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Perinatal mental health disorders are among the most common morbidities of the perinatal period with considerable adverse effects on mothers and their offspring. Members of ethnic minority groups, particularly those from migrant backgrounds, are at higher risk of developing mental illness with evidence of ongoing inequality in access to support. We will present an exploratory mixed-methods study scoping ethnic minority and migrant women’s experiences accessing perinatal mental health services in the UK. Results showed how women perceived access to services as very challenging and how they experienced ‘suffering in silence’, a ‘need for a safe space to talk and to be listened to’, and a ‘need of finding other women like them’. We will complement these findings with the lessons learned from a related project, a three-site European study (ORAMMA) evaluating the feasibility of implementing an integrated perinatal care model for migrant mothers comprising maternity peer supporters (MPSs)-women from migrant backgrounds who had lived in the country for a longer time and were trained to support other migrant women during the childbearing continuum-. Results showed that MPSs supported migrant women accessing maternity care, over- coming language barriers, and advocating for them in their encounters with healthcare professionals. Besides, they provided emotional support and increased women’s confidence, helping them overcome loneliness, encouraging them to build relationships with others and promoting bonding with the new baby. Bringing these two projects together, we will discuss how MPSs have the potential to help overcome barriers that immigrant women experience in seeking perinatal mental health and how the benefits of maternity peer supporters have the potential to reduce perinatal mental health risks amongst migrant mothers. Findings will point to the need for future research to evaluate the direct impacts of MPSs on immigrant’s mother perinatal mental health. [ABSTRACT FROM AUTHOR]

Background: effectiveness of single disease management programs (DMP) in general practice may be limited for patients with low socioeconomic status (SES), as DMPs insufficiently take into account the specific problems and needs of this population. A Person-Centred Integrated Care (PC-IC) approach focusing on patient's needs could address these problems., Aim: to explore experiences of patients with (multiple) chronic diseases with regard to the acceptability of a general practice-based PC-IC approach, with a focus on patients with low SES, and to establish which modifications are needed to tailor the approach to this group., Design and Setting: in 2021, a 6 month feasibility study in seven general practices in the Netherlands was carried out. The healthcare professionals provided care based on a PC-IC approach to patients with diabetes, chronic respiratory diseases and/or cardiovascular disorders., Method: a qualitative study using focus group discussions, in-depth interviews, and semi-structured telephone interviews in a combined total of 46 patients with chronic diseases and multimorbidity, including 31 patients with low SES., Results: an overall positive experience of participants with the PC-IC approach was observed. Discussing their health made patients feel being taken more seriously, and provided the opportunity to discuss their life and health concerns. Recommended adaptations of the PC-IC approach for patients with low SES include creating comprehensible materials and offering communication training for healthcare professionals., Conclusion: the PC-IC approach seems helpful for chronic disease patients, provided that it is tailored to their skills and abilities. Several modifications for patients with low SES were suggested., (Copyright © 2024, The Authors.)

Background: Previous research highlights persistent differential attainment by ethnicity in medical education, wherein the perceived inclusiveness significantly influences ethnic minority students' and trainees' outcomes. Biased organizational practices and microaggressions exacerbate the challenges faced by ethnic minorities, leading to lower academic performance and higher dropout rates. Consequently, understanding ethnic minority GP-trainees' experiences and perspectives regarding relevant educational aspects is crucial for addressing these disparities and cultivating a more inclusive environment within medical education., Research Question: We aimed to investigate the experiences of minority GP-trainees throughout their educational journey in Dutch GP-specialty training, emphasizing their challenges, sources of support, and suggestions for enhancing their learning environment., Method: We conducted semi-structured, in-depth interviews with minority GP trainees, employing purposive convenience sampling to ensure diversity across multiple dimensions. These included gender, age, ethnicity, social background, migration generation, educational stage, encountered challenges, sources of support, and the GP training institute attended. The analysis involved iterative, open and axial coding, followed by generating, reviewing, and defining themes. For a structured analysis of encountered microaggressions, we adopted Sue's Taxonomy of Microaggressions., Results: All fourteen ethnic minority interviewees had faced educational barriers stemming from misunderstandings and stereotyping in a predominantly 'white' organization. These barriers impacted various aspects of their education, including professional identity formation, application, admission, assessment procedures, social networks, course content, and expert guidance. Microaggressions permeated throughout their educational journey, hindering their full expression and potential. Their ideal GP-specialty training emphasized uniqueness of all trainees, comprehensive staff engagement in inclusivity, robust diversity, equity, and inclusion (DEI)-policies, individual mentorship, transparent standards, concise language usage in test questions, and bias elimination through mandatory DEI staff training., Conclusion: Ethnic minority GP-trainees in the Netherlands face significant challenges like biased assessment and admission, stereotyped course content, inadequate support networks, and microaggressions, putting them at risk for underperformance outcomes. They emphasize the need for inclusive training with robust DEI-policies to eliminate bias., Competing Interests: Declarations. Ethics approval and consent to participate: In accordance with the Declaration of Helsinki, participation in the study was voluntary, with informed consent for participation and publication obtained from all participants. The Dutch Association for Medical Training's Ethical Review Board approved the study (file number 2018.7.14). Data handling followed the General Data Protection Regulation and Amsterdam UMC Clinical Research Unit procedures and we shared the study results with all participants. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Training can improve healthcare providers' cultural competence and increase their awareness of bias and discrimination in medical decision-making. Cultural competences training is lacking in the education of dieticians in the Netherlands. The aim of this study was to describe the pilot-implementation of a cultural competence training for dieticians and preliminary evaluation of the training., Methods: A training was developed based on Seeleman's cultural competence framework and previously held interviews with migrants, dieticians, and experts. The training consisted of a mixture of didactic and experiential methods, alternating knowledge transfer with exercises to increase awareness, reflection, and feed-back on recorded consultations, and communication training with migrant training actors. The training was piloted in 8 participating dieticians and preliminary mixed-method evaluation was done using a Cultural Competence Questionnaire, Experience Evaluation Questionnaire, and consultation observations., Results: The questionnaires showed that dieticians were positive about the training. They found it valuable and educational. Participants reported an increase in self-perceived cultural competence and attitudes. Knowledge and skills remained approximately the same. The observations showed that dieticians applied the teach-back method and discussed treatment options more often after training. There was no increase in the use of visual materials., Conclusion: The training was well appreciated and, although a small-scale pilot, this mixed-method study suggests an ability to change cultural competence. The combination of a self-assessment instrument and consultation observations to evaluate cultural competence was highly valuable and feasible. These encouraging results justify a broader implementation of the training.

Background: Fibroids are non-cancerous uterine growths that can cause symptoms impacting quality of life. The breadth of treatment options allows for patient-centered preference. While conversation aids are known to facilitate shared decision making, the implementation of these aids for uterine fibroids treatments is limited. We aimed to develop two end-user-acceptable uterine fibroids conversation aids for an implementation project. Our second aim was to outline the adaptations that were made to the conversation aids as implementation occurred., Methods: We used a multi-phase user-centered participatory approach to develop a text-based and picture-enhanced conversation aid for uterine fibroids. We conducted a focus group with project stakeholders and user-testing interviews with eligible individuals with symptomatic uterine fibroids. We analyzed the results of the user-testing interviews using Morville's Honeycomb framework. Spanish translations of the conversation aids occurred in parallel with the English iterations. We documented the continuous adaptations of the conversation aids that occurred during the project using an expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME)., Results: The first iteration of the conversation aids was developed in December 2018. Focus group participants (n = 6) appreciated the brevity of the tools and suggested changes to the bar graphs and illustrations used in the picture-enhanced version. User-testing with interview participants (n = 9) found that both conversation aids were satisfactory, with minor changes suggested. However, during implementation, significant changes were suggested by patients, other stakeholders, and participating clinicians when they reviewed the content. The most significant changes required the addition or deletion of information about treatment options as newer research was published or as novel interventions were introduced into clinical practice., Conclusions: This multi-year project revealed the necessity of continuously adapting the uterine fibroids conversation aids so they remain acceptable in an implementation and sustainability context. Therefore, it is important to seek regular user feedback and plan for the need to undertake updates and revisions to conversation aids if they are going to be acceptable for clinical use., (© 2024. The Author(s).)

Background: The rise of global forced migration urges healthcare systems to respond to the needs of forced migrants (FM) during pregnancy and childbirth. Yet, comprehensive data on the health outcomes of pregnant FM in destination countries remain scarce. This study aimed to describe the characteristics and maternal and perinatal outcomes of pregnancy in this specific migrant population on a national scale in the Netherlands and to explore differences from other populations., Methods: The Dutch perinatal registry was linked to national migration data to analyze pregnancy outcomes in FM (2014-2019), using non-migrants (NM) and resident migrants (RM) as reference populations. We reported outcome rates (% [95 % CI]) for a range of primary and secondary pregnancy outcomes. Primary outcomes included perinatal mortality, small for gestational age infants (SGA), preterm birth, and emergency cesarean section (CS), for which we also calculated the crude relative risk (RR [95 % CI]) of FM compared to NM and RM. In addition, we conducted binary logistic regression analyses on primary outcomes to report adjusted odds ratios (aORs [95 % CIs]) while controlling for multiple births, maternal age and parity., Findings: Compared to the NM group, the FM group had increased risks of perinatal mortality (RR 1.50 [95 % CI 1.20-1.88]), SGA (1.65 [1.59-1.71], and emergency CS (1.19 [1.13-1.25]). Compared to RM, FM still had elevated risks of SGA (1.17 [1.13-1.22]). In contrast, the risk of preterm birth was lower in FM than in NM (0.81 [0.76-0.86]) and RM (0.83 [0.77-0.88]). These differences were confirmed in the adjusted analysis. Differences in secondary outcomes included higher rates of late antenatal care in FM (29.4 % [28.5-30.3]) than in NM (6.7 % [6.6-6.9]) and RM (15.5 % [15.1-15.9]). Rates of planned CS were similarly elevated (14.3 % [95 % CI 13.7-14.8] versus 7.·8 % [7.7-7.8] and 9.6 % [9.5-9.7]), while FM had lower rates of postpartum hemorrhage (3.9 % [3.6-4.2]) versus 6.8 % [6.8-6.9] and 5.7 % [5.6-5.9])., Conclusion: This first Dutch registry-based study demonstrated increased risks of multiple, though not all, adverse pregnancy outcomes in forced migrants. Our results emphasize the imperative to further unravel and address migration-related disparities, dismantle structural barriers to health among forced migrants, and improve the inclusivity of data systems. Collaborative policy, clinical practice, and research efforts are essential to ensure equitable care for every individual, regardless of migration status., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: The physical and the social environment are important predictors of healthy weight, especially in low socioeconomic position (SEP) neighborhoods. Many Dutch municipalities have implemented a healthy weight approach (HWA). Yet, there is room for improvement. This system science study examined what influences the utilization of HWA facilities and activities, and what aspects can help to achieve a desired systems change (also called leverage point themes (LPTs)) in the HWA system as perceived by citizens living in low SEP neighborhoods., Method: All research phases were performed with four citizens co-researchers. Forty-seven citizens living in low SEP neighborhoods were semi-structurally interviewed about the neighborhood HWA facilities and municipal HWA activities. A rapid coding qualitative analysis approach was applied per topic. The topics were citizens' healthy living description, personal circumstances, and satisfaction with foot and cycle paths, sports facilities, playgrounds, green spaces, museums and theaters, community centers, churches, healthcare, school, food supplies, contact with neighborhood, unfamiliar and/or unused activities, familiar and used activities, unavailable but desired (lacking) activities, and reaching citizens., Results: The utilization of HWA facilities and activities was influenced by the overarching themes of social cohesion, familiarity, reaching citizens, maintenance, safety, physical accessibility, financial accessibility, social accessibility, fit with personal context, and fit with the neighborhood's specific needs. Different overarching themes stood out across different facilities and activities. LPTs indicated the overarching themes needed in combination with one another for a specific activity or facility to increase utilization. For example, the LPT regarding foot and cycle paths was "accessible, safe, and maintained foot and cycle paths". The LPTs regarding familiar and used activities were "customized activities; information provision (e.g., about possibilities to join without paying); social contact, meeting others, and everyone feels included"., Conclusion: Conducting inclusive qualitative research from a systems perspective among citizens living in low SEP neighborhoods has contributed valuable insights into their needs. This enables practical implementation of HWAs by providing a deeper understanding of the LPTs within the HWA system. LPTs can help HWA stakeholders to further develop current HWAs toward systems approaches. Future research could study the leverage points that may contribute to LPT implementation., (© 2024. The Author(s).)

Purpose: Person-centered care is foundational to good quality primary care and has positive effects on health outcomes and patient satisfaction. The Person-Centered Primary Care Measure (PCPCM) is a recently developed, patient-reported survey able to assess person-centeredness and has demonstrated strong validity and reliability. Little is known, however, about the feasibility of the PCPCM in non-English-speaking settings. We aimed to translate the questionnaire into Dutch, psychometrically evaluate the translated version, and ensure its feasibility for patients in Dutch primary care., Methods: We translated the PCPCM into Dutch using forward-backward translations. We conducted psychometric evaluations to ensure its feasibility among Dutch-speaking primary care patients, with special attention to low literacy populations. Next, we assessed structural validity, convergent validity using the Quality of Care Through the Patient's Eyes (QUOTE) questionnaire, and internal consistency in a cross-sectional study in primary care., Results: Translation and adaptation for low literacy populations required 4 iterations. In 4 general practices, 205 patients completed the survey. Confirmatory factor analyses could not confirm the 1-factor solution. The 3-factor solution was found to be a more optimal fit: comprehensiveness of care, personal relation, and contextual care. Internal reliability was high (Cronbach's α were 0.82, 0.73, and 0.86, respectively). We found a strong correlation between the total PCPCM and QUOTE scores (Spearman's ρ = 0.65, P <.001), indicating good convergent validity., Conclusion: The Dutch version of the PCPCM has acceptable validity and reliability for measuring person-centeredness in primary care among Dutch-speaking populations including those with low literacy., (© 2024 Annals of Family Medicine, Inc.)

General practitioners (GPs) are often unaware of antipsychotic (AP)-induced cardiovascular risk (CVR) and therefore patients using atypical APs are not systematically monitored. We evaluated the feasibility of a complex intervention designed to review the use of APs and advise on CVR-lowering strategies in a transmural collaboration. A mixed methods prospective cohort study in three general practices in the Netherlands was conducted in 2021. The intervention comprised three steps: a digital information meeting, a multidisciplinary meeting, and a shared decision-making visit to the GP. We assessed patient recruitment and retention rates, advice given and adopted, and CVR with QRISK3 score and mental state with MHI-5 at baseline and three months post-intervention. GPs invited 57 of 146 eligible patients (39%), of whom 28 (19%) participated. The intervention was completed by 23 (82%) and follow-up by 18 participants (64%). At the multidisciplinary meeting, 22 (78%) patients were advised to change AP use. Other advice concerned medication (other than APs), lifestyle, monitoring, and psychotherapy. At 3-months post-intervention, 41% (28/68) of this advice was adopted. Our findings suggest that this complex intervention is feasible for evaluating health improvement in patients using AP in a trial., (© 2024. The Author(s).)