Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project

Abstract

ObjectivesComparing language-supported group antenatal care (gANC) and standard antenatal care (sANC) for Somali-born women in Sweden, measuring overall ratings of care and emotional well-being, and testing the feasibility of the outcome measures.DesignA quasi-experimental trial with one intervention and one historical control group, nested in an intervention development and feasibility study.SettingMidwifery-led antenatal care clinic in a mid-sized Swedish town.ParticipantsPregnant Somali-born women (<25 gestational weeks); 64 women in gANC and 81 in sANC.InterventionLanguage-supported gANC (2017–2019). Participants were offered seven 60-minute group sessions with other Somali-born women led by one to two midwives, in addition to 15–30 min individual appointments with their designated midwife.OutcomesPrimary outcomes were women’s overall ratings of antenatal care and emotional well-being (Edinburgh Postnatal Depression Scale (EPDS)) in gestational week ≥35 and 2 months post partum. Secondary outcomes were specific care experiences, information received, social support, knowledge of pregnancy danger signs and obstetric outcomes.ResultsRecruitment and retention of participants were challenging. Of eligible women, 39.3% (n=106) declined to participate. No relevant differences regarding overall ratings of antenatal care between the groups were detected (late pregnancy OR 1.42, 95% CI 0.50 to 4.16 and 6–8 weeks post partum OR 2.71, 95% CI 0.88 to 9.41). The reduction in mean EPDS score was greater in the intervention group when adjusting for differences at baseline (mean difference −1.89; 95% CI –3.73 to −0.07). Women in gANC were happier with received pregnancy and birth information, for example, caesarean section where 94.9% (n=37) believed the information was sufficient compared with 17.5% (n=7) in standard care (p<0.001) in late pregnancy.ConclusionsThis evaluation suggests potential for language-supported gANC to improve knowledge acquisition among pregnant Somali-born women with residence in Sweden ˂10 years. An adequately powered randomised trial is needed to evaluate the effectiveness of the intervention.Trial registration numberClinicalTrials.gov Registry (NCT03879200).

Unlocking the mechanisms of change in the MAMAACT intervention to reduce ethnic disparity in stillbirth and newborns' health: integration of evaluation findings

“…A Swedish project concluded that group antenatal care for women of Somali origin led to more comprehensive care as the voice and narratives of the women were strengthened and the midwives expanded their understanding of the women and their needs ( 61). An effectiveness evaluation indicated an improved understanding of health information; however, no effect was shown on postpartum depression (17). Further, a Swedish community-based bilingual doulas intervention indicated a potential to lower caesarean section/instrumental delivery, while no significant effect on postpartum depression was shown (18).…”

“…There is a need to learn across the interventions, develop new clinical outcome measures, and have more consistency in the choice of outcomes, which can reflect improved communication and interactional dynamics of importance to maternal and perinatal health and morbidity. The MAMAACT study is the largest of the mentioned trials in the field (17,18,22), involving almost all maternity wards in Denmark, and the only one designed as a cluster-randomised trial. The limitations of the different data sources and specific analytical approaches are in detailed discussed in the original articles.…”

“…Different approaches to address these inequalities and barriers to quality maternity care for women with immigrant backgrounds have been initiated. Evaluations from Sweden and Norway of group antenatal care models and the use of doulas have shown a potential to improve the quality of the communication and interaction with maternity care providers, however, the evidence of positive effects on clinical practice and health outcomes is vague, possibly due to methodological limitations (17,18). Another approach has been the training of healthcare professionals in cultural competence (10,19,20), i.e., the obligation for healthcare providers to accept and respect diversity, consistently engage in introspection regarding the dynamics of such differences and adapt their services to cater to the needs of diverse populations (10).…”

Trauma-Informed Care and Equity in Group Pregnancy Care for Women of Refugee Background: Reflections from the Workforce

“…The formative evaluation report is also available via the study website [30]. GPC for women of refugee background is the first model of its kind in Australia and one of the first worldwide [31]. In the context of the unique nature of this model and the small staff teams at each site, and to prevent participant identities from being deduced by local readers of this paper, we use the language 'professional staff' to refer to the range of clinical and social care staff, stakeholders, and leaders involved in the implementation, facilitation, or oversight of GPC for women of refugee background.…”