Maternal Acculturation and the Prenatal Care Experience

Abstract

Background: Acculturation may influence women's perceptions of health care experiences and may explain the epidemiologic paradox, whereby foreign-born women have lower rates of adverse birth outcomes than United States (US)-born women. We evaluated the relationship between maternal acculturation and specific dimensions of prenatal interpersonal processes of care (IPC) in ethnically diverse women. Methods: Cross-sectional analysis of 1243 multiethnic, postpartum women who delivered at Kaiser Permanente Medical Center in Walnut Creek or San Francisco General Hospital. Women retrospectively reported on their experiences in seven domains of IPC during their pregnancy pertaining to communication, decision making, and interpersonal style. The primary independent variables were four measures of maternal acculturation: birthplace, English language proficiency, the number of years residing in the US, and age at immigration to the US. Generalized linear models, stratified by infant outcome, measured the association between each maternal acculturation measure and specific IPC domains while adjusting for type of health insurance, demographic, and reproductive factors.Results: Approximately 60% of the sample was foreign-born, 36% reported low English proficiency, 43% had resided in the US < 10 years, and 35% were age 20 years or older when they immigrated to the US. Over 64% of the women reported having public insurance during pregnancy. In adjusted analyses among women who delivered term and normal birth weight infants, less acculturated women and women with non-private health insurance were more likely to have higher mean IPC scores when compared to more acculturated or US-born women and women with private health insurance, respectively. Conclusion: In a large and ethnically diverse sample of childbearing women in Northern California, less acculturated pregnant women reported better prenatal care experiences than more acculturated and US-born women, another dimension of the ''epidemiologic paradox.'' However, the relationship between acculturation and IPC, as reported during the postpartum period, differed according to infant outcomes.

Racial and ethnic disparities in birth Outcomes: A decomposition analysis of contributing factors

“…This was partially reflected in this study whereby 9.2% of Hispanic women in the study had to pay for their health insurance themselves, as compared to 2.5% among NHW women and 3.7% among NHB women. Besides lower income and lack of health insurance coverage, many Hispanic women, especially foreign-born Hispanic women had to overcome language barriers and potential acculturative stress before they could effectively navigate the health care system in the U.S. for prenatal care ( Fuentes-Afflick et al, 2014 ).…”

Maternal health literacy and health numeracy conceptualizations in public health: A scoping review

“…Mothers discuss choices regarding care, diagnostics, and treatment (Aune & Möller, 2012; Farrell et al, 2015; Martis et al, 2018; Vilella et al, 2017) with healthcare providers (Lagan et al, 2010; Lagan et al, 2011; Lori et al, 2017; Regan et al, 2013; Vamos, Merrell, Detman, et al, 2019), family members (Huberty et al, 2013), or friends (Castro‐Vázquez, 2013; Slomian et al, 2017) in order to make decisions, thus empowering them to receive the best care and support for self and family (Bert et al, 2013; Lagan et al, 2011). Two‐way dialogue and active listening during healthcare encounters instill feelings of mutual respect (Bergman & Connaughton, 2013; Carolan et al, 2012; Crowther & Lau, 2019; Fuentes‐Afflick et al, 2014; Payakachat et al, 2016), but mothers may not always initiate discussions (Castro‐Vázquez, 2013; Vamos, Merrell, Livingston, et al, 2019). Writing is a language competency that is essential to MHL because it represents learning and thinking, which is expressed through correct spelling, understanding of homophones, and encoding oral sounds into written prose; writing also provides mothers with opportunities to understand their lived experience and maintain verbal stories across generations, or healthcare encounters.…”

“…Third, practices of MHL and HN are essential to interpersonal communication with a support network she trusts (Fleury et al, 2010; Fuentes‐Afflick et al, 2014). Communication is used when mothers voice concern over their health, need emotional support and reassurance, and experience discrimination (Fuentes‐Afflick et al, 2014).…”

“…Third, practices of MHL and HN are essential to interpersonal communication with a support network she trusts (Fleury et al, 2010; Fuentes‐Afflick et al, 2014). Communication is used when mothers voice concern over their health, need emotional support and reassurance, and experience discrimination (Fuentes‐Afflick et al, 2014). Cultural competency during interactions with healthcare provider enhances satisfaction and trust, which is necessary for mothers to adhere to medical recommendations (Evans & Sheu, 2019).…”

Foreign-born Status on the risk of Gestational Diabetes Mellitus and Subsequent Complications: The Effect of Acculturation

“…There are several factors could be contributing to our result, showing an increased risk of adverse birth outcomes, with more acculturation among women with GDM. One is the presence of signi cant barriers to accessing healthcare, along with a lack of familiarity with the system and anti-immigration policies, which has been shown to lead to worse long-term health outcomes [25][26][27] . Also, the lessening of the protective effect from the healthy migrant effect, along with high levels of stress levels due to high levels of prejudice and discrimination, could contribute to worse birth outcomes for our 11 years in the US > foreign-born group 28 .…”