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      Migrant women’s experiences of pregnancy, childbirth and maternity care in European countries: A systematic review

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          Abstract

          Background

          Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities.

          Objective

          To provide up-to-date systematic evidence on migrant women’s experiences of pregnancy, childbirth and maternity care in their destination European country.

          Search strategy

          CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017.

          Selection criteria

          Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe.

          Data collection and analysis

          Qualitative data were extracted and analysed using thematic synthesis.

          Results

          The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: ‘Finding the way—the experience of navigating the system in a new place’, ‘We don't understand each other’, ‘The way you treat me matters’, and ‘My needs go beyond being pregnant’.

          Conclusions

          Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs.

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          Most cited references93

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          Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series

          The GRADE-CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’) approach provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. Confidence in the evidence from qualitative evidence syntheses is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. CERQual provides a systematic and transparent framework for assessing confidence in individual review findings, based on consideration of four components: (1) methodological limitations, (2) coherence, (3) adequacy of data, and (4) relevance. A fifth component, dissemination (or publication) bias, may also be important and is being explored. As with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach for effectiveness evidence, CERQual suggests summarising evidence in succinct, transparent, and informative Summary of Qualitative Findings tables. These tables are designed to communicate the review findings and the CERQual assessment of confidence in each finding. This article is the first of a seven-part series providing guidance on how to apply the CERQual approach. In this paper, we describe the rationale and conceptual basis for CERQual, the aims of the approach, how the approach was developed, and its main components. We also outline the purpose and structure of this series and discuss the growing role for qualitative evidence in decision-making. Papers 3, 4, 5, 6, and 7 in this series discuss each CERQual component, including the rationale for including the component in the approach, how the component is conceptualised, and how it should be assessed. Paper 2 discusses how to make an overall assessment of confidence in a review finding and how to create a Summary of Qualitative Findings table. The series is intended primarily for those undertaking qualitative evidence syntheses or using their findings in decision-making processes but is also relevant to guideline development agencies, primary qualitative researchers, and implementation scientists and practitioners. Electronic supplementary material The online version of this article (10.1186/s13012-017-0688-3) contains supplementary material, which is available to authorized users.
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            Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues.

            Psychological science on pregnancy is advancing rapidly. A major focus concerns stress processes in pregnancy and effects on preterm birth and low birth weight. The current evidence points to pregnancy anxiety as a key risk factor in the etiology of preterm birth, and chronic stress and depression in the etiology of low birth weight. Key mediating processes to which these effects are attributed, that is neuroendocrine, inflammatory, and behavioral mechanisms, are examined briefly and research on coping with stress in pregnancy is examined. Evidence regarding social support and birth weight is also reviewed with attention to research gaps regarding mechanisms, partner relationships, and cultural influences. The neurodevelopmental consequences of prenatal stress are highlighted, and resilience resources among pregnant women are conceptualized. Finally, a multilevel theoretical approach for the study of pregnancy anxiety and preterm birth is presented to stimulate future research.
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              Language proficiency and adverse events in US hospitals: a pilot study.

              To examine differences in the characteristics of adverse events between English speaking patients and patients with limited English proficiency in US hospitals. Six Joint Commission accredited hospitals in the USA. Adverse event data on English speaking patients and patients with limited English proficiency were collected from six hospitals over 7 months in 2005 and classified using the National Quality Forum endorsed Patient Safety Event Taxonomy. About 49.1% of limited English proficient patient adverse events involved some physical harm whereas only 29.5% of adverse events for patients who speak English resulted in physical harm. Of those adverse events resulting in physical harm, 46.8% of the limited English proficient patient adverse events had a level of harm ranging from moderate temporary harm to death, compared with 24.4% of English speaking patient adverse events. The adverse events that occurred to limited English proficient patients were also more likely to be the result of communication errors (52.4%) than adverse events for English speaking patients (35.9%). Language barriers appear to increase the risks to patient safety. It is important for patients with language barriers to have ready access to competent language services. Providers need to collect reliable language data at the patient point of entry and document the language services provided during the patient-provider encounter.
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                Author and article information

                Contributors
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisition
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                11 February 2020
                2020
                : 15
                : 2
                : e0228378
                Affiliations
                [1 ] Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
                [2 ] Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
                [3 ] Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
                [4 ] Pharos, Centre of Expertise on Health Disparities, Utrecht, Netherlands
                Ben-Gurion University of the Negev Faculty of Health Sciences, ISRAEL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ¶ Membership of the ORAMMA team is provided in the Acknowledgments.

                Author information
                http://orcid.org/0000-0001-7613-3393
                http://orcid.org/0000-0002-5479-8527
                http://orcid.org/0000-0001-9611-6777
                Article
                PONE-D-19-13980
                10.1371/journal.pone.0228378
                7012401
                32045416
                739b97e8-6888-4b3b-8498-245db5a9ef46
                © 2020 Fair et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 May 2019
                : 14 January 2020
                Page count
                Figures: 1, Tables: 3, Pages: 26
                Funding
                Funded by: European Commission: Consumers, Health, Agriculture and Food Executive Agency
                Award ID: 738148
                Award Recipient :
                Funded by: European Commission: Consumers, Health, Agriculture and Food Executive Agency
                Award ID: 738148
                Award Recipient :
                MM,HS & VV - grant received from the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) of the European Commission Grant Number 738148. http://ec.europa.eu/chafea/index_en.htm The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Research and Analysis Methods
                Research Design
                Qualitative Studies
                People and Places
                Geographical Locations
                Europe
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Social Sciences
                Sociology
                Culture
                Research and Analysis Methods
                Database and Informatics Methods
                Database Searching
                People and Places
                Population Groupings
                Ethnicities
                African People
                Somalian People
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Language
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Language
                Social Sciences
                Psychology
                Cognitive Psychology
                Language
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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