Access to and use of healthcare services by Palestinian women in the UK. Focusing on maternal and child healthcare services

Alshawish, Eman (2013) Access to and use of healthcare services by Palestinian women in the UK. Focusing on maternal and child healthcare services. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

The UK has a relatively large and increasing Black and Minority Ethnic (BME) population. It is acknowledged that this group has, until now, experienced poorer health, and that there have been barriers for them accessing certain services. There are an increasing number of women from Palestine currently living in the UK. Their access to, and use of, maternal and child healthcare (MCH) services have not been investigated before. From an initial review of the literature there does not appear to be any research which has examined Palestinian women’s access to and use of MCH services. This study will address these gaps and explore the access and use of MCH services by Palestinian women in the UK. The overall aim of the study is to investigate the access to, and use of, MCH in the UK by Palestinian women. The specific objectives are: to explore facilitators and barriers to care for Palestinian women in in the UK; to determine what provisions exist which are intended to facilitate access to healthcare services; to explore factors that may demonstrate effective and positive change to health services and to make recommendations for improving the health service provision for Palestinian women in the UK. The study was designed to use a sequential, exploratory, mixed-method, pragmatic approach. In phase one - twenty-two, in-depth, face-to-face, semi-structured interviews were conducted. In phase two - survey questionnaires were distributed through the Palestinian organisations to generalise the qualitative findings and 243 questionnaires were returned from responders. Four themes emerged from the findings of the qualitative interview, which were: ‘cultural variations’; ‘knowledge of the NHS and the UK healthcare system’; ‘healthcare services and their utilisation, focusing on maternal and child healthcare services,’ and ‘communication, information provision and needs’. The quantitative findings focused on issues specific to Palestinian women, although they might resonate with other BME groups. These include: cultural variations, such as the use of herbal medicine; self-prescribed medication (antibiotics); termination of pregnancy (fatalism); circumcision for male babies; breastfeeding practice and preference for a female GP and caregiver; knowledge of the UK health system; confidence in using the English language; interpreter services; late booking of pregnancy; not attending antenatal classes; duration of visit time and information needs. This study strives to reduce inequalities in MCH among Palestinian women in the UK by highlighting the issue surrounding Palestinian women’s access to, and use of, MCH services. It is important to have a culturally sensitive MCH service that is flexible, adequate and accessible. The study concludes with the following recommendations:  Having cultural competence care and adaptive services for Palestinian and all minority ethnic groups are crucial to have equitable services.  Culturally appropriate care could be satisfactorily achieved through effective and continuous training programmes based on culture, ethnicity and religion for all health professionals, in order to understand patient needs.  Interpretation services should be provided to Palestinian women who have the need. Midwives or nurses should provide oral explanations as well as leaflets to allow patients a full choice when making a decision.  An important implication for midwifery-nursing practice is that, when developing education interventions for this population, it may not be appropriate to implement a “One Size Fits All” programme.  Another practical suggestion is to have a videotape/podcast provided explaining all the required information in English and Arabic languages. This could increase the patients’ knowledge about using and accessing healthcare services