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Ahrne, M., Schytt, E., Andersson, E., Small, R., Adan, A., Essén, B. & Byrskog, U. (2019). Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives. Midwifery, 74, 107-115
Open this publication in new window or tab >>Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 107-115Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives´ experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.

DESIGN: Eight focus group discussions with 2-8 participants in each were conducted, three with Somali-born mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling´s tool "Thematic networks".

SETTING: Two towns in mid-Sweden and a suburb of the capital city of Sweden.

PARTICIPANTS: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.

FINDINGS: Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.

KEY CONCLUSIONS: ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed.

Keywords
Antenatal care, Father, Focus group discussions, Group antenatal care, Midwife, Mother, migrant
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29864 (URN)10.1016/j.midw.2019.03.022 (DOI)000465986700014 ()30953966 (PubMedID)2-s2.0-85063733482 (Scopus ID)
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-05-23Bibliographically approved
Klingberg-Allvin, M., Hatakka, M., Erlandsson, K., Osman, F., Byrskog, U. & Egal, J. (2019). "Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region. Midwifery, 69, 135-142
Open this publication in new window or tab >>"Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 135-142Article in journal (Refereed) Published
Abstract [en]

The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.

Design

In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.

Setting and participants

Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.

Findings

Findings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.

Conclusion

The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.

Keywords
Net-based education, Quality midwifery education, Midwifery care, Somaliland, Capability approach, Choice framework
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29004 (URN)10.1016/j.midw.2018.11.007 (DOI)000454129800018 ()30503998 (PubMedID)2-s2.0-85057779256 (Scopus ID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-01-10Bibliographically approved
Erlandsson, K., Byrskog, U., Osman, F., Pedersen, C., Hatakka, M. & Klingberg-Allvin, M. (2019). Evaluating a model for the capacity building of midwifery eduators in Bangladesh through a blended, web-based master's programme. Global Health Action, 12(1), Article ID 1652022.
Open this publication in new window or tab >>Evaluating a model for the capacity building of midwifery eduators in Bangladesh through a blended, web-based master's programme
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2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1652022Article in journal (Refereed) Published
Abstract [en]

Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master's programme in SRHR and the extent to which these were realized after 12 months of part-time study. Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses. Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students' learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master's programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students' learning and how to foster reflective and critical thinking among them. Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.

Keywords
Bangladesh, Midwifery education, South Asia, capacity building, web-based education
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30616 (URN)10.1080/16549716.2019.1652022 (DOI)31411128 (PubMedID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-16Bibliographically approved
Byrskog, U., Members of the Midwifery Faculty Master’s degree holders in Sexual and Reproductive Health and Rights, B., Bogren, M. & Erlandsson, K. (2019). Midwives realities in Bangladesh: A focus group enquiry with midwifery students and educators. In: : . Paper presented at The 21st Congress of the Nordic Federation of Midwives, 2-4 May 2019, Reykjavik, Iceland.
Open this publication in new window or tab >>Midwives realities in Bangladesh: A focus group enquiry with midwifery students and educators
2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30430 (URN)
Conference
The 21st Congress of the Nordic Federation of Midwives, 2-4 May 2019, Reykjavik, Iceland
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Byrskog, U., Ahrne, M., Small, R., Andersson, E., Essén, B., Adan, A., . . . Schytt, E. (2019). Rationale, development and feasibility of group antenatal care for immigrant women in Sweden. In: : . Paper presented at The 21st Congress of the Nordic Federation of Midwives, 2-4 May 2019, Reykjavik, Iceland.
Open this publication in new window or tab >>Rationale, development and feasibility of group antenatal care for immigrant women in Sweden
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30428 (URN)
Conference
The 21st Congress of the Nordic Federation of Midwives, 2-4 May 2019, Reykjavik, Iceland
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Byrskog, U., Ahrne, M., Small, R., Andersson, E., Essen, B., Adan, A., . . . Schytt, E. (2019). Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project. BMJ Open, 9(7), Article ID e030314.
Open this publication in new window or tab >>Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e030314Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes.

OVERALL AIM: To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study.

METHODS AND ANALYSIS: An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group.

ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.

Keywords
feasibility study, group antenatal care, immigrants, midwives, process evaluation, somali-born women
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30596 (URN)10.1136/bmjopen-2019-030314 (DOI)31371301 (PubMedID)
Note

Open Access APC beslut 11/2019

Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-08-12Bibliographically approved
Byrskog, U., Akther, H. A., Khatoon, Z., Bogren, M. & Erlandsson, K. (2019). Social, economic and professional barriers influencing midwives’ realities in Bangladesh: a qualitative study of midwifery educators preparing midwifery students for clinical reality. Evidence Based Midwifery., 17(1), 19-26
Open this publication in new window or tab >>Social, economic and professional barriers influencing midwives’ realities in Bangladesh: a qualitative study of midwifery educators preparing midwifery students for clinical reality
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2019 (English)In: Evidence Based Midwifery., ISSN 1479-4489, Vol. 17, no 1, p. 19-26Article in journal (Refereed) Published
Abstract [en]

Introduction

Identifying existing barriers inhibiting the provision of quality care in Bangladesh can guide both the government, in fulfilling its commitment to establishing the midwifery profession, and midwifery educators, in preparing midwifery students for the reality of midwifery clinical work.

Aim

The aim of this study was to describe midwifery educators’ perceptions of midwives’ realities in Bangladesh, focusing on social, economic, and professional barriers preventing them from carrying out quality care.

Methods

Data were collected through focus group discussions with 17 midwifery educators and analysed using qualitative content analysis, guided by the analytical framework “What prevents quality midwifery care?”. Ethical clearance was obtained from Bangladesh’s Directorate General of Nursing and Midwifery.

Results

The results generated by the application of the framework included social barriers of gender structures in Bangladeshi society. This influenced entry into midwifery education, carrying out midwifery work safely, and the development of the profession. Economic barriers included challenges for Bangladesh as a low-income country with a large population, inadequate salaries, and staff shortages, adding extra strain to midwives’ working conditions. These social and economic barriers were further enhanced by professional barriers due to the midwifery profession not yet being fully established or acknowledged in the health system.

Conclusions and implications

The study presents novel country-specific perspectives but confirms the general underlying issues of gender inequality as a base for barriers preventing midwives from carrying out quality care, in line with the framework “What prevents quality midwifery care?”. Addressing these structures can facilitate more students to enter midwifery education, enable quality midwifery work free from discrimination, and provide sufficient working space and professional integrity. Leadership training is pivotal to increasing responsiveness to the needs of the new cadre of midwives. Midwifery educators should take the lead in sensitising clinical supervisors, mentors, and preceptors about midwives’ realities in Bangladesh.

National Category
Health Sciences
Identifiers
urn:nbn:se:du-30424 (URN)
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Ahrne, M., Adan, A., Schytt, E., Andersson, E., Small, R., Flacking, R. & Byrskog, U. (2018). Antenatal care for Somali born women in Sweden – perspectives from mothers, fathers and midwives. In: European Journal of Public Health, Volume 28, Issue suppl_1, May 2018: . Paper presented at 1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh. , 28
Open this publication in new window or tab >>Antenatal care for Somali born women in Sweden – perspectives from mothers, fathers and midwives
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2018 (English)In: European Journal of Public Health, Volume 28, Issue suppl_1, May 2018, 2018, Vol. 28Conference paper, Oral presentation with published abstract (Refereed)
Series
European Journal of Public Health, ISSN 1101-1262
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30423 (URN)10.1093/eurpub/cky047.252 (DOI)
Conference
1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Byrskog, U., Hussein, I. H., Yusuf, F. M., Egal, J. A. & Erlandsson, K. (2018). The situation for female survivors of non-partner sexual violence: A focused enquiry of Somali young women's views, knowledge and opinions. Sexual & Reproductive HealthCare, 16, 39-44
Open this publication in new window or tab >>The situation for female survivors of non-partner sexual violence: A focused enquiry of Somali young women's views, knowledge and opinions
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 39-44Article in journal (Refereed) Published
Abstract [en]

Objective

The aim of the study is to elucidate young women’s perceptions of the situation for female survivors of non-partner sexual violence in Somaliland.

Methods

Young Somali women with diverse backgrounds (n = 25) shared views, knowledge and opinions about non partner sexual violence in focus group discussions held in urban settings. Data was analysed using content analysis.

Results

A main category “Bound by culture and community perceptions” with four subcategories comprises the informants’ perceptions of non-partner sexual violence among young women in Somaliland. Illuminated is the importance of protecting oneself and the family dignity, a fear of being rejected and mistrusted, how the juridical system exists in the shadow of tradition and potential keys to healthcare support.

Conclusion

The study raises awareness of the dilemmas which may be faced by young women subjected to non-partner sexual violence and healthcare providers in the intersection between state and traditional norms. Education is a key when it comes to a young woman considering the use of the services available in a society where traditional problem-solving is relied on parallel to state-based support. State-based functions, communities and families need to work together to provide comprehensive support to young female survivors of non-partner sexual violence in Somaliland.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Content analysis; Healthcare; Non-partner sexual violence; Perceptions; Somalia; Somaliland; Young women
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27313 (URN)10.1016/j.srhc.2018.01.006 (DOI)000440877700007 ()2-s2.0-85041821320 (Scopus ID)
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2018-08-23Bibliographically approved
Bogren, M., Erlandsson, K. & Byrskog, U. (2018). What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students. BMC Health Services Research, 18(1), Article ID 639.
Open this publication in new window or tab >>What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students
2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 639Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With professional midwives being introduced in Bangladesh in 2013, the aim of this study was to describe midwifery students perceptions on midwives' realities in Bangladesh, based on their own experiences.

METHOD: Data were collected through 14 focus group discussions that included a total of 67 third-year diploma midwifery students at public nursing institutes/colleges in different parts of Bangladesh. Data were analyzed deductively using an analytical framework identifying social, professional and economical barriers to the provision of quality care by midwifery personnel.

RESULTS: The social barriers preventing midwifery quality care falls outside the parameters of Bangladeshi cultural norms that have been shaped by beliefs associated with religion, society, and gender norms. This puts midwives in a vulnerable position due to cultural prejudice. Professional barriers include heavy workloads with a shortage of staff who were not utilized to their full capacity within the health system. The reason for this was a lack of recognition in the medical hierarchy, leaving midwives with low levels of autonomy. Economical barriers were reflected by lack of supplies and hospital beds, midwives earning only low and/or irregular salaries, a lack of opportunities for recreation, and personal insecurity related to lack of housing and transportation.

CONCLUSION: Without adequate support for midwives, to strengthen their self-confidence through education and through continuous professional and economic development, little can be achieved in terms of improving quality care of women during the period around early and late pregnancy including childbirth.The findings can be used for discussions aimed to mobilize a midwifery workforce across the continuum of care to deliver quality reproductive health care services. No matter how much adequate support is provided to midwives, to strengthen their self-confidence through education, continuous professional and economic development, addressing the social barriers is a prerequisite for provision of quality care.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28364 (URN)10.1186/s12913-018-3447-5 (DOI)000441829700002 ()30111324 (PubMedID)2-s2.0-85051661540 (Scopus ID)
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-09-03Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1713-6014

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