Barrier-free Communication in Maternity Care of Allophone Migrants (BRIDGE)

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

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.

Study Overview

• Status: Completed
• Conditions: Communication; Expectant and Nursing Mother; Experiences
• Intervention / Treatment: Other: Focus Group Discussion in native Language; Other: Focus Group Discussion; Other: One-to-one Interview; Other: Retrospective Quantitative Analysis

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:

1. 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.
2. 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.
3. Perspective of interpreters: Qualitative assessment of experiences of professional Interpreters.

• Study Type: Interventional
• Enrollment (Actual): 82
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Basel, Switzerland
    • University Hospital Basel
  • Basel, Switzerland
    • FamilyStart
  • Bern, Switzerland
    • Swiss Midwifery Association SHV
  • Bern, Switzerland
    • University Hospital Insel Bern
  • Zürich, Switzerland
    • Swiss Service for Telephone Interpreter (Schweizerischer Telefondolmetschdienst )
  • Zurcih
    • Winterthur, Zurcih, Switzerland
      • Zurich Universtiy of Applied Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Migrant Women; Focus Group Discussion in native Language with n=20	Other: Focus Group Discussion in native Language; 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.
Other: Health Care Professionals; Focus Group Discussion with n=20 Health Care Professionals	Other: Focus Group Discussion; Group Interview with semi-structured key question, audio-recorded and ad verbatim transcription
Other: Interpreters; One-to-one Interviews with n=4 intercultural Interpreters	Other: One-to-one Interview; One-to-one Interview with semi-structured key question, audio-recorded and ad verbatim transcription.
Other: Telephone Interpreting Protocols; Retrospective quantitative analysis of n=50 Telephone Interpreting Protocols (questionnairs)	Other: Retrospective Quantitative Analysis; Retrospective Quantitative Analysis of questionnaires (Telephone Interpreting Protocols)

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

Collaborators and Investigators

• Sponsor: Bern University of Applied Sciences
• Collaborators: Swiss Tropical & Public Health Institute; Federal Office of Public Health, Switzerland; Zurich University of Applied Sciences; FamilyStart of both Basel; Swiss Midwifery Association; Swiss Agency for Combating Racism
• Investigators: Principal Investigator: Paola Origlia Ikhilor, MSc, Bern University of Applied Sciences

Publications and helpful links

General Publications

• Merten, S., & Gari, S. (2013). Die reproduktive Gesundheit der Migrationsbevölkerung in der Schweiz und anderen ausgewählten Aufnahmeländern. Eine Zusammenfassung der Literatur 2006-2012. Basel: Swiss Tropical and Public Health Institute.
• Kurth, E. (2013). FamilyStart beider Basel - ein koordinierter Betreuungsservice für Familien nach der Geburt. hebamme.ch(7/8), 35-37.
• Saladin, P. (Ed.). (2009). Diversität und Chancengleichheit. Grundlagen für erfolgreiches Handeln im Mikrokosmos der Gesundheitsinstitutionen (3. ed.). Bern: Bundesamtes für Gesundheit BAG in Zusammenarbeit mit H+ Die Spitäler der Schweiz.
• Hermann, M. (2013). Migrationsgerechte Angebote im Bereich reproduktive Gesundheit und frühe Kindheit in der Schweiz. In E. D. d. I. Schweizerische Eidgenossenschaft (Ed.), Eine Bestandesaufnahme von Projekten, Massnahmen und Arbeitsmethoden: Bundesamt für Gesundheit, Sektion Migration und Gesundheit.
• Bundesamt für Statistik. (2015). Integration - Indikatoren: Sprache - Personen, die 3,2,1 oder keine Landessprache beherrschen. Retrieved 23.03.2015, from Schweizerische Eidgenossenschaft www.bfs.admin.ch/bfs/portal/de/index/themen/
• Origlia Ikhilor P., van Goch S., Kurth E., Cignacco E. Stocker Kalberer B., Pehlke-Milde J. 2015 Lancierte Studie soll Kommunikation mit allophonen Migrantinnen erleichtern Hebamme.ch 10:4-8
• Origlia Ikhilor P, Hasenberg G, Kurth E, Stocker Kalberer B, Cignacco E, Pehlke-Milde J. Barrier-free communication in maternity care of allophone migrants: BRIDGE study protocol. J Adv Nurs. 2018 Feb;74(2):472-481. doi: 10.1111/jan.13441. Epub 2017 Oct 5.

Helpful Links

• Project database of the Midwifery Faculty of the Bern University of Applied Sciences (German)

Study record dates

Study Major Dates

• Study Start: September 1, 2015
• Primary Completion (Actual): June 1, 2016
• Study Completion (Actual): December 1, 2016

Study Registration Dates

• First Submitted: February 9, 2016
• First Submitted That Met QC Criteria: February 29, 2016
• First Posted (Estimate): March 1, 2016

Study Record Updates

• Last Update Posted (Estimate): February 1, 2017
• Last Update Submitted That Met QC Criteria: January 31, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Keywords: Switzerland; Professional-Patient Relations; Communication Barriers; Maternal Health Services; Migrants; Health Services Needs and Demand; Access to Health Care; Eritrea; Kosovo
• Other Study ID Numbers: BernUAS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No