Research
MAMAACT is a complex intervention aimed at reduced ethnic and social inequity in reproductive health. The project focuses on improving the communication about pregnancy complications between pregnant women and their midwives to ensure optimal response to pregnancy complications from both parties. The intervention consists of post graduate training of midwives in intercultural communication and a smart phone application and a leaflet, both in six different languages. The app and leaflet explain the most serious pregnancy complication warning signs and how the women should respond to them. It is our expectation that these initiatives together will promote both communication between the pregnant women and their midwives as well as the pregnant women’s ability to articulate symptoms and to navigate the health care system. This should ensure optimal and timely response to warning signs in pregnancy from both the women and the health system. Additionally, it will increase health among newborns and in the long term reduce infant mortality and stillbirths.
MAMAACT is implemented and evaluated in a randomized controlled trial and 10 maternity wards will receive the intervention, while nine maternity wards are included as control groups. The project is implemented at maternity ward level, and all pregnant women are included irrespective of their ethnic origin as the project can have beneficial effects among all pregnant women. The primary outcome of the project is that the health literacy of non-Western immigrant women’s will increase to the level that the ethnic Danish women possessed in the beginning of the project. This will be investigated through surveys. The secondary outcome is that the project promotes health at birth, which will be investigated through a registry study.
A further important focus in the evaluation is how the midwives and the pregnant non-Western immigrant women experience working with MAMAACT. Both barriers at the organizational level at the maternity wards as well as in the women’s everyday life will be analyzed. The data will be collected through interviews, focus groups and observations. In addition, data concerning the maternity wards’ organizational context, the number of pregnant women attending in the maternity wards and distributed leaflets and app downloads will be collected.
The evaluation of MAMAACT is divided into two PhD projects using quantitative and qualitative methods, respectively which subsequently will be combined in an integrated analysis of the project’s mechanisms and effects.
This Ph.D. will investigate and analyze the implementation process of the MAMAACT intervention and illuminate how the intervention activities are adapted and interact with the contextual factors of the different settings.
The Ph.D. project analyzes:
- The non-western migrant women’s assessment of the intervention’s relevance and fit to their needs.
- Midwives’ attitudes towards and experiences of using the MAMAACT intervention to promote intercultural communication.
- The implementation process of the intervention within different antenatal care settings.
The goal is that this Ph.D. will provide important insight into which factors inhibit and enhance the implementation of the MAMAACT project in Denmark specifically, but also that it will create insights into how complex interventions may be used to reduce ethnic disparities in reproductive health outcomes on a broader scale.
Contact: Helle Johnsen
Advisors: Ulla Christensen, Mette Juhl og Sarah Fredsted Villadsen
This Ph.D. project contributes with updated knowledge on ethnic disparities in stillbirth and infant mortality with specific attention to the implications of socioeconomic factors. As stillbirth and infant death are rare outcomes, it is not possible to measure an effect of the intervention on these outcomes within the time frame of the project. Based on register data this Ph.D. examines ethnic differences in the severity of pregnancy complications and indicators for perinatal health at the time of the delivery using indicators such as Apgar score, umbilical-cord pH at birth and the number of admissions to the neonatal ward etc. This Ph.D. will identify ethnic inequity in the outcome measures before and after the implementation to assess effects of the intervention. Furthermore, this Ph.D. project includes a quantitative evaluation of the effect of MAMAACT based on data from the baseline and endline survey, with the purpose to analyze potential improvements in women’s health literacy, experiences of the antenatal care and the women’s knowledge of warning signs in pregnancy.
The hope is that this Ph.D. will contribute with new knowledge in order to assess the relevance of the MAMAACT-intervention and more generally, how we reduce ethnic disparities in perinatal death as well as other reproductive health outcomes in Denmark.
Contact: Trine Damsted Rasmussen
Supervisors: Anne-Marie Nybo Andersen, Signe Smith Jervelund and Sarah Fredsted Villadsen