Literature Review: Models of Care for Working with CALD Communities in the Antenatal and Postnatal Periods

Purpose. South Eastern Sydney Local Health District (SESLHD) has commissioned a comprehensive literature review of models of care for working with culturally and linguistically diverse (CALD) communities in the antenatal and postnatal periods. The purpose of this project is to inform future planning and project implementation, including discussions with internal committees and working groups and external stakeholders. Methods. A search of electronic databases from January 2006" June 2016 yielded 96 items including three reviews of CALD women's experiences of maternity care, plus three recently-published comprehensive reviews of maternity care interventions for CALD communities in addition to an earlier review undertaken to inform NICE Clinical Guideline 110 in the United Kingdom. These were used as a basis for this report. A search for additional grey literature from Australia did not prove fruitful. Findings. A systematic and comparative review of migrant and non-migrant experiences of maternity care in Australia and overseas (Small et al., 2014) found few differences in what women wanted"”safe, high-quality, attentive and individualised care, with adequate information and support. Broader social and economic factors interact with cultural factors to affect access to mainstream services and the quality of care received. The systematic review to inform the NICE Clinical Guideline identified only five studies from four countries examining additional care and support for CALD communities, all of low quality (NCCWCH, 2010). A systematic global mapping of interventions to address cultural factors that affect women's use of maternity care services identified 96 items from 35 countries, including 23 impact evaluations. The various interventions were categorised as service delivery models, service provider interventions, health education interventions, participatory approaches or mental health interventions (Coast et al., 2014). A subsequent systematic review of the effectiveness of interventions (Coast et al., 2016) identified 15 articles reporting 14 interventions from five countries (including six from Aboriginal Australia). Outcome measures were mostly focussed on the antenatal period and care received, and overall quality of evidence was weak. Ten studies found a positive effect on care utilisation. Of these, three service provider interventions in the United States seem most relevant to SESLHD and merit closer examination. Although they had different governance arrangements (based in the community, a university and a community health centre), all used bilingual/bicultural lay or paraprofessional staff and provided a range of educational and support services within an outreach model. Conclusions. While the importance of ensuring maternity care services meet the specific needs of women with CALD backgrounds in the antenatal and postnatal periods is widely recognised, there are few fully documented and rigorously evaluated culturally-tailored/specific interventions. Given the limited literature on what works, models of care and recommendations for practice should also draw on the broader literature on CALD women's experiences, as well as consultations with target communities and lessons from previous projects designed to support vulnerable women and families from CALD communities in the SESLHD. Publication of SESLHD CALD project evaluations will contribute to the international evidence base. Project documentation should include detail on how issues are addressed and specify the links between the identified issues and intervention content.