Overview

The Group Pregnancy Care study is implementing and evaluating a new approach to antenatal and postnatal care that involves inter-agency collaboration between public maternity hospitals, refugee settlement agencies, and maternal and child health (MCH) services.

The aim of the program is to provide multifaceted, culturally appropriate preventive health care, information and support to refugee women during and after pregnancy in a group setting.

The program is cost-free; provides care and information that is woman-directed, culturally appropriate and in women’s language; and facilitates links and referrals to services as necessary.

Our site information

• Healthy Happy Beginnings, Karen families in Werribee517.23 KB
• Happy Mothers, Assyrian Chaldean Families in Craigieburn312.51 KB

Program Principles

The organisations and staff involved have agreed to apply these principles:

• Community consultation and engagement
• Establish rapport with the woman and when present her family
• Giving women time and space to ask questions, check understanding and consent for medical tests and other procedures and Inform family of procedures, when appropriate
• Provide an on-site interpreter for pregnancy appointments
• Continuity of care (including interpreters and bicultural workers)
• Support women and her family’s pathway through the health system
• Promote women’s understanding of preventative health
• Respect, empathy, openness and sensitivity to cultural difference
• Recognise and understand the refugee re-settlement experience
• Work within a social model of health
• Outreach, referral and service co-ordination
• Client feedback and evaluation.

Information for participants

Key elements of the program

• local partnerships between public maternity hospitals, maternal and child health services and multicultural agencies
• community and stakeholder involvement in the co-design of each local program
• establishment of a multidisciplinary care team
• fortnightly group information sessions co-facilitated by a midwife, maternal and child health nurse and a community and language specific bicultural worker - alongside pregnancy care with a midwife and professional interpreter
• locating the program in a community setting close to where families live
• flexibility to embed the model in ways that work for health services and communities.

Evaluation will involve

• use of routinely collected hospital data to compare health service use and maternal and infant outcomes before and after program implementation using an interrupted time-series design
• interviews with women participating in the program at 30 weeks gestation and at 4 months postpartum
• audit of hospital medical records for all participating women
• focus groups with participating women and service providers
• assessment of cost effectiveness.

The Healthy Happy Beginnings Project in Melbourne’s West

A successful demonstration project - called Healthy Happy Beginnings - was established by working with the Karen community (from Burma).

Community feedback about gaps in services and information was a catalyst for developing the program, and the Karen community have continued to be actively involved in refining how the program works to support their community. 

The Group Pregnancy Care Study will facilitate multi-faceted opportunities for refugee background bicultural staff to build capabilities relevant to improving maternal and child health outcomes in their communities through participation in service delivery and research activities.

Bicultural workers will be involved in program delivery as members of the multidisciplinary teams providing care to women during and after pregnancy.

In addition, bicultural researchers will contribute to program evaluation providing opportunities for building their skills and knowledge of research activities. 

Research team

Ms Ann Krastev
Group Pregnancy Care Project Coordinator, Healthy Mothers Healthy Families Research Group
Murdoch Children's Research Institute

Dr Ellie McDonald
Refugee and Migrant Health - Research Data Analyst, Healthy Mothers Healthy Families Research Group
Murdoch Children's Research Institute       

Lien Tran
Community Engagement Project Officer (Vietnamese), Healthy Mothers Healthy Families Research Group
Murdoch Children's Research Institute           

May Alqas Alias
Community Engagement Project Officer (Assyrian Chaldean), Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute 

Shadow Toke
Community Engagement Project Officer (Karen), Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute             

Shogoufa Hydari
Community Engagement Project Officer (Afghan), Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute

Collaborators

Project Partners

• The Victorian Foundation for Survivors of Torture (Foundation House)
• Victorian Cooperative on Children's Services for Ethnic Groups (VICSEG New Futures)
• Monash Health (Dandenong Hospital)
• Western Health (Sunshine Hospital)
• Northern Health
• Mercy Hospitals Victoria
• Wyndham City Council
• Brimbank City Council
• Hume City Council

Policy Partners

• Victorian Department of Premier and Cabinet
• Victorian Department of Health and Human Services
• Victorian Department of Education and Training
• Municipal Association of Australia

Study Investigators

Dr Elisha Riggs
Senior Research Fellow, Healthy Mothers Healthy Families Research Group
Murdoch Children's Research Institute

Dr Jane Yelland
Senior Research Fellow, Healthy Mothers Healthy Families Research Group
Murdoch Children's Research Institute

Professor Stephanie Brown
Group Leader, Healthy Mothers Healthy Families Research Group
Murdoch Children's Research Institute

Dr Fiona Mensah
Biostatistician, Clinical Epidemiology and Biostatics Unit
Murdoch Children's Research Institute

Associate Professor Philippa Middleton
Principal Research Fellow, Healthy Mothers, Babies and Children
South Australian Health and Medical Research Institute (SAHMRI)

Dr Ida Kaplan
Manager, Direct Services. Registered clinical psychologist.
Victorian Foundation for Survivors of Torture

Mr Josef Szwarc
Manager, Research and Policy
Victorian Foundation for Survivors of Torture

Professor Christine East
Professor of Midwifery, Monash Women’s Maternity Services & Monash University

Professor Jeremy Oats
Professorial Fellow, Melbourne School of Population and Global Health, University of Melbourne
Consultant obstetrician, the Royal Women’s Hospital

Associate Professor Lisa Gold
Head, Maternal and Child Health Economics, Deakin University

Professor Jeffrey Braithwaite
Director, Australian Institute of Health Innovation and the Centre for Healthcare Resilience and Implementation Science
Macquarie University

Ms Donna Chesters
Program Leader, Education and Early Years, Sector Development and Partnership Program
The Victorian Foundation for Survivors of Torture

Professor Caroline Homer
Associate Head, Centre for Midwifery, Child and Family Health and the WHO Collaborating Centre for Nursing, Midwifery and Health Development
University of Technology Sydney

Professor Louise Howard
Professor, Women’s Mental Health, Kings College London

Professor Rhonda Small
Adjunct Professor, La Trobe University and Foreign Adjunct Professor, Karolinska Institute, Sweden

Publications

Riggs E, Muyeen S, Brown S, Dawson W, Petschel P, Tardiff W, Norman F, Vanpraag D, Szwarc J, Yelland J. Cultural safety and belonging for refugee background women attending group pregnancy care: An Australian qualitative study. Birth. 2017;44(2):145-152

Riggs E, Yelland J Brown S, Dawson W, Szwarc J, Casey S. Group Pregnancy Care for Refugee Background Women. Bridging the Gap Policy and Practice Brief No. 2. Murdoch Children's Research Institute, Melbourne, 2017.

Yelland J, Riggs E, Szwarc J, Vanpraag D, Dawson W, Brown S. Improving the ascertainment of refugee-background people in health datasets and health services. Australian Health Review. 2017

Riggs E, Yelland J, Duell-Piening P, Brown SJ. Improving health literacy in refugee populations. The Medical Journal of Australia. 2016;204(1):9-10.

Riggs E, Yelland J, Szwarc J, Wahidi S, Casey S, Chesters D, Fouladi F, Duell-Piening P, Giallo R, Brown S. Fatherhood in a New Country: A Qualitative Study Exploring the Experiences of Afghan Men and Implications for Health Services. Birth. 2016;43(1):86-92.

Riggs E, Yelland J, Szwarc J, Casey S, Chesters D, Duell-Piening P, Wahidi S, Fouladi F, Brown S. Promoting the inclusion of Afghan women and men in research: reflections from research and community partners involved in implementing a `proof of concept' project. International Journal for Equity in Health. 2015;14(1):13

Yelland J, Riggs E, Szwarc J, Casey S, Dawson W, Vanpraag D, East C, Wallace E, Teale G, Harrison B, Petschel P, Furler J, Goldfeld S, Mensah F, Biro MA, Willey S, Cheng IH, Small R, Brown S. Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implementation Science. 2015;10(1):62.

Yelland J, Riggs E, Wahidi S, Fouladi F, Casey S, Szwarc J, Duell-Piening P, Chesters D, Brown S. How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families? BMC Pregnancy and Childbirth. 2014;14(1):348.