Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context

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Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context

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dc.contributor.author Binder, Pauline
dc.contributor.author Johnsdotter, Sara
dc.contributor.author Essén, Birgitta
dc.date.accessioned 2012-10-18T10:36:01Z
dc.date.available 2012-10-18T10:36:01Z
dc.date.issued 2012 en_US
dc.identifier.citation 2028-2036 en_US
dc.identifier.issn 0277-9536 en_US
dc.identifier.uri http://hdl.handle.net/2043/14235
dc.description.abstract Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems. 'Non-reciprocating care conceptualisations', 'limited system-level care guidelines', and 'low staff levels' can additionally delay timely care in Phase 3. en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.subject socio-cultural factors en_US
dc.subject maternal care encounter en_US
dc.subject immigrant women en_US
dc.subject health communication en_US
dc.subject obstetric intervention en_US
dc.subject ethnicity en_US
dc.subject migrant-friendly hospitals en_US
dc.subject maternity guidelines en_US
dc.subject.classification Humanities/Social Sciences en_US
dc.title Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context en_US
dc.type Article, peer reviewed scientific en_US
dc.contributor.department Malmö University. Faculty of Health and Society en
dc.identifier.doi http://dx.doi.org/10.1016/j.socscimed.2012.08.010 en_US
dc.subject.srsc Research Subject Categories::MEDICINE en_US
dc.relation.ispartofpublication Social Science and Medicine;11
dc.relation.ispartofpublicationvolume 75 en_US
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