Title: Cross Cultural Workers for women and families from migrant and refugee backgrounds:
A mixed-methods study of service providers perceptions
Version: 3 Date: 01 May 2021
Reviewer:  Lisa Merry
Reviewer's report:
The authors have addressed all of my comments. I think the manuscript is publishable and will
add to the literature on models of care for migrant women and their families during pregnancy
and early childhood. I made a few editorial suggestions below for the authors to consider.
Abstract
Recommended edit for last sentence of results : “There were three main categories; supporting
access to health and community-based services, improving the healthcare experience, and
organisational factors, including part-time hours, 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: the word “and” is missing: "that reduces barriers to access, AND has the potential
to improve perinatal outcomes
Background
“we USED UNHCR definitions” (should be either in present or past tense since the study is
already done)
“from refugee backgrounds INCLUDED women who are asylum seekers” (same comment)
Methods
Suggested edits: p.7, under the description of the CCW model of care: “Such care INCLUDES
language specific information (WHEN available), CCW with A shared cultural/linguistic
background with service users,,..”
Study recruitment
There should be an explanation as to why CCWs were recruited since the aim of the study was to
examine services providers’ perceptions- I recognize that the CCWs are also service-providers,
but it would be helpful to know that you gathered perceptions from those who USE the service,
and from those who PROVIDE the service.
The wording of this sentence isn’t clear, consider revising: “The email invitation explained
reason for invitation to participate was to hear about service providers opinions, views and
experience of the CCW Service”
Data collection
In one place it states : “An interview guide was developed (by HJR, AH and CH) based on a
literature search of health service evaluation by service providers, as well as clinical and research
experience” and then further down under analysis, it states: “These data was used develop the
interview questions that would explore, the issues further.” –which I believe means the survey
results were also used to inform the interview guide? – just make sure the information on how
the interview guide was developed is consistent..
“Data saturation was reached after 17 interviews, with no new themes raised in the PRECEDING
two interviews.” – I think you mean “subsequent” two interviews ?
Analysis
“grouping of free text responses”- not sure exactly what this means? You mean they were
grouped and counted ?
“Coding was aligned to the research questions, with quantitative survey used to ask similar
questions to code and contrast” – I think a word might be missing after survey (maybe “data”) ?
Also the wording is a bit awkward, maybe say something like “the quantitative results were also
used as a guide for the coding.”.. I don’t think you need to say the contrast part since further
down in the text you explain how the quantitative data were used to triangulate the findings.
Results
Page 12-13: “AchievementS included the provision of health education and promotion for
women (n=14), increased access to health and community services (n=14), supportive and
trusting relationship formed with women (n=14), supports the transition from maternity to child
and family health services (n=4), CCWs employed in the role are a strength of the service (n=3),
and builds capacity of staff to provide culturally responsive services (n=2).”
Achievement should be plural. Not sure what is meant by “promotion for women”.
Discussion
“This may genuinely be that there has no impact, or may be related to service providers working
only within health services and not having knowledge or experience, the part-time hours of the
CCWs not being adequate to support impact, and the recency of the model of care and its ability
to have an impact in an 18-month timeframe is too early to be supported or refuted.”
The sentence structure doesn’t flow, consider revising. Not clear what is meant by “working
only within health services and not having knowledge or experience” ?
p.21, line 628: “Conversely, a major perceived limitation of the CCW...” – I don’t think this
sentence should begin with conversely now that a new paragraph was inserted just before this
one.
p.21, line 635: “The need to increase CCW Service visibility is required to dispel
misconceptions, specifically not being interpreters or case-workers, and their ability to
participate in consultations with clinicians which is limited by part-time hours as opposed to not
being part of their role.”
The sentence structure doesn’t flow, consider revising.