This scoping review seeks to addressing the following: What evidence is currently available to describes access to formal maternal health services and informal supports for resettled refugee women during the postnatal period?
The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews.25 The population-concept-context (PCC) framework will be used to align the research question with study selection.25 See Additional File 1 for PRISMA-P flowchart.
This review will consider studies that focus on refugee women who have been resettled in designated UNHCR resettlement countries. Immigrant, migrant, and refugee-claimant women will not be included. No restrictions will be placed on country of origin, women’s age, religion, sexual orientation, or marital status. Studies that have elicited healthcare providers’ perceptions on access to postnatal services and supports for refugee women will also be included.
Access to postnatal health services. For the purposes of this study, the postnatal period will be defined as the first 12 months after childbirth. Maternal, not infant health, will be the focus of this review. Formal health services will include any health services provided by a healthcare professional. This will include, but is not limited to, services provided by family physicians, obstetricians and gynecologists, nurses, pharmacists, social workers, psychologists, counsellors, physiotherapists, massage therapists, doulas, midwives. Access to healthcare has been defined as “the opportunity to reach and obtain appropriate healthcare services in situations of perceived need for care” (p.4).26 Access to healthcare has five key features. This includes the possibility of the user to: 1) identify their healthcare needs, 2) seek out healthcare services, 3) reach necessary healthcare resources, 4) obtain or use healthcare services, and 5) be offered services appropriate to the needs of care.26
Informal supports. Informal supports can include: informational support (providing advice or guidance), instrumental support (offering material aid or assistance with tasks), and emotional support (acting as a confident, bolstering self-esteem) during the postnatal period, as provided by spouses, relatives, friends or associates (in-person and online).8
This review will consider studies have been conducted in UNHCR resettlement countries. The complete list of countries that have historically resettled refugees (between the years 2003 and 2020) in collaboration with the UNHCR have been listed in Table 1.27 This includes predominately high and upper-middle income countries.28 Access to services in refugee camps or other temporary settlements will not be included in this review. Refugees of any ethnicity or country of origin will be included.
Types of sources
This scoping review will consider all study designs including randomized controlled trials, non-randomized controlled trials, before and after studies and interrupted time-series studies. In addition, analytical observational studies including, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies, will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports, and descriptive cross-sectional studies.
Qualitative studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research will also be considered. Other sources that meet inclusion criteria, such as systematic reviews, dissertations, gray literature, opinion papers, and research papers that include sub-analyses, will be considered for inclusion. Studies published in English will be included. Only studies published after 2003 will be included, as that was when UNHCR resettlement data was made publicly available.
The JBI three-step search strategy will be implemented in this review.25 The search strategy, developed in conjunction with a librarian scientist, will aim to locate both published and unpublished primary studies. An initial limited search of CINAHL (Appendix I) was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for CINAHL. The search strategy, including all identified keywords and index terms will be adapted for each included information source. The reference lists of articles selected for full text review will be screened for additional studies.
The databases to be searched include CINAHL (EBSCO), MEDLINE (OVID), Embase (Elsevier), Studies on Women & Gender Abstracts (Taylor and Francis), Academic Search Premier (EBSCO), Sociological Abstracts (ProQuest), Social Services Abstracts (ProQuest), PAIS Index (ProQuest), Public Affairs Index (EBSCO), and PsycINFO (American Psychological Association). Sources of unpublished studies and gray literature to be searched include: The United Nations, the United Nations High Commissioner on Refugees, the International Organization for Migration, Centre for Disease Control, United Nations Population Fund, the World Health Organization, Google Scholar, ProQuest Dissertations and Theses Databases, Migration Policy Institute, Refugee Council, Canadian Council for Refugees, Gray Literature Report [via New York Academy of Medicine website],
Following the search, all identified records will be collated and uploaded into Covidence (Veritas Health Innovation, Melbourne, Australia) and duplicates removed. Titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant papers will be retrieved in full and their citation details imported into the Joanna Briggs Institute’s System for the Unified Management, Assessment and Review of Information (JBI SUMARI) (The Joanna Briggs Institute, Adelaide, Australia). The full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of full text papers that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the selection process will be resolved through discussion or with a third reviewer. The results of the search will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) flow diagram.29
Data will be extracted from papers included in the scoping review by two independent reviewers using a data extraction tool developed by the reviewers. The data extracted will include specific details about the population, concept, context, methods, and key findings relevant to the review question. A draft data extraction tool is provided in Appendix II. This tool has been piloted by ESC. The draft data extraction tool may be modified and revised as necessary during the process of extracting data from each included paper. Modifications will be detailed in the full scoping review. Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Authors of papers will be contacted to request missing or additional data, where required.
The extracted data will be presented in diagrammatic or tabular form in a manner that aligns with the objective of this scoping review. A narrative summary will accompany the tabulated and/or charted results and will describe how the results relate to the reviews objective and question.