Evaluation and outcome of the implementation of the Guideline integrated birth care for Asylum seekers and development of a toolbox for Local pathways for Integrated birth care for asylum seekers and sTatus holdErs: the EGALITE study
EGALITE studie: Integrale geboortezorg voor asielzoekers en statushouders
De gezondheid van een kind bij de geboorte is bepalend voor levenslange gezondheid. Ongeveer 14% van de kinderen heeft echter geen goede start en daarom lanceerde de Minister van VWS in 2018 het programma ‘Kansrijke Start’. Er is niet veel bekend over de gezondheid van pasgeborenen van vluchtelingen. Naar schatting zijn er zeker 7000 bevallingen per jaar van deze vrouwen.
Het doel van dit onderzoek is het bewerkstelligen van goede geboortezorg voor deze groep vrouwen door optimale samenwerking tussen alle betrokken partners.
Onderzoek en verwachte uitkomst
Het onderzoek wordt uitgevoerd in 4 fasen:
- Beschrijving van de doelgroep en evaluatie van de landelijke en regionale richtlijnen geboortezorg asielzoekers met identificatie van succes- en faalfactoren aan de hand van uitkomstgegevens, interviews en focusgroepen;
- Formuleren vanaanbevelingen voor verbetering van de ketenrichtlijn;
- Testen van deze aanbevelingen in de praktijk;
- Opstellen van een plan voor landelijke implementatie van de verbeterde richtlijn.
Kijk voor meer informatie op de website van de EGALITE studie.
Auteur: EGALITE projectteam
Auteur: Saar Slegers
Auteur: Gatool Katawazi
Auteur: J. Tankink, P. van der Lans, J.P. de Graaf, A. Franx
Auteur: GGD GHOR, EGALITE, UMCG
Samenvatting van de aanvraag
An unhealthy start of life has a negative impact on a child’s performance in school and future employment, perpetuating the vicious cycle of social deprivation and poverty into subsequent generations. Furthermore, children with health, socio-emotional, and learning problems also influence the well-being of families and communities. Thus, the Minister of Health, Welfare and Sport launched the action program "Promising Start" in 2018. Approximately 14% of children do not have a good start at birth. This group includes the children of asylum seekers and refugees who have a residential status, in this proposal referred as “status holders”. Just as for the general population, socioeconomic, cultural, environmental and lifestyle factors are key determinants for the health of asylum seekers and refugees. These determinants are also largely responsible for inequities within and between population groups in terms of health. Pregnant asylum seekers and status-holders have a need for understandable information about pregnancy and health care, and caregivers who pay attention to their medical and psychosocial problems. Problems due to language barriers, cultural differences and low health literacy also hamper access to and quality of care. Asylum seekers are not a homogeneous group; all have different social, economic and cultural circumstances accounting for varying vulnerabilities throughout the migration process. Most asylum seekers still face poorer pregnancy and birth outcomes, with a higher incidence of induced abortions, caesarean sections, instrumental deliveries and complications. In the EU, asylum seekers tend to have poorer perinatal outcomes than the host population. The scarce Dutch studies showed that the asylum seekers had a 10 times increased risk for maternal death and twice the risk for perinatal death as compared to the Dutch population. There is limited scientific data on the course and outcome of pregnancies, including the start of life of infants of asylum seeking women and status holders in the Netherlands; the target groups of this proposal. According to the Central Organ Asylum seekers, there are about 800 pregnant refugees annually, spread over 40 Asylum Seekers Centres (ASCs) in the Netherlands. In addition, there are more than 1,000 pregnant women each year who have already been granted asylum, so-called refugees with residential status. This proposal aims 1) to evaluate birth care and pregnancy outcomes and 2) to achieve better and more integrated birth care in these target groups, by all relevant caregivers, asylum seekers' centres (ASCs) and public health organisations, by developing and testing a toolkit for local implementation of regional pathways for integrated birth care to pregnant asylum seekers and status holders, based on the existing national guideline. The design of this study is based on a mixed-method research approach (both quantitative and qualitative). In Phase 1 (exploring and developing) we will use the data files of PERINED, non-public microdata of “The Dutch Population Register” from Dutch Statistics and the health use data from Vektis linked by RIVM for analysing the characteristics, perinatal outcomes of the target groups over the period of 2008-2017. We will study the extent of implementation of the national and regional guidelines (e.g. "Integrated guideline birth care asylum seekers”) and the needs and wishes of the professionals and representatives of the target groups by semi-structured interviews. Next, based on all existing insights and results of the quantitative and qualitative data obtained in phase 1, we will develop a toolkit for “local implementation of integrated birth care pathways for pregnant asylum seekers and status holders”. In Phase 2 we will test this toolkit in 9 integrated birth care settings of the participating ASCs and professionals. During this test phase we will also evaluate satisfaction with the toolkit. Effects will be measured on the level of 1) the pregnant asylum seeker/status holders, 2) professionals and 3) organisational level. 1) Outcome measures in the group of pregnant asylum seekers/ status holders will include: occurrence of adverse perinatal outcomes, experienced patient satisfaction with care, first antenatal consultation, the use of the 20 weeks ultrasound scan, perspectives on continuity of care, number of transfers between obstetric professionals & residence, use of interpreter; 2) Outcome measures in the group of professionals will include: satisfaction with the provided care, time investment; 3) Outcome measures on the organisational level will include: feasibility and acceptability of the toolkit, degree of application of the toolkit, and barriers and facilitators. Based on these results we will optimize the toolkit and develop a nationwide implementation plan. In Phase 3 we will communicate and disseminate results, in particular the optimized tested toolkit. Budget requested €344.000, own contribution €44.000.