Migration and perinatal health surveillance an international delphi survey
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Migration and perinatal health surveillance: An international Delphi survey. Anita Gagnon, Jennifer Zeitlin, Meg Zimbeck for the ROAM collaboration & in conjunction with EURO-PERISTAT. Sophie Alexander, Université libre de Bruxelles (Belgium) B é atrice Blondel, INSERM (France)

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Migration and perinatal health surveillance: An international Delphi survey

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Migration and perinatal health surveillance an international delphi survey

Migration and perinatal health surveillance:An international Delphi survey

Anita Gagnon, Jennifer Zeitlin,

Meg Zimbeck

for the ROAM collaboration & in conjunction with EURO-PERISTAT


Roam r eproductive o utcomes a nd m igration an international research collaboration

Sophie Alexander, Université libre de Bruxelles (Belgium)

Béatrice Blondel, INSERM (France)

Simone Buitendijk, TNO Institute – Prevention and Care (Netherlands)

Marie Desmeules, Public Health Agency of Canada

Dominico DiLallo, Agency for Public Health – Rome (Italy)

Anita Gagnon (co-leader), McGill University/MUHC, (Canada)

Mika Gissler, STAKES (Finland)

Richard Glazier, Inst. For Clinical Evaluative Sciences (Canada)

Maureen Heaman, University of Manitoba (Canada)

Dineke Korfker, TNO Institute – Prevention and Care (Netherlands)

Alison Macfarlane, City University of London (UK)

Edward Ng, Statistics Canada

Carolyn Roth, Keele University (UK)

Rhonda Small (co-leader), LaTrobe University (Australia)

Donna Stewart, Univ. Hlth Netwk of Toronto/U of T (Canada)

Babill Stray-Pederson, University of Oslo (Norway)

Marcelo Urquia, Inst. For Clinical Evaluative Sciences (Canada)

Siri Vangen, Dept Ob/Gyn of The National Hospital of Norway

Jennifer Zeitlin, INSERM and EURO-PERISTAT (France)

Meg Zimbeck, INSERM and EURO-PERISTAT (France)

ROAM = Reproductive Outcomes And Migration: An international research collaboration:


Funding acknowledgements

Funding acknowledgements

  • Canadian Institutes of Health Research (CIHR) - International Opportunities Program

  • Start-up support: Immigration et métropoles (Center of Excellence in Immigration Studies - Montreal)

  • Career support to AJG: Le fonds de la recherche en santé du Québec (FRSQ)

  • Visiting Scientist Scholarship to AJG: l'Institut national de la santé et de la recherche médicale (INSERM, France)


Background

Background

  • Perinatal health of migrant women is a priority for many governments

  • No consensus exists on indicators for monitoring migration and perinatal health

  • ROAM began its work by undertaking an extensive review of the literature:

    • One purpose was to inventory migrant terms and definitions used to study this issue

    • This inventory formed the basis from which the expertise of researchers specializing in this topic was sought to identify the most appropriate indicators to be used through a Delphi process


Objectives for this project

Objectives for this project

  • To achieve consensus on migration indicators to be used internationally for:

    • Perinatal health surveillance indicator sets &

    • Routine population-based perinatal surveys

  • To obtain suggestions on migration indicators and definitions to be used for research projects.


Methods modified delphi process

Methods:Modified Delphi process

  • A formalized consensus method:

    • A panel of people respond to successive series of questionnaires with the aim of achieving a consensus on key principles/proposals

    • Participants rank items by priority or importance; can give comments

  • Participants:

    • 38 perinatal clinicians, epidemiologists, experts in health information systems from EURO-PERISTAT, ROAM, and others (recommended by ROAM)

    • 22 countries including Europe, Scandinavia, Australia, Canada

  • Questionnaires:

    • Derived from the ROAM systematic review of literature

    • Each participant completed between 1 and 3 questionnaires (“rounds” of questionnaires)

    • Summary results of each preceding round of questionnaires were provided in conjunction with a new set of questions


Results

Results


Importance of indicator

Importance of indicator

  • Concepts considered important/essential by >50%:

    • Country of birth

    • The time that the migrant has been in the country (measured by: recent immigrant, length of time in country, age at migration and year of migration)

    • Immigration status (undocumented, irregular migrant, immigration status, asylum seeker, refugee)

    • Language fluency

    • Ethnicity


Feasibility of indicator

Feasibility of indicator

  • Generally low

  • Country of birth had the highest rating

    • 65% thought this indicator could be collected in data registries with no or minor modifications

    • 69% in routine population surveys

  • In general, feasibility was considered to be higher in routine population surveys.

  • Poor feasibility for: undocumented/ irregular status, asylum-seeker/refugee status, ethnicity, receiving country language fluency


Consensus to reduce the migration indicator list

Consensus to reduce the migration indicator list

  • Agreement with the reduced list of indicators to consider = 79%

    • Country of birth

    • Recent immigrant

    • Immigration status

    • Language

    • Ethnicity


Recommendations core indicator routine data collection

Recommendations:Core indicator - routine data collection


Recommendations recommended indicator routine data collection

Recommendations:Recommended indicator - routine data collection


Recommendations recommended indicator specific studies or added to routine data collection

Recommendations:Recommended indicator - specific studies or added to routine data collection


Recommendations recommended indicator specific studies or added to routine data collection cont d

Recommendations:Recommended indicator - specific studies or added to routine data collection (cont’d)


Additional info to be provided when issuing common recommendations ethics

Additional info to be provided when issuing common recommendations: Ethics

  • Collecting and presenting data on migration requires special attention to ethics and the way that these data are used and interpreted in my country:

    Yes = 70%

    No = 18%

    No response = 12%

  • Comments:

    • Useful for healthcare providers not to know about legal status of patients – can’t refuse them treatment

    • Several privacy laws apply

    • Info may be censored with small sample sizes

    • Using broader categories to report results may reduce “singling out” any particular group


Additional info to be provided when issuing common recommendations ethics cont d

Additional info to be provided when issuing common recommendations: Ethics (cont’d)

  • Comments (cont’d):

    • Use of data on migrant groups is always a worry even when we are clear on our intentions regarding optimizing care…

    • We could be helping to create negative social stereotypes

  • Precautions to be taken:

    • Try to get government buy-in

    • Consult those upholding privacy regulations

    • Could ensure measuring aspects of health thought to be positive in migrants at the same time as measuring those that are negative

    • Be aware of the discourse…

    • Inform women of their privacy rights

    • Create institutions with legal mandates to collect this information

    • Include migrants in data interpretation and reporting


Conclusions

Conclusions

  • Our group recommends:

    • Essential indicator to be used in international comparisons of migration and perinatal health be migrant country of birth

    • Perinatal mortality rates by migrant country of birth be presented for each source region (data not presented)

    • Time since arrival in receiving country be added to routine data collection

    • Studies be undertaken to complement routine data collection on:

      • immigration status

      • receiving country language fluency

      • ethnic origin as defined by maternal parents’ place of birth

    • As soon as available, present several perinatal indicators with the recommended migration indicators


Thank you

Thank you!

[email protected]


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