Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South Wales
Abstract Background Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools de...
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| Format: | Article |
| Language: | English |
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Wiley
2022-10-01
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| Series: | Health Expectations |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/hex.13333 |
| _version_ | 1797989675620630528 |
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| author | Laura Goodwin Aled Jones Billie Hunter |
| author_facet | Laura Goodwin Aled Jones Billie Hunter |
| author_sort | Laura Goodwin |
| collection | DOAJ |
| description | Abstract Background Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees. |
| first_indexed | 2024-04-11T08:24:13Z |
| format | Article |
| id | doaj.art-127fae61dd9e44b7a9be4b915f244320 |
| institution | Directory Open Access Journal |
| issn | 1369-6513 1369-7625 |
| language | English |
| last_indexed | 2024-04-11T08:24:13Z |
| publishDate | 2022-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Health Expectations |
| spelling | doaj.art-127fae61dd9e44b7a9be4b915f2443202022-12-22T04:34:49ZengWileyHealth Expectations1369-65131369-76252022-10-012552124213310.1111/hex.13333Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South WalesLaura Goodwin0Aled Jones1Billie Hunter2Faculty of Health and Applied Sciences University of the West of England Bristol UKSchool of Healthcare Sciences Cardiff University Cardiff UKSchool of Healthcare Sciences Cardiff University Cardiff UKAbstract Background Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees.https://doi.org/10.1111/hex.13333conceptual modelculturally safe careethnic inequalityhealthcare relationship |
| spellingShingle | Laura Goodwin Aled Jones Billie Hunter Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South Wales Health Expectations conceptual model culturally safe care ethnic inequality healthcare relationship |
| title | Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South Wales |
| title_full | Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South Wales |
| title_fullStr | Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South Wales |
| title_full_unstemmed | Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South Wales |
| title_short | Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South Wales |
| title_sort | addressing social inequity through improving relational care a social ecological model based on the experiences of migrant women and midwives in south wales |
| topic | conceptual model culturally safe care ethnic inequality healthcare relationship |
| url | https://doi.org/10.1111/hex.13333 |
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