Knowledge About How to Manage Warning Signs of Pregnancy Complications Among Immigrants and Their Descendants Compared to Women of Danish Origin

The Danish implementation study on response to pregnancy complications, MAMAACT

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1070 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Villadsen ◽

H Johnsen ◽

T D Rasmussen ◽

J Sørensen ◽

U Christensen ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Complications ◽

Smart Phone ◽

Target Group ◽

Warning Signs ◽

Perinatal Health ◽

Vulnerable Groups ◽

Contributing Factors ◽

Increased Risk ◽

Ward Level

Abstract Differential incidence and severity of pregnancy complications are likely important contributing factors to the increased risk of poor pregnancy outcomes among ethnic minority women in Europe. To address this issue, the MAMAACT trial has been developed based on a thorough mixed methods needs assessment and co-creation process, feasibility tested, now implemented in a nationwide complex intervention. The overall aim of the Danish MAMAACT trial is to reduce ethnic and social disparity in stillbirth and newborns' health by improved management of pregnancy complications. The overall target group is all pregnant women, and the specific target group is women of non-Western origin. The hypothesis of MAMAACT is that improved communication between pregnant women and midwives regarding body symptoms that need prompt reaction will improve perinatal health among these vulnerable groups. The intervention consists of postgraduate training of midwives in intercultural communication and a smart phone application and a leaflet, both in six different languages. The app and leaflet target the women and explain the most serious warning signs of pregnancy complications and how to respond to them. MAMAACT is implemented and evaluated in a randomized controlled cluster trial and 10 maternity wards consist the intervention groups, while nine maternity wards are the control groups. The evaluation is a mixed method evaluation focusing on understanding the mechanisms of change, how context at both maternity ward level as well as in the everyday life of women affects the implementation, and finally if effects on health literacy of the women and perinatal health of the children can be documented.

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Contextual Factors Influencing the MAMAACT Intervention: A Qualitative Study of Non-Western Immigrant Women’s Response to Potential Pregnancy Complications in Everyday Life

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17031040 ◽

2020 ◽

Vol 17 (3) ◽

pp. 1040

Author(s):

Helle Johnsen ◽

Ulla Christensen ◽

Mette Juhl ◽

Sarah Fredsted Villadsen

Keyword(s):

Everyday Life ◽

Maternity Care ◽

Pregnancy Complications ◽

Immigrant Women ◽

Warning Signs ◽

Delayed Response ◽

Full Potential ◽

Care Providers ◽

Sources Of Knowledge ◽

Increased Risk

In western countries, immigrant women have an increased risk of negative birth outcomes. Immigrant women’s and maternity care system’s delayed response to pregnancy complications contribute to ethnic inequities in reproductive health. The MAMAACT intervention was developed to improve midwives’ and women’s response to pregnancy complications in Denmark. The study examines the context of the implementation of the MAMAACT intervention and investigates how the intended intervention mechanisms regarding response to pregnancy complications were affected by barriers in non-Western immigrant women’s everyday life situations. Twenty-one interviews with non-Western immigrant women were undertaken. Systematic text condensation and the situational-adaptation framework by Alonzo were used to analyze data. Four main categories were identified: ‘Sources of knowledge during pregnancy’, ‘Containment of pregnancy warning signs’, ‘Barriers during the onset of acute illness’ and ‘Previous situations with maternity care providers’. Attention to potential pregnancy complications may conflict with immigrant women’s everyday life situations and result in the containment of symptoms as well as causing delays in seeking medical assistance. It is probable that barriers in women’s everyday life will impact the intended intervention mechanisms and thus the full potential of the intervention may not be reached.

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Implementation, Mechanisms and Context of the MAMAACT Intervention to Reduce Ethnic and Social Disparity in Stillbirth and Infant Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168583 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8583

Author(s):

Trine Damsted Rasmussen ◽

Helle Johnsen ◽

Signe Smith Jervelund ◽

Ulla Christensen ◽

Anne-Marie Nybo Andersen ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Complications ◽

Infant Health ◽

Training Session ◽

Organizational Factors ◽

Warning Signs ◽

Interaction Patterns ◽

Cross Sectional Survey ◽

Social Disparity ◽

Contextual Barriers

The MAMAACT intervention aimed to address ethnic and social disparity in stillbirth and infant health by improving management of pregnancy complications. This process evaluation of the intervention was guided by the British Medical Research Council’s framework. We examined implementation through dose, reach, and fidelity, important mechanisms and the influence of contextual factors. The intervention included a six-hour training session for antenatal care (ANC) midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials (leaflet and app) on warning signs of severe pregnancy complications and how to respond for pregnant women. A mixed-methods approach was applied. Cross-sectional survey data and administrative data were used to assess intervention reach and dose. Qualitative data (records from dialogue meetings with midwives, participant observations and field notes from ANC visits, focus group interviews with midwives, and individual interviews with non-Western immigrant women) evaluated intervention fidelity, mechanisms, and contextual barriers. More than 80% of women received the MAMAACT leaflet and many found the content useful. The app was used more selectively. Midwives described being more aware and reflective in their communication with women from various cultural backgrounds. Organizational factors in ANC (time pressure, lack of flexibility in visits, poor interpreter services), barriers in women’s everyday life (lack of social network, previous negative experiences/lack of trust and domestic responsibilities), and habitual interaction patterns among midwives served as contextual barriers. The reach of the intervention was high and it was evaluated positively by both pregnant women and midwives. Organizational factors hindered changes towards more needs-based communication in ANC potentially hindering the intended mechanisms of the intervention. When interpreting the intervention effects, attention should be drawn to both organizational and interpersonal factors in the clinic as well as the pregnant women’s life situations.

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