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Table 2 Linking implementation factors with the systematic review outcomes

From: Interventions to provide culturally-appropriate maternity care services: factors affecting implementation

Studies from systematic review that report overall improvement in care-seeking outcomes Findings from synthesis of factors influencing implementation
Study Setting Important stakeholder perspectives critical to success Implementation factors critical to successful outcomes
Bilenko et al., 2007 [14] ISRAEL, Negev Desert Recognition that women are often dependent on family members for transportation and that geographical barriers may further restrict access to medical services; recognition of female illiteracy Establishment of maternal and child health clinics in desert areas serving a Bedouin Arab population living within 3 km, employment of an Arabic-speaking Bedouin public health nurse, the addition of a local Bedouin woman liaison worker
Gabrysch et al., 2009 [5] PERU, Ayacucho rural Santillana district Recognition of the importance of respecting traditional practices and including family in the birth process; acknowledgement of factors like low education levels, extreme poverty, previous conflict, and widespread female illiteracy; acknowledgement of limited transport options; recognition of inadequate communication between women and providers, either because the providers speak Spanish which is not understood by many or because provider rotation does not allow time to build trust; recognition that health professionals had treated women in unfriendly, brusque, and sometimes discriminatory ways Hygiene procedures performed by the woman herself or family after explanations, provision of maternity waiting homes, inclusion of family, use of health providers who speak the Quechua language and are friendly and respectful of local culture, permitting women to wear their own clothes, changes to the delivery room setting (e.g. providing rope and bench to allow vertical crouching position, providing normal beds instead of gynaecological bed), integrating traditional Andean elements into the modern medical model (e.g. offering rollete if desired, placenta handed to family for burial), use of a participatory approach to ensure that services meet the local population’s needs
Jan et al., 2004 [15] AUSTRALIA, western Sydney Recognition that women will not return for services if they feel the male doctor is superior; recognition of inadequate communication between women and providers; recognition of the disempowering nature of hospital care for Aboriginal women and the inaccessibility of hospital clinics; acknowledgement that utilisation of services are influenced by factors like poor education, low income, high unemployment, and racial discrimination Provision of transport service, short waiting times, provision of informal childcare, non-judgemental approach to providing care, cultural awareness sessions with local hospital staff, female general practitioners, Aboriginal health worker, provision of information in a way that suits women’s individual needs, assistance with infant feeding, flexible and proactive approach to seeing the client
Jewell et al., 2000 [16] USA, Indiana Recognition of factors influencing minority women’s poorer utilisation of early ANC than non-minority women (e.g. cultural insensitivity of providers, lack of encouragement to seek care, and the importance of advice from family and friends) Staff helping women to work through the decision-making process on how to resolve barriers to their cultural beliefs and practices, staff providing advocacy for women if barriers occurred in navigating the health and social service systems, involvement of grassroots community-driven coalitions in the provision of culturally relevant care, provision of social support, provision of transport service, referrals to community services, health education, use of minority professional and paraprofessional staff, project monitoring by the minority health coalition boards, staff engaging in cultural brokering
Julnes, 1994 [17] USA, Norfolk, Virginia Acknowledgement that teenagers targeted by the intervention have limited social and financial support and may experience psychological barriers to ANC Use of resource mothers (lay visitors) who often grew up in the same cultural milieu as the teenagers they serve (and were often teenage mothers themselves) and may be in a better position to provide empathy and social support, low cost of the intervention, encouragement of teenagers to seek ANC, provision of practical assistance to the teenagers and their families
Marsiglia et al., 2010 [18] USA, Phoenix, Arizona Acknowledgement of Latino spiritual and cultural beliefs related to health; recognition of the importance and influence of social support from family and friends; acknowledgement of cultural and linguistic influences that can become barriers between women and providers Bilingual and bicultural Prenatal Partners who served as cultural brokers, active client outreach, improved communication between women and providers, patient-driven communication, encouragement of women to be active in their health decisions, education on prenatal care, development of a plan for ANC and postpartum visits
McQuestion and Velazquez, 2006 [20] PERU, communities in high-risk distritos in 12 of 25 departmentos Acknowledgement that utilisation of services is influenced by factors like poverty, social exclusion, and residing in a remote area; acknowledgement that facilities lack female caregivers; recognition of inadequate communication between women and providers, partly because the providers speak Spanish which is not understood by many; acknowledgement that reports of discrimination and mistreatment by health workers are commonplace Extension of the Maternal and Child Health Insurance Program to cover most maternal and child health costs, including institutional delivery; emphasis on making services ‘woman-friendly’ (i.e. incorporation of local cultural beliefs and social norms into services, providing accessible and convenient facilities, offering high-quality services, guaranteeing confidentiality, respecting clients’ choices); use of mass media, health education and social mobilisation efforts promoting delivery in the nearest public emergency obstetric care facility
Nel et al., 2003 [21] AUSTRALIA, remote northern and western Queensland Recognition of the importance of extended family, acknowledgement that notes and test results must be shared between the medical centre and hospital facility, acknowledgement of women’s desire for continuity of care Provision of transport service, ANC outreach visits, consultations with local Indigenous representatives to identify shortcomings and problems with ANC from an Indigenous perspective, inclusion of family at ANC consultations, use of Indigenous staff, patient tracking, seeing patients in a familiar setting, implementation of a shared care policy for doctors in the region
NSW Health, 2005 [22] AUSTRALIA, New South Wales Recognition that transport services are essential for access to health services and that in some places, access to ANC and midwifery services is non-existent; acknowledgement that some women are unable to afford fees for health care; acknowledgement that women value continuity of care and carer; recognition that some women chose not to utilise services due to the bureaucratic nature of mainstream public services (e.g. inflexible appointments, long wait times) Statewide Training and Support Program for midwives and Aboriginal health workers, employment of an Aboriginal
health worker or Aboriginal Health Education Officer, use of community development programs, taking a primary health care approach as opposed to a welfare model of care, basing services in the community where women could access care close to home in a familiar setting
Panaretto et al., 2005 [23] AUSTRALIA, Townsville, north Queensland Acknowledgement that the Australian Indigenous community had little evidence to guide ANC planning Provision of transport service, family involvement, health care providers taking an integrated team approach, interventions for risk factors (e.g. smoking cessation, breastfeeding, testing for sexually transmitted infections, nutrition)
Panaretto et al., 2007 [24] AUSTRALIA, Townsville, north Queensland Health service providers and the Indigenous community working closely together to improve ANC Provision of community-based and community-focused ANC, commitment to quality in service delivery, development of a sustainable health infrastructure, collaboration between health service providers and the Indigenous community to develop an integrated model of shared ANC