Migrant women can find it challenging to access maternity care for a number of reasons. Chinese women may also encounter poor treatment as a result of racial discrimination and social stigma as further barriers, besides language and communication issues affecting their ability talk about their medical history and current health concerns.
Dr Sarah Gong at the University of Leicester investigates how this under-researched group interacts with and uses digital health resources. Her research touches on whether digital resources can help pregnant Chinese women access maternity health information, and the co-development of interventions to encourage vaccine uptake.
Read the original article: https://doi.org/10.1016/j.midw.2022.103493
Image source: Adobe Stock Images /220 Selfmade Studio
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In this episode, we’ll delve into the research of Dr Sarah Qian Gong which explores the role of communication in promoting health information to Chinese communities living in the UK. Her research touches on whether digital resources can help pregnant Chinese women access maternity health information. Dr Gong has explored the hesitancy among Chinese communities towards COVID-19 vaccines, with the aim of co-developing communication interventions to encourage vaccine uptake.
In 2017, Dr Gong embarked on a research study to investigate how digital tools, such as websites and apps, help pregnant Chinese women access information about their maternity care. In advanced industrial societies, websites and apps are frequently used as part of pregnant women’s maternity care. After the national maternity review in 2016, the UK’s National Health Service, or NHS, recommended that digital tools be made available to pregnant women to provide the information they need throughout pregnancy and birth. While some research has looked into the impact of these new resources on general maternity service users, few studies have focused on how they may be used by migrant or ethnic minority communities. Although digital tools are often hailed as a solution for health inequality, it is important to test their effectiveness in different populations, especially those who may have limited digital access or lower digital literacy.
Migrant women can find it challenging to access maternity care for a number of reasons which may include cultural differences, socio-economic status, and lack of digital proficiency. Chinese women may also encounter poor treatment as a result of racial discrimination and social stigma, which imposes further barriers to accessing medical information and services. In addition, language and communication issues can be a major barrier for many migrant women who speak no English, or may only have a limited grasp of the language – and certainly not always have knowledge of the specialised vocabulary to talk about their medical history and current health concerns.
A growth in the number of digital tools and resources to support pregnant women is beneficial for many, but there is still a lack of data on how effective these prove to be in migrant communities. Most studies have tended to focus on migrants from Eastern Europe or African countries, and very little research has covered the experiences of Chinese women living in the UK. In 2016, Chinese women made up 0.5% of all UK births and were the 10th most common group among non-UK-born mothers and fathers. Indeed, according to the Office of National Statistics, Chinese migrants are one of the fastest growing non-European migrant groups in the UK.
Dr Sarah Gong, Associate Professor in Media and Communication at the University of Leicester, carried out a study to investigate how this under-researched, yet clearly sizeable, demographic group interacts with and uses digital health resources. More specifically, she explored the role of digital tools in facilitating communication between pregnant Chinese women and their midwives. Dr Gong used in-depth qualitative interviews to uncover the experiences and opinions of pregnant Chinese women and their midwives, using their native language. The participants were recruited from two NHS Trusts in the north of England, chosen because they serve large Chinese communities. Research midwives played a key role in recruiting pregnant Chinese women and their midwivies as research participants. Recruitment also took place at a large Chinese community organisation called Wai Yin Society, based in Manchester. In total, 17 Chinese pregnant women and 13 midwives took part in the research, with interviews lasting from 45 to -90 minutes. Dr Gong and colleagues then identified key themes from the participants’ responses.
The first key theme that emerged was how the digital tools themselves helped Chinese women access information about their pregnancy. Interestingly, all the women in the study had used digital resources to access pregnancy-related health information. The level of use often depended on the participant’s English proficiency. The 14 women who spoke Chinese as their first language typically used apps and forums in their native language. Meanwhile, those with higher English proficiency or native English speakers tended to use English maternity sources. Dr Gong notes the missed opportunity for accessibility in the lack of translated NHS resources, as even basic navigation through apps and websites can be difficult in an unfamiliar language. Midwives were often supportive of digital resources as they could be updated quickly to reflect changing medical practice, and they were generally felt to be more accessible than printed materials.
As mentioned previously, Chinese women who did not speak English as a first language were much less likely to use the resources recommended by their midwives and typically preferred Chinese resources. This was accompanied by a perception that the NHS only provided minimal information, and that the Chinese sources were more comprehensive. One reason for this scepticism may lie in the cultural differences surrounding pregnancy care. In China, maternity care is often more medicalised and doctor-led, as opposed to the midwife-led approach in the UK where only a handful of tests are conducted for low risk pregnancies. This stark contrast in maternity care resulted in a clash in expectations for pregnant Chinese women, and introduced difficulties in adjusting – particularly for those who had previously given birth in China.
Mismatched expectations might also have arisen from participants’ social circles. Participants’ close friends were often also Chinese, which may have been fundamental in shaping their expectations of maternity care and pregnancy according to Chinese norms. Furthermore, Dr Gong highlights that the first midwife appointment, held between 8 to 12 weeks in the UK, fell slightly later than when most women in the study became aware of their pregnancy and started seeking information. Since this appointment missed the ‘window of opportunity for information’, many participants had already sought out pregnancy-related information from Chinese sources long before they started communication with NHS midwives and services.
Another key theme that arose from the interviews was e-health literacy, which refers to a person’s ability to search for information digitally and then use this knowledge to solve health-related issues. It has been suggested that migrants may have a lower level of digital literacy, affecting their ability to find and use information from digital resources. However, Dr Gong’s study did not confirm this to be the case, as the midwives in the study described Chinese pregnant women as ‘technology savvy’ . In fact, it was more frequent that the midwives would raise concerns about their own digital abilities.
The study highlights a concern that many pregnant Chinese women seeking information from non-NHS resources could be receiving information of questionable quality or legitimacy. Many women confirmed that they were not checking the reliability of the websites or apps they were using. Dr Gong notes that the use of different sources among pregnant women may lead to inconsistent or unrealistic expectations of NHS care. On a positive note, the study found that digital tools were often a helpful means of translation during conversations with midwives. However, these translation tools proved insufficient for the first booking appointment, where a pregnant woman’s comprehensive medical history is usually taken.
The research emphasises that while digital tools are widely used by Chinese pregnant women, midwives had little understanding about the Chinese resources they were using. Dr Gong’s study recommends that all NHS pregnancy apps and materials be translated into Chinese. This can ensure that high-quality information is accessible for Chinese pregnant women, and reduce their potential reliance on Chinese sources for medical information with, sometimes, conflicting information. The study further advocates for digital literacy training to be provided not only to patients but also to midwives, to help them identify trustworthy and reliable digital resources to recommend to their clients.
In her more recent research, Dr Gong has investigated the Chinese communities’ hesitancy to take the COVID-19 vaccine. The study examines the potential barriers and enablers of vaccine uptake by using focus groups to explore the attitudes of the Chinese community towards the vaccine, and identify risk factors for vaccine avoidance. Dr Gong aims to provide valuable insights from the study to inform the NHS and local authorities to help co-design interventions which will improve vaccine uptake.
Initial findings from the study show that the Chinese community shared similar concerns about the vaccine as other communities across England did. However, some cultural differences did appear to shape their understanding of the vaccines. For example, a preference among some Chinese communities for natural remedies over pharmaceutical drugs may play a part in vaccine hesitancy. Moreover, an unfamiliarity with the UK health care system may contribute to the caution around the vaccine and related information. As found in the previous study, language barriers can also direct Chinese communities towards native sources of information, which may conflict with and thereby reduce trust in UK sources. Such language barriers are important to overcome, since Chinese participants were found to be more receptive of information provided in their native language, and many reported a desire for direct contact with a Chinese-speaking doctor for COVID-19 vaccine information and updates.
This later research once again highlights that health information needs to be delivered with cultural sensitivity to the diverse needs of the Chinese community, across age, gender, health, and socioeconomic status. The findings also confirm the value in the NHS providing translated material into both Cantonese and Mandarin, two widely spoken Chinese dialects, as well as using community organisations, faith venues, and social media platforms to share information to the Chinese community.
Dr Gong’s research brings sharp focus to how mainstream health information can often be missed or ignored by migrant communities, due to language barriers, cultural differences, and gaps in communication. The Chinese community, like many others, has diverse needs. While online resources may benefit the younger and more digitally-literate, it is not suitable for everyone, especially with current levels of training in e-Health Literacy. These studies show the importance of translating health information materials into peoples’ native languages, as well as working with community groups to deliver this vital information.
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