Abstract
BackgroundLiterature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women’s reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada?Methods/designOur synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al. (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors.DiscussionThe narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women. PROSPERO registration number CRD42012003020.
Highlights
Literature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women
The aforementioned level of increased risk may be conservative since other studies have found relative risks for depressive symptomatology of four-to-five times for refugee and immigrant women, respectively [9] and an odds ratio of 2.97 (CI 1.70 to 5.17) for major postpartum depression (PPD) [10]
Many studies have focused attention on how health care practices based on Western cultural concepts influence the ways in which immigrant women use mental health care services
Summary
This synthesis seeks to address gaps in knowledge and generate new interpretations of research findings and other literature for translation into improvements to maternity services provision throughout Canada. It aims to have substantive and sustainable impact on health outcomes, practice, programs and/or policy in the study context. The project involves conducting a narrative synthesis of quantitative and qualitative research This will be important methodologically as there is a recognized need to bring together comprehensive evidence on research and policy questions to inform programs and service delivery but few examples of the integration of these types of research exist.
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