TransfOrming Transnational intErcultural sensitivity for Midwifery students through an inclusive mobility model: A mixed-method evaluation of the TOTEMM project.

BACKGROUND: Contemporary midwifery curricula require that student midwives have insight and understanding of global health practice and intercultural sensitivity. The current mobility model excludes large numbers of students from engaging in transnational learning. OBJECTIVES: 1) to evaluate midwifery students' experiences of blended mobility; 2) to investigate if the combination of virtual and physical mobility activities supported development of intercultural sensitivity and soft skills. DESIGN: Multi-centre mixed-methods study. SETTINGS: Four European Higher Education Institutions located in England, Italy, Estonia and The Netherlands. PARTICIPANTS: Sixty-four midwifery students studying in one of the four partner institutions selected as study sites and who participated in the TOTEMM blended mobility scheme took part in the evaluation. METHODS: Data were collected through two online surveys, face-to-face focus groups and learning analytics. Descriptive summary statistical analysis of survey data was undertaken. Focus group discussions were subjected to thematic analysis. Findings from the quantitative survey and qualitative focus groups were merged using a convergent mixed methods approach. Learning Analytics were interpreted as complementary to the above components, to further triangulate the findings. RESULTS: Both virtual and physical components were evaluated positively by students, with high engagement confirmed by learning analytics. A statistically significant increase in the mean of the Total Intercultural Sensitivity Scale score was seen between the pre- and post-mobility surveys, indicating participation in the TOTEMM mobility model was associated with enhanced intercultural sensitivity. Positive effects on confidence, open-mindedness, empathy, interaction and non-judgment were shared by participants. CONCLUSIONS: TOTEMM is an innovative inclusive approach to enable a diverse student group to benefit from transnational learning, including the development of intercultural sensitivity. The TOTEMM blended mobility model has potential for integration into future midwifery curricula and programmes in the four partner settings involved in TOTEMM and utility for the wider European context.

Midwives' perceived barriers in communicating about depression with ethnic minority clients.

OBJECTIVE: This study aimed to assess the most influential barriers midwives perceive in communicating about depression-related symptoms with ethnic minority clients. METHODS: In-depth interviews were held with midwives (N = 8) and Moroccan-Dutch women (N = 6) suffering from perinatal depression to identify the most salient communication barriers. Subsequently, an online survey among midwives (N = 60) assessing their perceived barriers and the occurrence of these barriers in practice was administered. Composite scores using the QUOTE methodology were calculated to determine influential barriers. RESULTS: Three types of barriers emerged from the interviews. Educational-related barriers, client-related barriers and midwife-related barriers. Results of the survey showed that the most influential barriers were educational-related barriers (e.g. lack of culturally sensitive depression screening instruments) and client-related barriers (e.g. cultural taboo about talking about depression). CONCLUSION: Culturally sensitive screening instruments for depression and patient education materials should be developed to mitigate the educational-related barriers to communicating about depression. Patient education materials should also target the clients' social environment (e.g. husbands) to help break the cultural taboo about depression. PRACTICE IMPLICATIONS: Based on this study's results, communication strategies to empower both midwives and ethnic minority clients with depression can be developed in a collaborative approach.

'She convinced me'- partner involvement in choosing a high risk birth setting against medical advice in the Netherlands: A qualitative analysis.

Home births in high risk pregnancies and unassisted childbirth seem to be increasing in the Netherlands. There is a lack of qualitative data on women's partners' involvement in these choices in the Dutch maternity care system, where integrated midwifery care and home birth are regular options in low risk pregnancies. The majority of available literature focuses on the women's motivations, while the partner's influence on these decisions is much less well understood. We aimed to examine partners' involvement in the decision to birth outside the system, in order to provide medical professionals with insight and recommendations regarding their interactions with these partners in the outpatient clinic. An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. In-depth interviews were performed with twenty-one partners on their involvement in the decision to go against medical advice in choosing a high risk childbirth setting. Open, axial and selective coding of the interview data was done in order to generate themes. Four main themes were found: 1) Talking it through, 2) A shared vision, 3) Defending our views, and 4) Doing it together. One overarching theme emerged that covered all other themes: 'She convinced me'. These data show that the idea to choose a high risk birth setting almost invariably originated with the women, who did most of the research online, filtered the information and convinced the partners of the merit of their plans. Once the partners were convinced, they took a very active and supportive role in defending the plan to the outside world, as well as in preparing for the birth. Maternity care providers can use these findings in cases where there is a discrepancy between the wishes of the woman and the advice of the professional, so they can attempt to involve partners actively during consultations in pregnancy. That will ensure that partners also receive information on all options, risks and benefits of possible birth choices, and that they are truly in support of a final plan.