpreters. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to content analysis of interview material.Results21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Women shared experiences and perceived consequences on their psychosocial health. The following five key themes were identified during content analysis: a) psychosocial stressors, b) stressful living circumstances, c) stressful relationships, d) social support and e) coping styles. Psychosocial factors were a significant source of mental stress for participants, especially due to future uncertainties linked with the asylum seeking process. Living circumstances were also marked by stressors including a lack of privacy, verbal and physical threats and experiences of powerlessness. Further strain and emotional pressure were caused by stressful relationships with the unborn child's father. Social support and personal coping styles provided relief for some participants.ConclusionsThis study provides in-depth insights into the experiences and perceived needs of pregnant asylum seekers and new mothers living in state-provided accommodation. Key results identified psychosocial factors such as future uncertainties, stressful living circumstances and stressful relationships, as social determinants of health that were perceived to adversely affect women's health. Adequate social support and individual coping styles increased resilience and counterbalanced psychosocial stressors during the asylum seeking process

Early evaluation of experiences of health care providers in reception centers with a patient-held personal health record for asylum seekers: a multi-sited qualitative study in a German federal state

Jahn R, Ziegler S, Nöst S, Gewalt SC, Straßner C, Bozorgmehr K. Early evaluation of experiences of health care providers in reception centers with a patient-held personal health record for asylum seekers: a multi-sited qualitative study in a German federal state. Globalization and Health. 2018;14(1): 71

Potentially avoidable and ambulatory care sensitive hospitalisations among forced migrants: a protocol for a systematic review and meta-analysis

Lichtl C, Gewalt SC, Noest S, Szecsenyi J, Bozorgmehr K. Potentially avoidable and ambulatory care sensitive hospitalisations among forced migrants: a protocol for a systematic review and meta-analysis. BMJ Open. 2016;6(9): e012216

Comparison of financial limitations and field of studies.

Comparison of financial limitations and field of studies.</p

Logistic regression results for financial distress.

Logistic regression results for financial distress.</p

Distress due to financial difficulties.

Distress due to financial difficulties.</p