Exercise and physical activity in asylum seekers in Northern England; using the theoretical domains framework to identify barriers and facilitators

Background Many asylum seekers have complex mental health needs which can be exacerbated by the challenging circumstances in which they live and difficulties accessing health services. Regular moderate physical activity can improve mental health and would be a useful strategy to achieve this. Evidence suggests there are barriers to engaging black and minority ethnic groups in physical activity, but there is little research around asylum seekers to address the key barriers and facilitators in this group. Methods A two stage qualitative study used semi-structured interviews underpinned by the Theoretical Domains Framework. The interviews were conducted in voluntary sector groups in four towns/ cities in Northern England. Purposive sampling recruited 36 asylum seekers from 18 different countries. Interviews were audio recorded, transcribed verbatim and subject to framework analysis. Stage two involved a nominal group technique with five key stakeholders including asylum seekers and those that work with them. They followed a four stage process to rank and reach consensus on the key barrier to undertaking physical activity/ exercise that could be addressed locally through a future intervention. Results A number of barriers and facilitators were identified including a lack of understanding of the term physical activity and recommended levels but knowledge of the health benefits of physical activity/ exercise and the motivation to increase levels having engaged with activities back home. Living as an asylum seeker was considered a barrier due to the stress, poverty and temporary nature of living in an unfamiliar place. The outcome of the nominal group technique was that a lack of knowledge of facilities in the local area was the prevailing barrier that could be addressed. Conclusions Public health practitioners could develop interventions which capitalise on the motivation and knowledge of asylum seekers to encourage an increase in physical activity which may in turn reduce the breadth and depth of mental health needs of this group

Peer volunteering; an innovative approach to striving towards achieving normal childbirth in asylum seeking and refugee women.

ye

Asylum seekers and refugees: A cross European perspective

yesIn this chapter we explore issues of psychosocial resilience and risk related to asylum seeking and refugee women during the perinatal period, drawing on experiences from three diverse European countries; the United Kingdom (UK), Malta and the Netherlands. First we define the terms asylum seekers and refugees to allow us to focus on the issues that pertain specifically to women experiencing this form of migration. We also note the prevalence of migration in contemporary society. We explore recent research on asylum seeking and refugee women in the perinatal period to identify; the barriers women face in accessing care in their reception countries and their experiences of perinatal care. Through this work, the challenges faced by healthcare professionals to provide culturally appropriate and high quality care to these women who face a range of psychosocial challenges are also highlighted. We suggest possible ways to address some of these challenges including how health professionals can actively build on the resilience of asylum seeking and refugee women to improve their perinatal experiences. We conclude by focusing on the implications of these findings; drawing on examples of good practice from the UK, Netherland and Malta to provide recommendations for practice and service development

Striving for excellence in maternity care: The Maternity Stream of the City of Sanctuary.

yesAsylum-seeking and refugee (AS&R) women living in the UK often have complex health and social care needs, with poor underlying mental and physical health and an increased risk of negative pregnancy outcomes. Despite this, AS&R women are less likely to attend for timely maternity care and when they do, care may be poor, with staff not understanding their specific needs and displaying poor attitudes. This article discusses the Maternity Stream of the City of Sanctuary and how this charity aims to work with statutory and voluntary sector maternity-related services and groups to develop services that are inclusive for AS&R women and meet their specific needs. Volunteer AS&R women are central to the activities of the Maternity Stream and this article discusses how they engage with midwives and other maternity workers to facilitate the development of services that may ultimately improve pregnancy outcomes for AS&R women

Hospital postnatal discharge and sepsis advice: Perspectives of women and midwifery students

Background: Women are discharged home from hospital increasingly early, but there is little evidence examining the postnatal hospital discharge process and how this may impact on the health of women and babies. In particular, there is little on sepsis prevention advice, despite it being the biggest direct cause of maternal mortality. Aim: To explore the perceptions of women and senior student midwives related to the postnatal hospital discharge process and maternal sepsis prevention advice. Methods: Three focus group interviews were undertaken, involving 9 senior student midwives and 14 women attending paid or specialist classes for vulnerable migrant women. Findings: All participants believed that the postnatal hospital discharge process was inadequate, rushed and inconsistent. Sepsis advice was patchy and the condition underplayed. Conclusions: Cost effective, time-efficient and innovative ways to impart vital information are required to support the postnatal hospital discharge process

Cues for Early Social Skills: Direct Gaze Modulates Newborns' Recognition of Talking Faces

Previous studies showed that, from birth, speech and eye gaze are two important cues in guiding early face processing and social cognition. These studies tested the role of each cue independently; however, infants normally perceive speech and eye gaze together. Using a familiarization-test procedure, we first familiarized newborn infants (n = 24) with videos of unfamiliar talking faces with either direct gaze or averted gaze. Newborns were then tested with photographs of the previously seen face and of a new one. The newborns looked longer at the face that previously talked to them, but only in the direct gaze condition. These results highlight the importance of both speech and eye gaze as socio-communicative cues by which infants identify others. They suggest that gaze and infant-directed speech, experienced together, are powerful cues for the development of early social skills

What are lay UK public perceptions of frailty: a scoping review.

Rationale and objective Perceptions of frailty can influence how families cope, quality of life and access to support services. Yet little is known of how lay members of the UK general public perceive frailty. This scoping review aimed to explore how frailty is perceived among the lay public in the United Kingdom. Methods The established scoping review methodology by Arksey and O’Malley was followed and searches were conducted across eight electronic databases and grey literature websites for articles published between 1990 and August 2022. In total, 6,705 articles were identified, of which six were included in the review. Data were analysed using Braun and Clarke’s thematic analysis framework. Results Three key themes were identified; frailty as a normal part of ageing, perceived consequences of frailty and coping with frailty. Overall, frailty has negative connotations and is perceived as linked to a natural part of the ageing process, increased dependency, loss of identity and social exclusion and stigma. However, it is unclear whether these perceptions have a direct bearing on access to support services for communities. Conclusion and implications This review identifies that it is imperative for health and social care service providers to consider the individual meaning of frailty for older people and families, to understand and integrate their particular needs and preferences when planning and delivering person centred frailty care and support. There is also a need for development of interventions that focus on increasing education and reducing stigma around frailty in order to change frailty perceptions in the UK

Pregnancy-related telephone consultations to an out-of-hours provider: a retrospective study

Pregnant women generally have 24-hour access to advice from maternity services; they can also contact out-of-hours (OOH) services, but the nature of this contact is poorly understood. The aim of the study was to describe the characteristics of pregnancy-related telephone consultation calls to an OOH service to compare the differences between the way calls were handled by GPs and nurse practitioners (NPs). The authors analysed 2,022 telephone pregnancy-related consultations made between January and December 2011 to an NHS OOH primary care service provider; 102 GPs and 36 NPs were involved. The mean length of consultation differed depending on clinician type: GPs were more likely to provide advice only, while NPs were more likely to recommend a base visit. Most consultations related to the first trimester of pregnancy, a time when women do not generally have access to maternity services. Later in pregnancy, women access OOH services when they could be accessing maternity services directly. GPs and NPs handle calls differently; it is unclear whether this affects clinical outcome

Inclusiveness of Access Policies to Maternity Care for Migrant Women Across Europe: A Policy Review

IntroductionDespite the interconnectedness of the European Union, there are significant variations in pregnant women's legal status as migrants and therefore their ability to access maternity care. Limited access to maternity care can lead to higher morbidity and mortality rates in migrant women and their babies. This study aimed to investigate and compare maternal health access policies and the context in which they operate across European countries for women who have migrated and are not considered citizens of the host country.MethodsThe study adopted a mixed-methods research design exploring policies on migrant women's access to maternity care across the migration regimes. Data were extracted from legal documents and research reports to construct a new typology to identify the inclusiveness of policies determining access to maternity care for migrant women.ResultsThis study found inconsistency in the categorisation of migrants across countries and significant disparities in access to maternity care for migrant women within and between European countries. A lack of connection between access policies and migration regimes, along with a lack of fit between policies and public support for migration suggests a low level of path dependency and leaves space for policy innovation.DiscussionInequities and inconsistencies in policies across European countries affect non-citizen migrant women's access to maternity care. These policies act to reproduce structural inequalities which compromise the health of vulnerable women and newborns in reception countries. There is an urgent need to address this inequity, which discriminates against these already marginalised women.Some migrant women in Europe struggle to access maternity care when compared to non-migrant women, resulting in poorer pregnancy outcomes. Systematic inconsistencies in maternal health care access policies across Europe reveal the extent of inequity faced by vulnerable migrant women. Our analysis demonstrated significant policy differences across and within migration regimes, but also highlighted that some countries do not have a good fit between policies regulating migrants' access to maternity care and public or policy level support for migrants. This points to limited relevance of path dependency in these policies, suggesting that a more inclusive approach across Europe might be possible

Embedding the 6 Cs : problem-based learning the Bradford way

This discussion paper examines the 6 Cs of good health care practice, suggesting that by using a problem-based learning (PBL) approach, midwifery education can assist student midwives in developing a wide variety of essential skills from competence to compassion, communication to courage and caring to commitment. Starting with a brief discourse on the philosophical and educational basis for PBL along with an explanation of the process, the paper proceeds to examine each component of the 6 Cs, exploring in some detail how these relate to a PBL midwifery curriculum