OP94 ‘I needed somebody like her in my life’: migrant women’s experiences and perceptions of health navigation services to increase access to maternity care in the UK

Abstract

Background Migrant women in the UK are at increased risk of maternal morbidity and mortality compared to UK-born women, in part due to inequalities in healthcare access. Health navigation is a person-centred intervention delivered by lay or professional workers (‘health navigators’), addressing individualised barriers to accessing healthcare. Despite recognition of health navigation as a promising intervention for migrant women, there remains a significant paucity of research on stakeholders’ perspectives. The aim of this study is to understand migrant women service users’ experiences and perceptions of health navigation. Methods This study is based on a multiple, instrumental case study carried out between May 2019 and January 2020 in two English cities, in collaboration with a grassroots charity and a National Health Service (NHS) programme - both providing health navigators to support migrant women. Through purposeful sampling, semi-structured interviews were conducted with migrant women using these services (n=14), with interviews conducted in English (n=9), or with interpretation in Arabic (n=4) or French (n=1). Additionally, organisational documents were examined for information on women’s needs upon referral to the services. Data from interviews and documents were coded in NVivo, and analysed using reflexive thematic analysis. Results Study participants were refugee, asylum-seeking or trafficked women. They were pregnant or recent mothers, aged between 19 and 41 years. Five overarching themes were developed: ‘Need for support’, ‘Knowledge’, ‘Tools for life in Britain’, ‘Close relationships’ and ‘Expectations’. Women reported needing companionship, material support and signposting - which mainstream NHS services have limited capacity to provide. They described having gained knowledge of NHS services and of pregnancy, birth and early motherhood - which they perceived as empowering and as increasing their access to healthcare. Health navigators reportedly reduced women’s social isolation and helped to improve their English language proficiency, supporting women’s integration into British society and promoting their general wellbeing. Finally, women described having close relationships with health navigators, but had expectations of them beyond health navigators’ remit and boundaries. These themes were consistent across both case study sites. Conclusion Health navigation was viewed positively by migrant women in this study. They perceived it as improving their access to maternity care - and other healthcare services - as well as improving their wellbeing, although greater clarity on health navigators’ roles may help to manage women’s expectations. Future research could explore health navigation interventions for migrant women operating beyond the first six weeks of motherhood.