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Commentary on: Shorey S, Debby E, Downe S. Cultural competence and experiences of maternity health care providers on care for migrant women: A qualitative meta-synthesis. Birth 2021; 1–12. doi: 10.1111/birt.12581
Implications for practice and research
Ensuring optimal maternity care for im/migrant and visible minority women requires proper training for care providers.
More research is needed towards implementation of relevant integrated policies, resources, and training towards culturally relevant care models.
Cultural competency among healthcare practitioners is critical to ensure congruent healthcare for women from diverse cultural and ethnic backgrounds.1 Existing cultural competency research focuses mainly on the views and experiences of local and indigenous people from an insider’s perspective.2 Although patients’ perspectives are vital, healthcare practitioners’ perspectives and experiences are also required to address critical challenges associated with developing culturally inclusive, high-quality healthcare for various minority groups.
Shorey et al, in this study,3 systematically reviewed maternal healthcare providers’ perspectives on migrant women’s care to better understand healthcare practitioners’ cultural competency perspectives to improve healthcare for migrant women.
The authors conducted a systematic review of qualitative studies on maternity healthcare providers’ experiences with migrant women in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The authors formulated research question, conducted search of academic databases, employed two-step screening process to select eligible papers using two-reviewers and assessed quality of the finally selected mixed-methods and qualitative papers. A single ‘best-fit’ framework synthesis approach was used for data synthesis, and Campinha-Bacote’s model of cultural competence4 was used to derive a list of themes and framing data. Using line-by-line coding of verbatim and non-verbatim statements, they first generated codes and then categorised the codes into subthemes. The subthemes were then assigned to the specific components of the model of a cultural competency framework to form the main themes.4
After title-abstract screening of 4846 papers and full-text screening of 36 paper, 11 studies were finally included for this review. These included studies were predominantly conducted in European countries and were published between 2021 and 2020. The authors reported the existence of evidence related to cultural awareness, cultural knowledge, cultural experiences and cultural desire. But, very importantly, no evidence could be identified related to cultural skill (the ability to collect relevant cultural data or perform a culturally based physical assessment accurately). Results showed that most maternal healthcare workers fall in the middle of the cultural awareness spectrum. In addition, evidence on cultural knowledge revealed that most healthcare providers acknowledged the varied socioeconomic backgrounds of marginalised women often result in conflicting care related expectations. Furthermore, care providers believe that better tools are required to ensure transcultural cares for migrant women. Healthcare providers also encounter language barriers in sharing information and emotional connection with minority groups. A strong cultural desire was found among the healthcare providers. However, the theme of cultural skill, including collecting data and showing cultural competency in performing physical assessments, was not found.
This study highlighted the importance of cultural competency among healthcare providers for responsiveness of the healthcare system and respect the intersectional needs of maternity care for immigrant/migrant and ethnic minority women. A lot of studies in this field of research generally focus on communication or language barriers, which often appear as immigrant/migrants’ shortcomings.5 Although most healthcare providers intend to minimise gaps in healthcare, but there seem to be lack of focus for competency development among providers in culturally relevant maternity care.3
An important limitation of this study, that need to be acknowledged, is not including grey literature sources in the systematic review process. Given the recent nature of digitalisation of information, excluding this exponentially growing literature source is unbefiting. Studies identified for this review were from high-income developed countries, so the findings lack generalisability to low-income regions such as Asia and Africa. Despite these issues, the lack of empirical evidence on how to best implement culturally relevant maternity care models in practice appears to be a major gap which needs attention from academics, providers, as well as policy-makers.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.