Title: Interventions that improve maternity care and access for immigrant women in England: a narrative synthesis systematic review
Funder: Department of Health and Social Care

Abstract: INTRODUCTION Our systematic review uses a narrative synthesis (NS) approach to identify, appraise and synthesise reports on empirical research focused on access and interventions that improve maternity care for immigrant women. We will review qualitative, quantitative and mixed-methods research evidence. NS a) Facilitates understanding and acknowledges the broader influences of theoretical and contextual variables, ethnicity, socioeconomic status, and geographical location; b) Enables understanding of the shaping of differences between reported outcomes as a result of differing study designs and childbearing populations c) Provides results that enable the development and implementation of maternity services and interventions. METHODS Popay et al's NS [1] is 'an approach to the systematic review and synthesis of findings from multiple studies that relies primarily on the use of words and text to summarise and explain the findings of the synthesis". The emphasis is on an interpretive synthesis of the narrative findings of research rather than on a meta-analysis of the data. All review steps will involve two or more reviewers. NS allows us to embrace cross-disciplinary and methodologically pluralistic research to map access and interventions in maternity care. The major findings of this synthesis are then used to explain how and why maternity care interventions focused on immigrant women have been implemented and how these interventions address access and inequalities experienced by immigrant women. NS comprises four elements: a) Development of a theory of how the intervention works, why it works, and for whom b) Development of a preliminary synthesis of the findings of the included studies c) Exploration of the relationships in the data d) Assessment of the robustness of the synthesis. These elements are not exclusive and the synthesis takes an iterative approach. In each element, a variety of tools and techniques may be used depending on the nature of the research evidence. Audience specific knowledge transfer products will ensue. A librarian designed the database search strategies (1990 to present), which was reviewed by the entire research team. We will employ a three-stage process: 1) screening; 2) preliminary categorization 3) retrieval, final selection and categorization. Firstly, two independent reviewers will screen all citations retrieved by applying a screening tool. The search for grey literature includes select database searches (ProQuest Dissertations, Theses, Google /Scholar), internet-based searches, review of reference lists, and email/phone contact with researchers and stakeholders with subject expertise. Grey literature will be screened for relevance and categorised using the National Information Centre on Health Services Research system [2]. DATA EXTRACTION AND QUALITY APPRAISAL To ensure robustness of the NS and the methodological quality of key literature and the analytical methods used to will be quality appraised using the Center for Evidence Based Management tools and review confidence with CERQUAL. SYNTHESIS We will explore relationships within and between studies using a range of tools. OUTPUTS An E-workshop for policy makers, collaborative practitioner workshops,scientific papers and conference presentations. PATIENT AND PUBLIC INVOLVEMENT (PPI) active input is assured as PPI are members of our project advisory group (PAG) including clinicians,policy makers and commissioners. 1. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S: Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. A Product from the ESRC Methods Programme April (2006). Available from: http://www.lancs.ac.uk/shm/research/nssr/research/dissemination/publications/NS_Synthesis_Guidance_v1.pdf website

Lay abstract: BACKGROUND The United Kingdom (UK) is often a 'first choice' country for many immigrants and 26.5% of births in the UK are to foreign born women. We have a lot of evidence of showing that immigrant women receive poor maternity care and have higher maternal and infant death rates. Our systematic review uses a narrative synthesis (NS) approach. This means we will identify and integrate findings from all types of research evidence examining access and interventions that improve maternity care for immigrant women. We will review all forms of research evidence. NS enables us to take a comprehensive approach to understanding the wide range of factors which impact upon access to maternity care for immigrant women and identify which interventions provide the best quality of care. This integrated evidence will enable us to make recommendations about the development and organisation of maternity care services and interventions. METHODS The NS approach to systematic review relies mainly on the use of words and text to summarise and explain the findings of the integrated evidence. All review steps will involve two or more reviewers. NS allows us to embrace all disciplines and different ways of conducting research to map out access and interventions in maternity care. The major findings of this synthesis are then used to explain how and why maternity care interventions focused on immigrant women have been applied and how these interventions address access and inequalities experienced by immigrant women. NS comprises four elements: a) Development of a theory of how the intervention works, why it works, and for whom b) Development of a preliminary integration of the findings of the included studies c) Exploration of the relationships in the data d) Assessment of the quality of the synthesis. These elements are not separate and the integration takes a circular approach. In each element, a variety of tools and techniques may be used depending on the nature of the research evidence. Audience specific recommendations will be made. A librarian designed the database search strategies (1990 to present, which was reviewed by the entire research team. We will employ a three-stage process: 1) Screening; 2) Preliminary categorization 3) Retrieval, final selection and categorization. Firstly, two independent reviewers will screen all citations retrieved by applying a screening tool. The search for grey literature includes select database searches, internet-based searches, review of reference lists, and email/phone contact with researchers and stakeholders with subject expertise. Grey literature that is research that does not appear in published scientific journals will be screened for relevance and categorised using an established system [2]. DATA EXTRACTION AND QUALITY APPRAISAL To ensure the scientific quality of the NS and the scientific quality of the literature selected and the analytical methods used will be reviewed using the Center for Evidence Based Management tools and review confidence with CERQUAL. SYNTHESIS We will explore relationships within and between studies using a range of tools. OUTPUTS An E-workshop for policy makers, collaborative practitioner workshops,scientific papers and conference presentations. PATIENT AND PUBLIC INVOLVEMENT (PPI) active input is assured as PPI are members of our project advisory group (PAG) including clinicians and a NHS commissioner.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH