How to promote maternal mental well-being in refugee mothers through home visiting: the Danish experience

Abstract

Refugee women are at increased risk to develop perinatal mental health problems, including postpartum depression. The fact that refugee and immigrant women suffering PPD are more likely to be exposed to poverty, lack of social support, or restricted working opportunities suggest that a comprehensive approach that addresses the broader social determinants of health is suited to effectively support their perinatal mental health needs. However, public health programs with such a comprehensive approach are scarce in most European countries. We will present qualitative findings from ‘Health nurses strengthen integration', a universal home visiting program aimed to strengthen the integration of refugee families in Denmark. The program includes a minimum of five 2-h meetings including a mind-mapping of families' psychosocial needs, a focus on parenting in a new culture, and support to connect with social and health services. Nurses are trained in cultural competencies and are provided with interpreters. We conducted 3 focus groups (n = 11) and 2 interviews with health visitors (HV) and 9 interviews with refugee mothers to identify what aspects of a comprehensive approach that foster families' integration can support the mental well-being of refugee mothers after birth. Using thematic network analysis we found how the structure, extra time, and training in cultural competence facilitated HV to use critical self-reflection and cultural sensitivity, use respectful curiosity, create a safe space for sharing, and ‘hand-hold' families in interactions with other services. These practices permitted HV understand the complex needs of families, build trust, and facilitate interactions with others services. Interviews with families illustrated how 1) feeling that someone cared ‘like family', 2) and build-bridging with services (doctor, school, job center) reduced families daily stress. Using the family stress and adaptation theory we will discuss program and policy implications.