Barriers and facilitators of maternal healthcare utilisation in the perinatal period among women with social disadvantage: A theory-guided systematic review

Background: Women with social disadvantage have poorer perinatal outcomes compared to women in advantaged social positions, which may be linked to poorer healthcare utilisation. Disadvantaged groups may experience a greater diversity of barriers (e.g., feeling embarrassed about pregnancy, lack of transportation) or barriers judged to be particularly difficult (e.g., embarrassment about pregnancy). They may also experience barriers more frequently (e.g., depression). Using Levesque et al.’s (2013) framework of healthcare access, our review identifies the barriers and facilitators that affect maternal healthcare utilisation in the perinatal period among women with social disadvantage in high-income nations. Objectives: Our review searches for the barriers and facilitators affecting maternal healthcare utilisation in the perinatal period, from pregnancy to the first year postpartum, among women with social disadvantage (Prospero registration CRD42020151506). Design: We conducted a theory-guided systematic review. PubMed, Embase, MEDLINE, PsycINFO, and Social Science Citation Index databases were searched for publications between 1999 and 2018. Findings: 37 articles out of 12’972 were included in the qualitative synthesis. 19 domains of barriers and facilitators were extracted. Domains on the provider side includes ‘information regarding available treatments’ and ‘trustful relationships.’ On the user-side, domains include ‘awareness of pregnancy’ and ‘unplanned/unwanted pregnancy’ Key conclusions: Provider- and user-side characteristics interact to affect access. User-side characteristics that pose a barrier can be offset by provider-side characteristics that lower barriers to access. Implications for practice: User-side characteristics (e.g., lack of awareness of pregnancy) play an important role in the initial steps toward access. Among women with social disadvantage, reducing barriers may require active outreach on the part of providers

Mixed methods instrument validation: Evaluation procedures for practitioners developed from the validation of the Swiss Instrument for Evaluating Interprofessional Collaboration.

BACKGROUND Quantitative and qualitative procedures are necessary components of instrument development and assessment. However, validation studies conventionally emphasise quantitative assessments while neglecting qualitative procedures. Applying both methods in a mixed methods design provides additional insights into instrument quality and more rigorous validity evidence. Drawing from an extensive review of the methodological and applied validation literature on mixed methods, we showcase our use of mixed methods for validation which applied the quality criteria of congruence, convergence, and credibility on data collected with an instrument measuring interprofessional collaboration in the context of Swiss healthcare, named the Swiss Instrument for Evaluating Interprofessional Collaboration. METHODS We employ a convergent parallel mixed methods design to analyse quantitative and qualitative questionnaire data. Data were collected from staff, supervisors, and patients of a university hospital and regional hospitals in the German and Italian speaking regions of Switzerland. We compare quantitative ratings and qualitative comments to evaluate the quality criteria of congruence, convergence, and credibility, which together form part of an instrument's construct validity evidence. RESULTS Questionnaires from 435 staff, 133 supervisors, and 189 patients were collected. Analysis of congruence potentially provides explanations why respondents' comments are off topic. Convergence between quantitative ratings and qualitative comments can be interpreted as an indication of convergent validity. Credibility provides a summary evaluation of instrument quality. These quality criteria provide evidence that questions were understood as intended, provide construct validity, and also point to potential item quality issues. CONCLUSIONS Mixed methods provide alternative means of collecting construct validity evidence. Our suggested procedures can be easily applied on empirical data and allow the congruence, convergence, and credibility of questionnaire items to be evaluated. The described procedures provide an efficient means of enhancing the rigor of an instrument and can be used alone or in conjunction with traditional quantitative psychometric approaches

Anwendung und Optimierung des Schweizer Interprofessionalitäts-Evaluations-Instrumentariums SIPEI

Das Schweizer Interprofessionalitäts-Evaluations-Instrumentarium SIPEI wurde entwickelt, um die in der Praxis umgesetzte interprofessionelle Zusammenarbeit (IPZ) an Institutionen des Gesundheitswesens zu evaluieren. Das Instrumentarium wurde als Teil des Förderprogramms «Interprofessionalität» des Bundesamts für Gesundheit erarbeitet und sollte im Rahmen dieses Projekts erstmalig eingesetzt werden. Ziel des Projekts war es, das Instrumentarium SIPEI durch den Einsatz in verschiedenen Settings auf Validität und Reliabilität zu prüfen. Ferner sollten Möglichkeiten zur Optimierung des Instrumentariums aufgezeigt werden

Psychosoziale Prädiktoren von Schwangerschaftsabbrüchen in der Schweiz

Gibt es in der Schweiz einen Zusammenhang zwischen sozialer Benachteiligung und nicht medizinisch indizierten Schwangerschaftsabbrüchen? Die Evidenzlage dazu ist schlecht. Um diese Forschungslücke zu schliessen, führt die Berner Fachhochschule im Fachbereich Geburtshilfe eine Sekundäranalyse der Daten des Bundesamts für Statistik zu Schwangerschaftsabbrüchen durch

Barrieren abbauen

Ein theoretisches Modell zeigt, warum schutzsuchende Frauen Gesundheitsdienstleistungen für Schwangerschaft, Geburt und Wochenbett selten oder verspätet in Anspruch nehmen. Die Gründe liegen auf beiden Seiten und beeinflussen sich gegenseitig. Deshalb sind systemische Lösungsansätze gefragt

Peripartal health of women asylum seeker in Switzerland: who cares?

Zusammenfassung: Die sexuelle und reproduktive Gesundheit von asylsuchenden Frauen findet in der Gesundheitsversorgung wenig Aufmerksamkeit. Für diese vulnerable Population wurden in der Schweiz zentrale Zugangsbarrieren zur peripartalen Gesundheitsversorgung identifiziert, die mit schlechteren neonatalen und mütterlichen Outcomes einhergehen. Eine Studie der Berner Fachhochschule erhebt aktuell Daten zur Perspektive von asylsuchenden Frauen, um die Zugangsbarrieren aus deren Sicht besser zu verstehen.Abstract: Little attention is paid to the sexual and reproductive health of women asylum seekers. Important barriers to perinatal healthcare access which are associated with poorer neonatal and maternal outcomes were identified for this vulnerable population. A study of the Bern University of Applied Sciences is currently collecting data on the perspectives of women asylum seekers to better understand access barriers from the women’s perspective

Sexual and reproductive healthcare for women asylum seekers in Switzerland: a multi-method evaluation

Abstract Background Forced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers’ health. Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study’s objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers. Methods The study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis. Results The accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise. Conclusions The standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers