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Table 3 The grid displaying these themes and their relationships between the studies

From: Immigrant women’s experiences of maternity-care services in Canada: a systematic review using a narrative synthesis

Author, citation Study design and broad category Sample and ethnocultural group Access to social support Access/adequacy of prenatal care Utilisation of prenatal care Reception/ adequacy of care in hospital Reception/adequacy of care – post- partum Access to appropriate information Barriers—prenatal Barriers— postnatal Postpartum health—mom (not mental health) Baby health Postpartum mental health Breast feeding and other child care problems/success related to access
   Total 7 8 11 12 16 12 7 9 7 3 7 5
Quantitative research papers             
Kingston, JOGC, 2011 [55] 1. Secondary analysis of MES 1. Stratified random, 6,421 drawn from sampling frame x   x x x x    x   x  
2. Maternity experiences 2. All but limited language (no Hindi or Punjabi)
Brar, JOGC, 2009 [52] 1. Exploratory matched—sample survey 1. 30 immigrant, 30 Canadian   x x x   x x      
2. Experiences—use of perinatal services 2. South Asian
Sword, JOGNN, 2006 [69] 1. Cross-sectional survey 1. 1,250 with 30% immigrants x     x x   x     
2. Experiences and outcomes. Postpartum health, service needs, access and use 2. All but English, French, Spanish and Chinese languages
Katz, CJNR, 2002 [63] 1. Retrospective cross-sectional hospital and community records review 1. 20 immigrant breastfeeding women with health or social concerns 2.9 countries x    x x x    x x x x
2. Experiences and outcomes. Adequacy of postpartum care to 2 months
Minde, JAACAP, 2001 [68] 1. Cross-sectional observational 1. 45 mother-infant pairs in Montreal with 45% immigrants      x     x
(Psychosocial status more than maternal outcomes per se)
2. Experiences and outcomes. Nurse and physician adequacy of interviews 2. All, with English and French languages.
Gagnon, Am J Ob Gyn, 1997 [35] 1.RCT 1. 54 treatment and 100 control     x x      x   x
2. Outcomes and experiences. Early postpartum discharge programme 2. Only 35 recent immigrants, had to speak English, French or Spanish
Gagnon, CJPH, 2007 [30] 1. Matched cohort study with in-hospital questionnaire and data collected and in-person visits to home 1. 341 pairs of women from 10 hospitals      x    x x   x  
2. Experiences and outcomes. Unaddressed concerns in postpartum period (7–10 days after discharge) 2. if spoke 1 of 13 languages [Arabic, Dari/Persian, English, French, Mandarin/Cantonese (oral; ‘simple’ and ‘complex’ Chinese written), Punjabi, Russian, Serbo-Croatian, Somali, Spanish, Tamil and Urdu
Poole, J Social Psychol, 1995 [57] 1. 2 observational studies with Euro and Indo-Canadian women in early postpartum period whilst in hospital 1. 27 and 24 and 33 and 24 Euro versus Indo-Canadian women    x x         
2. Experiences in hospital 2. Euro- and Indo-Canadians. Euro-Canadians all born in Canada and Indo-Canadians all born in India
Chalmers, Birth, 2000 [53] 1. Survey study of Somalian women who had experienced FGM 1. 432 recruited within greater Toronto area in community and through snowball    x x         x
2. Perinatal experiences although some outcomes 2. Somalian
Loiselle, CJNR, 2001 [56] 1. Cross-sectional survey study using telephone questionnaires at 3 weeks postpartum 1. 108 women with 69 being born outside Canada and 50% immigrants new <5 years, all living in Montreal    x x x x       
2. Experiences related to breastfeeding support 2. 30 countries but most prevalent countries being Philippines, Romania, Sri Lanka and Vietnam
Chalmers, J Reprod Infant Psych, 2002 [65] 1. Mixed method study with closed and open-ended questionnaire. Report is based on open-ended questions which used ‘descriptive content analysis approach with quantitative methodologies’ 1. 432 women of Somalian origin recruited from community sites and through snow balling     x         
2. Experiences 2. Somalian
Stewart, Can J Psych, 2008 [58] 1. Quantitative cross-sectional survey study with some collection from records. 1. Consecutive sample of 277 women in 4 groups recruited in 10 hospitals in Vancouver, Montreal and Toronto.            x  
2. Outcomes via access 2. All with questionnaire translated into 13 languages
Wallace, Calgary Health Region, 2002 [59] 1. A survey study with questionnaire in hospital and approximately 2 weeks later 1. Convenience sample of 65 non-English-speaking women. Almost 60% moved to Canada within last 7 years; 22.4% within last 2 years.   x x x   x x      
2. Experiences 2. 12 ethnicities represented with largest groups being South Asian (44.6%), West Asian/Arab (18.5%) and Chinese (12.3%).
Jarvis, JOGC, 2011 [54] 1. Quantitative retrospective case comparison study was performed using medical charts 1. 71 uninsured women and 72 insured women presenting for prenatal care between 2004 and 2007 to 2 family practice centres in Montreal   x x     x    x   
2. Experiences (prenatal) and birth outcomes 2. All
Qualitative research papers             
Ahmed, Arch Women’s Ment Health, 2008 [70] 1. Qualitative study using semi-structured telephone interviews 12–15 months after birth 1. 10 women, who scored 10 or over on EPDS at 2–3 week postnatal visit -Refugee, asylum seeking, non-refugee, and immigrants living in Toronto for less than 5 years x     x x   x     
2. Experiences 2. 2 women had emigrated from China, 2 from India, 1 from Pakistan, 3 from South America, 1 from Egypt and 1 from Haiti.
Ardal, Neonatal Networks, 2011 1. Exploratory, qualitative design based on grounded theory 1. Convenience. 8 non-English speaking mothers recruited from a Canadian NICU who had given birth to VLBW infants      x x       
2. Experiences 2. Spanish, Portuguese, Chinese and Tamil
Gagnon, Journal of Immigrant Minority Health, 2010 [29] 1. Qualitative with individual and group interviews 1. 25 women were a combination of asylum seekers, non-refugee immigrants, refugees and Canadian born (n = 1)      x    x x    
1. Experiences 2. 16 different countries
Grewal, JOGNN, 2008 [18] 1. Naturalistic, descriptive. Individual interviews with mothers. Focus group undertaken with Punjabi healthcare professionals to affirm results and offer recommendations. 1. 15 first time mothers, immigrated to Canada within the last 5 years from Punjab, given birth to a healthy infant in the last 3 months. Recruited from large BC hospital. 5 healthcare professionals were also recruited and took part in a focus group.   x x x x   x      
2. Experiences—the interaction with the Canadian healthcare system during the perinatal period 2. Punjabi women
Merry, Qual Res, 2011 [71] 1. Subproject of prospective cohort study, with qualitative analysis of notes made by nurses and care diaries of women about refugee and newcomers’ services received 1. 112 research records of refugee women, who have been in Canada 5 or less years, claiming to have 3 or more unaddressed concerns, at either 2 weeks or 4 months post-birth, were reviewed (51 Montreal; 61 Toronto). Recruitment at 12 hospitals. x     x x   x x   x  
2. Experiences and outcomes postpartum 2. Montreal participants were mainly from Nigeria, Mexico and India; Toronto participants were from Nigeria, Mexico, Colombia and St. Vincent
Morrow, Health Care Women Inter, 2008 [64] 1. Ethnographic narrative approach 1. 18 first-generation immigrant women (but most not newly immigrated), first language not English (Punjabi speaking, Cantonese speaking and Mandarin speaking), 1 year postpartum, either diagnosis of postpartum, or self-identified as having depression, post-birth. x x    x x   x    x  
2. Experiences postpartum (supports sought)
Reitmanova, Matern Health Child J, 2008 [24] 1. Qualitative with in-depth interviews 1. 6 immigrant Muslim women in Newfoundland, born in 5 countries x x x x x x x
(in hospital)
2. Experiences—healthcare needs and barriers 2. Just reference to religion and ‘5 countries’
Spitzer, Medical Anthropology Quarterly, 2004 [66] 1. Qualitative with individual and focus group interviews (not defined by number) 1. 19 new mothers who had given birth in 1 of 3 participating community centres or hospitals; also 11 obstetrical nurses were also interviewed about their experiences working with visible minority women     x    x (and in hospital)      
2. Experiences in hospital 2. South Asian and Vietnamese (also First Nations)
Sutton, Can J Diet Pract Res, 2007 [60] 1. Qualitative study with in-depth, semi-structured interviews 1. Heterogeneous sample of 11 (10 immigrant) Vietnamese mothers, whose children are under 2 years old   x x   x x x x     x
2. Experiences with breastfeeding and needs for maternity services 2. Vietnamese
Wiebe, J Transcult Nurs, 2011 [67] 1. Exploratory qualitative approach, grounded in an emic perspective, using open, non-directed interviews as much as possible 1. 21 families (13 immigrant and 6 Aboriginal) with infant in NICU x    x     x (in hospital postnatal)     
2. Experiences in a NICU 2. Several but largest African, Vietnamese and Eastern European