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Contextualising a South African social innovation for maternal and child health to mothers with experiences of migration in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre.ORCID iD: 0000-0002-3910-8225
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Despite a universally accessible and high-quality welfare system, disparities in health and wellbeing persist between families who have migrated to Sweden and the native population. The South African Mentor Mother programme, a social innovation for maternal and child health among socially disadvantaged communities, was transferred and adapted to benefit mothers and pregnant women with experiences of migrating to Sweden.

This thesis aims to explore the adaptation, implementation and further development of the South African Mentor Mother programme in two locations in Sweden, based on professional and lived experience among various groups of stakeholders.

In Study I, three workshops and eleven interviews were held with stakeholders to explore central aspects of the adaptation process. These aspects entailed prioritising social determinants of health over health behaviour change, using indirect mechanisms and social ripples to achieve change, prioritising referring clients over intervening directly, recruiting peer supporters with competencies responding to a heterogeneous socio-cultural context, and allowing flexibility in programme content and methods.

In Study II, nineteen interviews with different stakeholders and digital field logs of peer support meetings (n=1,294) were used to evaluate the implementations of the programme. Contextual factors of importance included institutional mistrust, gender norms, unpredictable funding, and the organisation's third sector affiliation. Peer supporters prioritised linking clients to welfare services over educational intervention components, and sometimes experienced blurring between professional and personal roles. Practical support and trustful relationships emerged as important entry points to support more sensitive issues. 

In Study III, the photovoice method was used to conduct a focus group discussion and six interviews with Mentor Mothers and their coordinator in Gothenburg, exploring how they developed empowerment strategies perceived to be relevant, feasible and effective. These strategies consisted of various aspects of using both informative, practical, psychosocial and motivational support to meet community health and social needs.

In Study IV, twenty-one interviews with Mentor Mothers, client mothers and other stakeholders were conducted to explore the emergence and management of mistrust in welfare services in Gothenburg. Mistrust was described to arise through rumours, unclear interactions with services, and lack of familiarity with the welfare system. Mentor Mothers used various strategies to build trusting relations with clients, which enabled them to promote institutional trust through information and humanisation of service providers.

This thesis illustrates how innovative community-based solutions to complex societal problems can be transferred between contexts, implemented and further developed to ensure their relevance to the target group.

Place, publisher, year, edition, pages
Uppsala: Uppsala University, 2024. , p. 108
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2033
Keywords [en]
Social innovation, peer support, migration, parenting, parents, children, health promotion, trust, mistrust, implementation, empowerment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-524965ISBN: 978-91-513-2069-4 (print)OAI: oai:DiVA.org:uu-524965DiVA, id: diva2:1844780
Public defence
2024-05-08, Lecture Hall IV, University Main Building, Biskopsgatan 3, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2024-04-11 Created: 2024-03-15 Last updated: 2024-04-11
List of papers
1. Adapting a South African social innovation for maternal peer support to migrant communities in Sweden: a qualitative study
Open this publication in new window or tab >>Adapting a South African social innovation for maternal peer support to migrant communities in Sweden: a qualitative study
2022 (English)In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 21, no 1, article id 88Article in journal (Refereed) Published
Abstract [en]

Introduction and aim Social and health disparities persist in Sweden despite a high quality and universally accessible welfare system. One way of bridging social gaps is through social innovations targeting the most vulnerable groups. The South African Philani model, a social innovation for peer support aimed at pregnant women and mothers of young children, was adapted to the local context in southern Sweden. This study aimed to document and analyze the process of adapting the Philani model to the Swedish context. Methods Eight semi-structured interviews and three workshops were held with eleven stakeholders and peer supporters in the implementing organization and its steering committee. The data were analyzed using thematic analysis. Results The analysis resulted in five main themes and fifteen sub-themes representing different aspects of how the peer support model was contextualized. The main themes described rationalizations for focusing on social determinants rather than health behaviors, using indirect mechanisms and social ripple effects to achieve change, focusing on referring clients to established public and civil society services, responding to a heterogeneous sociocultural context by recruiting peer supporters with diverse competencies, and having a high degree of flexibility in how contact was made with clients and how their needs were met. Conclusion The South African Philani model was contextualized to support socially disadvantaged mothers and expectant mothers among migrant communities in Sweden. In the process, adaptations of the intervention's overall focus, working methods, and recruitment and outreach strategies were motivated by the existing range of services, the composition of the target group and the conditions of the delivering organization. This study highlights various considerations that arise when a social innovation developed in a low- or middle-income context is implemented in a high-income context.

Place, publisher, year, edition, pages
Springer NatureSpringer Nature, 2022
Keywords
Health inequity, Paraprofessionals, Home visiting, Social determinants of health, Migration, Segregation, Social integration, Early childhood development, Social innovation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-479897 (URN)10.1186/s12939-022-01687-4 (DOI)000814630700001 ()35733169 (PubMedID)
Funder
EU, Horizon 2020
Available from: 2022-07-05 Created: 2022-07-05 Last updated: 2024-03-15Bibliographically approved
2. Implementing a social innovation for community-based peer support for immigrant mothers in Sweden: a mixed-methods process evaluation
Open this publication in new window or tab >>Implementing a social innovation for community-based peer support for immigrant mothers in Sweden: a mixed-methods process evaluation
Show others...
2024 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1332738Article in journal (Refereed) Published
Abstract [en]

Introduction: A South African social innovation based on peer support for mothers was contextualized in southern Sweden. The objective of the project was to support expectant women and mothers of young children in immigrant communities to access public services that would benefit maternal and child health. This study aimed to assess how the intervention was implemented, what the contextual barriers and facilitators were, and how the implementation was perceived by those who delivered and received it.

Methods: The study used mixed methods with a convergent parallel design and followed the Medical Research Council guidance on process evaluations of complex interventions. Semi-structured interviews (n = 19) were conducted with peer supporters, client mothers, and key stakeholders involved in the intervention. The qualitative data were analyzed using content analysis. Quantitative data on peer supporters' activities were collected during contacts with client mothers and were presented descriptively.

Results: The five peer supporters had 1,294 contacts with client mothers, of which 507 were first-time contacts. The reach was perceived as wide, and the dose of the intervention was tailored to individual needs. Barriers to implementation included community mistrust of social services, norms on gender roles and parenting, and funding challenges. The implementation was facilitated by the organization's reputation, network, experience, and third-sector affiliation. Peer supporters tended to prioritize linking clients to other services over the educational components of the intervention, sometimes doing more than what was originally planned. Implementation strategies used included building trust, using multiple outreach venues, using internal support structures, and providing practical assistance as an entry point to comprehensive psychosocial support. The personal connection between peer supporters and clients was highly valued, and the building of relationships enabled them to address sensitive topics. Peer supporters sometimes experienced a blurred line between professional and personal roles.

Conclusions: Peer supporters used a variety of strategies to navigate identified barriers and facilitators. Trust was central both as a contextual factor and a strategy for implementation. It is valuable to maintain a balance between flexibility and adherence to the function of peer supporters. Further research is needed to evaluate the effects of the intervention.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
social innovation, peer support, process evaluation, mixed-methods, parents, children, maternal and child health
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social Work
Identifiers
urn:nbn:se:uu:diva-522456 (URN)10.3389/fpubh.2023.1332738 (DOI)001148794600001 ()38283291 (PubMedID)
Funder
Uppsala University
Available from: 2024-02-07 Created: 2024-02-07 Last updated: 2024-03-15Bibliographically approved
3. Empowerment strategies of the Mentor Mother peer support program among immigrant mothers in Sweden: a Photovoice study
Open this publication in new window or tab >>Empowerment strategies of the Mentor Mother peer support program among immigrant mothers in Sweden: a Photovoice study
(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-524183 (URN)
Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2024-03-15
4. Mentor Mothers as trust brokers between immigrant communities and the Swedish welfare system: A qualitative study
Open this publication in new window or tab >>Mentor Mothers as trust brokers between immigrant communities and the Swedish welfare system: A qualitative study
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-524184 (URN)
Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2024-03-15

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