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Conceptualising the...
Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context
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- Binder, Pauline (author)
- Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH)
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- Johnsdotter, Sara (author)
- Malmö högskola,Institutionen för socialt arbete (SA),Malmö University
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- Essén, Birgitta (author)
- Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH)
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(creator_code:org_t)
- Elsevier, 2012
- 2012
- English.
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In: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 75:11, s. 2028-2036
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Abstract
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- Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems. 'Non-reciprocating care conceptualisations', 'limited system-level care guidelines', and 'low staff levels' can additionally delay timely care in Phase 3.
Keyword
- socio-cultural factors
- maternal care encounter
- immigrant women
- health communication
- obstetric intervention
- ethnicity
- migrant-friendly hospitals
- maternity guidelines
- Hälsa och samhälle
- Health and society
- International Health
Publication and Content Type
- ref (subject category)
- art (subject category)
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