Barrier-free Communication in Maternity Care of Allophone Migrants

Study Overview
=================
Brief Summary
-----------------
The aim of this study is to describe access and communication barriers of migrant women who do not speak the local language in the Swiss maternity care service provision from the perspective of users, health care professionals and interpreters.

Detailed Description
-----------------
In Switzerland pregnant migrant women and their families are burdened in multiple ways: pregnancy requires an adjustment process and women have to deal with foreign living conditions, limited communication or the uncertainty of their residence status. An increased maternal and child health morbidity and mortality in migrants is well documented. A poor health outcome seems also to be correlated with a limited access to obstetric and maternity care services for migrants. Nearly 10% of foreigners living in Switzerland for more than one year do not speak any of the official languages. In women native of non-EU27 and -EFTA countries and asylum seekers, these rate is considerably higher. To improve maternity care services for migrants in Switzerland several measures have been taken in the past, e.g. Hospitals for Equity, promotion of transcultural skills, written multilingual health information and interpreter services in hospitals. The availability of comparable measures in outpatient or home care services is rather an exception. One example is the midwives network FamilyStart, an outpatient institution that offers a helpline and home visiting services for mothers and thier newborns. It collaborates with the National Telephone Interpreter Service. It is currently unclear how successfully midwives and other health care professionals communicate with allophone migrants, if they use and benefit from any of the currently available support measures and thus may improve the access of migrant women to maternity care in Switzerland. The study aims to describe the access and communication barriers of allophone women with different migration backgrounds in maternity and obstetric health services from the perspective of users, health care professionals and Interpreters to make prioritized recommendations on behalf of the Swiss Midwives Association and other professional associations for improving the quality and access of maternity care Services; the transcultural understanding between professionals and users; and the coordination between the different involved services. It is an exploratory study in three parts: User perspective: Qualitative assessment of the women's experiences. The participants have different migration backgrounds: representatives of the resident foreign population of Switzerland (from Kosovo or Albania with native language Albanian) and asylum seekers (from Eritrea with native language Tigrinya) will be interviewed. Perspective of professionals: Qualitative assessment of the health care professionals experiences and quantitative analysis of protocols of counseling sessions from midwives who have used the telephone interpreting service during a home visit on behalf of FamilyStart. Perspective of interpreters: Qualitative assessment of experiences of professional Interpreters.

Official Title
-----------------
Barrier-free Communication in Maternity Care of Allophone Migrants (Barrierefreie Kommunikation in Der Geburtshilflichen Versorgung Allophoner Migrantinnen)

Conditions
-----------------
Expectant and Nursing Mother, Communication, Experiences

Intervention / Treatment
-----------------
* Other: Focus Group Discussion in native Language
* Other: Focus Group Discussion
* Other: One-to-one Interview
* Other: Retrospective Quantitative Analysis


Participation Criteria
=================
Eligibility Criteria
-----------------
Group 1: Inclusion criteria: healthy women speaking Albanian or Tigrinja mothers of a healthy infant up to one year after birth Exclusion criteria: women speaking fluent German women with a serious illness during pregnancy, childbirth and/or postpartum or who's infant was seriously ill or died Group 2: Inclusion criteria: Minimum one year working experience Experience with allophone Tigrinya or Albanian speaking women Group 3: Inclusion criteria: Female Minimum one year working experience having either telephone or face-to-face interpreting Expertise Group 4: No limitation

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Migrant Women<br>Focus Group Discussion in native Language with n=20 | Other: Focus Group Discussion in native Language<br>* Group Interview with semi-structured key question, moderated in the native language of the participants. Interpreters translate the discussion for the Researcher analogically and adapt it culturally. The discussions are audio-recorded, summarized, translated and transcribed into German.<br>|
| Other: Health Care Professionals<br>Focus Group Discussion with n=20 Health Care Professionals | Other: Focus Group Discussion<br>* Group Interview with semi-structured key question, audio-recorded and ad verbatim transcription<br>|
| Other: Interpreters<br>One-to-one Interviews with n=4 intercultural Interpreters | Other: One-to-one Interview<br>* One-to-one Interview with semi-structured key question, audio-recorded and ad verbatim transcription.<br>|
| Other: Telephone Interpreting Protocols<br>Retrospective quantitative analysis of n=50 Telephone Interpreting Protocols (questionnairs) | Other: Retrospective Quantitative Analysis<br>* Retrospective Quantitative Analysis of questionnaires (Telephone Interpreting Protocols)<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Experiences of migrant women by focus group discussions | Qualitative description of experiences made with maternity care services during pregnancy, birth, post partum up to one year after birth | after 6 weeks, up to 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Experiences of health care professionals by focus group discussions | Qualitative description of working experiences in maternity care with allohone migrants | within last five years of their professional experience | 
| Experiences of Interpreters by one-to-one interview | Qualitative description of working experiences when interpreting for pregnant women or mothers in maternity care services | within last five years of their professional experience | 
| Quality of telephone interpreting consultations with questionnairs | Descriptive analysis of protocols of telephone interpreted consultations with information on aim, content, perceived benefits and difficulties | within 24 hours after the consultation | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Migrants, Communication Barriers, Maternal Health Services, Health Services Needs and Demand, Access to Health Care, Professional-Patient Relations, Eritrea, Kosovo, Switzerland