CHILDBEARING WOMEN AND FAMILIES IN A MULTICULTURAL EUROPE

Transcription

1 CHILDBEARING WOMEN AND FAMILIES IN A MULTICULTURAL EUROPE Seminar and Workshop at Metropolia University of Applied Sciences, Tukholmankatu 10, Helsinki, FINLAND, September, th 2017 Abstract book edited by Pirjo Koski, Anita Wikberg and Terese Bondas 1

2 Contents Seminar and Workshop at Metropolia University of Applied Sciences, Tukholmankatu 10, Helsinki, FINLAND, September, th Organizers... 3 Invited Guest Professors... 3 Aim and place... 3 Program... 4 Childbearing in Europe the qualitative cross disciplinary research network... 7 WoMBH-Net... 7 Key note speakers... 8 Methasynthesis in Health Care Research: professor Terese Bondas, Nord University, Bfin, Norway... 8 Using the Listening Guide as a form of data analysis: Professor of Maternal Health Ruth Deery, The Institute for Healthcare Policy and Practice. University of West Scotland... 8 Abstracts A theory of intercultural caring in maternity care Deliveries and induced abortions among women of Russian, Somali and Kurdish origin, and the general population in Finland Comparison of self-reported and register data Asylum-Seeking Women s Experiences of Childbirth in Finland The Midwife-Woman Relationship in a South Wales Community: Experiences of Midwives and Migrant Pakistani Women in Early Pregnancy We are the stories we tell about ourselves Development of Birth- and Parenthood education for Somali families in Finland Maternal Health in Humanitarian Migrants Living in Finland A doctoral thesis Enhancing health dialogues with refugee women Participants experiences deepening understanding through the method of reduction and the concept of the lifeworld Childbirth at home viewpoint of families Issues encountered evaluating a feasibility study on group antenatal care Childbirth education as a midwifery intervention Multicultural family training experiences of professionals Vaccination Competence Metasynthesis as an approach in childbearing research

3 Organizers Childbearing in Europe the qualitative research network (BfiN) in collaboration with Nord University, Faculty of Nursing and Health Sciences, Norway, University of Gothenburg, Sahlgrenska Academy, Sweden and the University of the West of Scotland. Network for Women s Health in Childbearing, with the focus on Migrants and Minorities (WoMBH-net) in collaboration with Metropolia UAS, Helsinki Finland, Novia UAS, Vaasa, Finland and Nord University, Norway. Leader team of the workshop: Terese Bondas, Professor, Nursing Science, Nord University, Faculty of Nursing and Health Sciences, Norway, BfIN and WoMBH Pirjo Koski, PhD, Senior lecturer, Metropolia UAS, WoMBH and BfIN Anita Wikberg, PhD, Senior lecturer, Novia UAS, Finland, WoMBH and BfiN Practical arrangements: WoMBH, Senior lecturer Pirjo Koski, Metropolia UAS Invited Guest Professors Terese Bondas, Professor, Nord University, Bfin, Norway Ruth Deery, Professor of Midwifery, The University West of Scotland, the United Kingdom, BfiN and WoMBH Aim and place The aim of this collaboration research seminar and workshop is to enable a deeper understanding of various qualitative approaches and methods in childbearing research, and research on childbearing migrant women, and the contribution to new knowledge in intercultural care. The cultural and linguistic diversity of the population poses a significant challenge to health policy development, service provision, professional education, and research. Qualitative research is an important tool for developing cultural sensitive care for all childbearing women and their families. The lectures will present ways to strengthen qualitative research and discuss different approaches. The participants will have the possibility to present and reflect on her/his qualitative research project in the areas of all childbearing and childbearing migrant women, from pregnancy, birth, postpartum and neonatal care. The second aim of the research workshop is to create an opportunity to develop cooperation in the field of qualitative childbearing research and migrant and minority childbearing women. Place: Tukholmankatu 10, Helsinki. FloSpace2 (TB4-13) (Tram 4 from Helsinki city centre). Skype connection on Thursday, September 14th :00 (Ms Outi Sorri) 3

4 Program Thursday, September 14th , FloSpace2 (TB4-13) Moderator, Professor Terese Bondas, Nord University, Bfin, Norway Welcome to research network seminar Metropolia UAS, WOMBH-net UAS Pirjo Koski Novia UAS, WOMBH-net Anita Wikberg Nord University, BFIN professor Terese Bondas Refreshments and short presentations of participants Metasynthesis in Health Care Research Keynote speaker Terese Bondas, Professor, Nord University, Bfin, Norway Break A theory of intercultural caring in maternity care Anita Wikberg, Senior lecturer, Novia UAS, WOMBH-net, Finland Deliveries and induced abortions among women of Russian, Somali and Kurdish origin, and the general population in Finland Comparison of self-reported and register data Satu Jokela, Project Co-coordinator, National Institute for Health and Welfare, Finland Asylum-Seeking Women s Experiences of Childbirth in Finland Vilma Nihti, Student midwife, Metropolia UAS, Maija-Riitta Jouhki, PhD, Senior Lecturer, Metropolia UAS; Pirjo Koski (WoMBH- net); PhD, Senior Lecturer, Metropolia UAS, Finland The Midwife-Woman Relationship in a South Wales Community: Experiences of Midwives and Migrant Pakistani Women in Early Pregnancy Laura Goodwin, PhD, Research Fellow, University of Birmingham. The United Kingdom We are the stories we tell about ourselves Alys Einion, PhD, Associate Professor of Midwifery, Swansea University, the United Kingdom Lunch Using the Listening Guide as a form of data analysis Keynote speaker Professor Ruth Deery, The University West of Scotland, the United Kingdom, BfiN and WoMBH Development of Birth- and Parenthood education for Somali families in Finland Pirjo Koski, PhD, Senior Lecturer, Metropolia UAS, WoMBH- net, Finland Break 4

5 Multicultural family training experiences of professionals Susanna Lepola, MHS, University of Tampere, Faculty of Social Sciences, Nursing Science :00 Reflections and discussion on various qualitative approaches and methods in childbearing research, and research on childbearing migrant women, and the contribution to new knowledge in intercultural care the way forward Get together Dinner in Helsinki (at own cost) Onda- Siltanen Hämeentie Maternal Health in Humanitarian Migrants Living in Finland Satu Leppälä, PhD-student, Katri Vehviläinen-Julkunen, K., and Reeta Lamminpää, University of Eastern Finland, Mika Gissler, National Institute for Health and Welfare, Finland Break Enhancing health dialogues with refugee women Marit Alstveit, Associate Professor, University of Stavanger, Norway Participants experiences deepening understanding through the method of reduction and the concept of the lifeworld Kristiina Heinonen, Senior Lecturer, Savo Vocational College, Finland and University of Eastern Finland Childbirth at home viewpoint of families Maija-Riitta Jouhki, PhD, University of Tampere and Metropolia UAS, Päivi Åstedt- Kurki, Professor and Tarja Suominen, Professor, University of Tampere, Finland Issues encountered evaluating a feasibility study on group antenatal care Louise Hunter et al. REACH Pregnancy Programme Team City University, London, The United Kingdom Friday, September 15th, , FloSpace2 (TB4-13) Moderator, Senior lecturer Anita Wikberg, Novia UAS, WOMBH-net. Finland Lunch Childbirth education as a midwifery intervention 5

6 Sari Haapio, PhD, University of Tampere, Metropolia UAS,Finland, Marja Kaunonen, Professor and Päivi Åstedt-Kurki, Professor, University of Tampere, Finland Vaccination Competence Anne Nikula, PhD Senior Lecturer, Metropolia UAS, WoMBH- net, Finland :45 Break Presentation of the WoMBH- project plan 2017 Anita Wikberg and Pirjo Koski Senior lecturers, Novia and Metropoia UAS, WOMBH-net, Finland :00 Reflections and discussion on various approaches and methods in childbearing research, and research on childbearing migrant women, and the contribution to new knowledge in intercultural care the way forward Evaluation and planning of the next seminar/research course Planning of research collaboration 15: WOMBH- meeting, the way forward Anita Wikberg and Pirjo Koski Happy weekend in Helsinki and have a safe trip back home! 6

7 Childbearing in Europe the qualitative cross disciplinary research network Childbearing in Europe a qualitative cross disciplinary research network was initiated in 2002 as a Nordic network by Terese Bondas, professor, previously Åbo Akademi University, Finland, now Nord University, Professor Marie Berg, and Professor Ingela Lundgren, University of Gothenburg, Sahlgrenska Academy, Sweden and Professor Emerita Elisabeth Hall, Aarhus University, Denmark. BfiN has developed into a European research network. The network unites more than 90 researchers and doctoral students from 8 countries ( AIMS : 1) To promote international research collaboration in childbearing, 2) To strive towards excellence in childbearing research, 3) To develop an evidence and life-world based care in childbearing, 4) To increase research mobility, and to coordinate research teams in the area 5) To identify and gather resources to make international qualitative childbearing research programs possible, 6) To initiate and develop research education and supervision in qualitative research, both on novice and senior levels, 7) To increase the publication of research findings in childbearing 8) To promote the usage of research from different perspectives in childbearing to scientists, new parents, caregivers, politicians and to others who are interested, and 9) To organize research seminars, master classes, summer schools and conferences in the member countries open for early stage, postdoctoral, and experienced researchers in childbearing. For membership (free of charge), please contact Professor Terese Bondas (terese.bondas@nord.no). WoMBH-Net Network for Women s Health in Childbearing, with the focus on Migrants and Minorities WoMBH-netwas founded in 2015 by Pirjo Koski from Metropolia UAS, Finland and Anita Wikberg Novia UAS, Finland. The network has 50 professionals, researchers, doctoral students, teachers and other interested from 11 countries mostly from Europe. The aims of the network are: To promote health and wellbeing of childbearing migrant and minority women. To form a forum for teachers, researchers, students and professionals to discuss and develop knowledge, spread information and meet colleagues share experiences and reflect upon practices of care and support for migrant and childbearing women. To increase awareness, question prejudice, create and enhance knowledge about how everyday life of women of ethnic minority and women in actual migration movements and resettlement influence their health and that of their children and families. Special focus will be on childbearing and its sociocultural anchorage. For membership (free of charge), please contact Anita Wikberg (anita.wikberg@novia.fi). 7

8 Key note speakers Methasynthesis in Health Care Research: professor Terese Bondas, Nord University, Bfin, Norway Using the Listening Guide as a form of data analysis: Professor of Maternal Health Ruth Deery, The Institute for Healthcare Policy and Practice. University of West Scotland. Abstracts 1. A theory of intercultural caring in maternity care Author: Anita Wikberg RN, RM, PhD Novia University of Applied Science Background: Immigration to Europe increases and midwives move between countries to work. At the same time ethnic minority women and immigrant women receive suboptimal care and have higher maternal and perinatal morbidity and mortality. Therefor theories are needed to improve intercultural midwifery care during childbearing to improve the health outcome. Aim: The aim is to describe a theory for intercultural caring within maternity care. Methods: The theory has been developed through qualitative methods in 4 studies. Findings: In intercultural midwifery either the mother or the midwife or both can have a different culture than the majority culture. The theory of intercultural caring in maternity care has four dimensions: universal caring, which is similar everywhere and anytime; contextual caring, which is dependent on the maternity context; cultural caring depending on the cultural background of the mother, midwife/nurse and the organisation; unique caring depending on the individual mother. The intercultural caring can take place between the mother and the midwife or other health care personnel and can promote health and wellbeing as well as alleviate suffering. The caring is influenced by different layers of outer circumstances: health care organisation, family and community and society. Conclusion: The theory can assist midwives and others in considering intercultural caring in maternity care, midwifery education and midwifery research 2. Deliveries and induced abortions among women of Russian, Somali and Kurdish origin, and the general population in Finland Comparison of self-reported and register data Author: Satu Jokela Researcher: National Institute for Health and Welfare, Immigrants and Multiculturalism, Finland. Background: Reproductive health is an important component of general health especially among women. Reproductive health and family planning services are relatively well organized in Finland and most families are able to plan the number of children they desire as reliable methods of contraception are basically available for all but there are socio-economic differences. Previous studies show that some groups of migrant women and especially refugee women do not have equal access or appropriate use of health services and access to reproductive health information in their previous home countries but also in the host country. Furthermore, previous register- and survey studies in Europe show that abortion rates are higher among migrant women compared to general population women and they request abortion more 8

9 often than women in the general population. Abortions are associated with low education, weak social network, poverty, unemployment, and having limited access to healthcare. Immigrant women may thus be more vulnerable for abortions than women in the general population. Underreporting of induced abortions in surveys is a generally recognized problem and therefore the usefulness of surveys in studying highly personal or sensitive individual characteristics, such as sexual reproductive health, has been questioned. This study compared the prevalence of previous deliveries and induced abortions among three different groups of migrant women in Finland (Russian, Somali and Kurdish origin) and women in the general Finnish population. Survey and register based information were compared to assess the agreement between these data sets. 3. Asylum-Seeking Women s Experiences of Childbirth in Finland Authors: Vilma Nihti; Student midwife, Maija-Riitta Jouhki; Senior Lecturer, Pirjo Koski; Senior Lecturer. Metropolia University of Applied Sciences, Finland. Background: In 2015 Finland received over asylum-seekers. The synthesis of knowledge related to the asylum-seeking women s experiences of childbirth is increasingly essential for the maternity care providers as the majority of all applicants were fertility age women, men and their children. Aim: To describe asylum-seeking women s experiences of childbirth. Methods: The research approach is qualitative. Focused interviews, with five Iraqi women (N=5), were utilized as data collection method. Data were analysed by inductive content analysis. Findings: The following aspects contribute to the formation of the childbirth experience: the pregnancy, received care in birth unit, woman s experience of pain management during labour, the possible previous experiences of childbirth, and the asylum-seeking process which had mainly negative influence. Especially the uncertainty related to the decision on asylum cumulated the stress of displacement and future causing both psychological and physical changes among women and foetuses. Negative decision on asylum has a strong negative affect. Conclusion: Childbearing asylum-seekers in Finland are by law given the opportunity to obtain necessary maternity services. They suffer from various causes of stress that need to be paid attention to. More research is needed from asylum seekers childbearing experiences. 4. The Midwife-Woman Relationship in a South Wales Community: Experiences of Midwives and Migrant Pakistani Women in Early Pregnancy Author: Dr Laura Goodwin, University of Birmingham. UK In 2015, 27.5% of births in England and Wales were to mothers born outside of the UK. Compared to their white British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. A focused 9

10 Ethnography explored relationships between migrant Pakistani women and midwives in South Wales; focusing on the factors contributing to these relationships, and how relationships might affect women s experiences of care. Methods included semi-structured interviews with 10 migrant Pakistani participants and 11 practising midwives, fieldwork in the local migrant Pakistani community/local maternity services, observations of antenatal appointments, and longitudinal reviewing of media outputs. Data were analysed concurrently with collection using thematic analysis. A number of social and ecological factors were identified as influencing the midwifewoman relationship; family relationships, culture and religion, differing healthcare systems, authoritative knowledge, and communication of information. However, differences were seen between midwives and women in the perceived importance of these factors. In order to understand how midwife-woman relationships are created and maintained, more needs to be done to recognise and address these differences. A social ecological model of relationships was created to visually capture the complexity of the findings. 5. We are the stories we tell about ourselves Author: Dr Alys Einion Associate Professor of Midwifery, Swansea University, UK The Study: Seven learning journals; Convenience/purposive sample; Four journals covering the whole three years of the BMid; 3 journals covering one or two years; Anonymised; Ethical approval granted by CHHS Ethics Committee; Thematic Analysis; Constructive Analysis. The findings show that practice is a form of performance, through which we as midwives ensure that students perpetuate a medicalised midwifery culture. This is evident in the use of language and abbreviations which admit the student to the elite role of the midwife. From the beginning, students display an initial idealism about their role, and a fear of the level of responsibility. The primacy of medical skills and knowledge is evident. This results in the holistic role of the midwife, her autonomy and distinctiveness, being lost in the need to become medically competent. Students characterise themselves as incompetent and often place their own learning as the priority in their encounters with the women. 6. Development of Birth- and Parenthood education for Somali families in Finland Author: Pirjo Koski, RN, RM, PhD, University of Jyväskylä, Faculty of Sport and Health Sciences, Finland; Metropolia University of Applied Sciences, Finland Background: The rate of Somali parents participating Birth- and Parenthood (BPE) education is low. BPE as public service do not fulfil enough needs of Somali families. Aim: To try out and evaluate participatory action research (PAR) in developing Birth- and Parenthood education for Somali families. Participants: Four (n=4) public health nurses and two midwifes (n=2) and eight (n=8) external evaluators. Methods: The research approach was PAR. The data was collected by focus group interviews and by meetings memoranda; peer and self-evaluation and piloting reports. Outcome was assessed using a questionnaire. The data was analyzed by qualitative content analyses. 10

11 Results: Following topics: Pregnancy, birth, postpartum, parenthood and child-family life was included in the program. Dialogue and participatory teaching methods was selected as counselling methods. The new program still relies too much on Finnish perceptions of following concepts: family, relationship between the spouses and BPE. Thinning of national identity, language problems, lack of social support and fear of racism needs to be considered in BPE. PAR is applicable to developing the BPEP for Somali families. Conclusion: Development on cultural sensitive BPE for migrant families should be paid more attention. BPE providers need more information on intercultural group counselling. 7. Maternal Health in Humanitarian Migrants Living in Finland A doctoral thesis Author: Satu Leppälä Doctoral student, M.Sc., PHN, RN, University of Eastern Finland. Supervisors: Katri Vehviläinen-Julkunen PhD, professor, University of Eastern Finland Reeta Lamminpää, PhD, post doc researcher, University of Eastern Finland Mika Gisler, PhD, research professor, National Institute for Health and Welfare (THL) Background: Maternal morbidity is significantly greater in humanitarian migrant women [HMW] compared to receiving country-born women in western high-income settings. In Finland, the existing literature on immigrant maternal health is from a time when the dominating reasons for migration were family, work, and studying. However, migration from humanitarian causes to Finland has nearly ten-folded between the years , being in this time period. OBJECTIVE: We aim to describe HMW s maternal health during and after their asylum process, to identify potential delays in care, and to find conducts in defeating potential obstacles in care in a Finnish context. Methods: Qualitative data are collected in health care professionals and HMW s interviews and focus group discussions which are audio-recorded and transcribed. Data are analysed through qualitative content analysis as described by Graneheim and Lundman (2004). Theories on social constructionism of reality (Berger & Luckmann 1966) and the Three Delays Model (Thaddeus & Maine 1994) guide data collection and analysis. IMPLICATIONS: This study will possibly prevent economic and human costs of suboptimal maternal health in a potentially vulnerable population of HMW. The results can provide stakeholders with evidence-based recommendations and development ideas to improve maternal health in HMW. 8. Enhancing health dialogues with refugee women Author: Marit Alstveit, Faculty of Health Sciences, University of Stavanger, Norway Background: Lately, Norwegian municipals have had increased settlement of work migrants and refugees and among them minority women - both refugees and asylum seekers. New user groups with a variety of cultural and linguistic backgrounds is a challenge in providing sufficient health care for to the public health services in the municipals. To encounter this challenge an interdisciplinary research project is set up. The aim of the project is to develop knowledge and competencies regarding communication between primary health workers and refugee women. This, in turn, will improve the refugee women s patient safety and lead to more equitability in health services. 11

12 The project s overall research question is: How may the dialogue of health professionals with refugee women be enhanced in order to provide equitable health services in the Norwegian society? Methods: The project consist of 4 WPs. WP1 will provide further insight in which communication difficulties health professionals experience, and how both health professionals and refugee women cope with them. By WP2 we will explore how dialogue can be enhanced by health literacy and communication tools. By WP3 we will explore how dialogue can be improved by enhanced cultural sensitivity. WP4 is a theory driven synthesis of WP1, 2 and 3. Empirically, the project will be limited to refugee women from Horn of Africa and the Middle East. Results: The project will deliver articles for national and international journals, workshops and an international conference arranged, and a web page established. 9. Participants experiences deepening understanding through the method of reduction and the concept of the lifeworld Author: Kristiina Heinonen, PhD, MNSc, RN, PHN, University of Eastern Finland, Department of Nursing Science; Savo Vocational College, Finland. Aim: The aim is to describe reduction as a method and the concept of the lifeworld, using van Manen s hermeneutic phenomenological research approach, and also give an empirical example regarding social and health care professionals. Method: The research describes reduction as a method and the concept of the lifeworld (temporality, corporality, relationality and spatiality) in research process. The material consisted of open interviews with the parents of twins, public health nurses and family care workers, written outputs, and notes. Results: Reduction as a method with the concept of the lifeworld provides a good opportunity in deeply research. In the research process, reduction helps to consecrate to keep research stages separate, but also see the whole picture. The concept of the lifeworld is universal and results were described through it. The phenomena of the lifeworld of supporting multiple-birth families as described by nurses can be expressed as: "Recognising the strain", "Targeting special needs" and "Lightening the load of daily life". Conclusions: Reduction enables in-depth phenomenological hermeneutic research, helping to see the research stages both as parts and as a whole and the hermeneutic circle that accumulates understanding. Social and health care professionals need to listen more to parents' voices to better understand the needs and situation of multiple-birth families. More education and training is needed to empower parents of twins. The concept of the lifeworld and modalities helps to describe sensitive areas and understand human lives in depth. Implications: Evidence-based family care nursing is needed for professional working with multiplebirth families in different contexts. Educating of social and health care students is needed. Developing a model for family care nursing in multiple-birth families will be a challenge for future research. 12

13 10. Childbirth at home viewpoint of families Authors: Maija-Riitta Jouhki, RN, RM, PhD, University of Tampere, Faculty of Social Sciences, Finland; Metropolia University of Applied Sciences, Finland Tarja Suominen, RN, PhD, Professor of Nursing Science, University of Tampere, Faculty of Social Sciences, Finland Background: The rate of planned home births has been low in Finland. It is not included in the public maternity care. It seems that provided public services do not fulfil needs of all the families. Aim: To describe, understand and to produce the theoretically understandable structure of meaning of the experience of childbirth at home. Participants: 14 women who gave birth at home, 11 fathers and seven children who participated birth at home. Methods: The research approach was phenomenological, and the data was collected by using open interviews and children s drawings. Interviews were analysed by Colaizzi s method and a child psychologist analysed the drawings. Results: For the families the experience meant being together, helping and supporting each other. The home environment made family members feeling safe and closer to each other. The families faced challenges, such as other people s negative attitudes towards their decision to give birth at home. They also worried about their ability to cope with birthing process. Conclusion: Home birth was positive, but also demanding experience for the families. Health care staff need more information on home births and client and family centred care should be paid more attention. 11. Issues encountered evaluating a feasibility study on group antenatal care. Authors: Dr Louise Hunter, Research Fellow (attending author) Louise.hunter@city.ac.uk, City University, London, UK Hunter L, Da Motta G, McCourt C, Wiseman O, Rayment J, Haora P, Wiggins M, Sawtell M, & Harden A on behalf of the REACH Pregnancy Programme Team I would welcome the opportunity to present and reflect on a qualitative evaluation of a feasibility study into group antenatal care for a population of high cultural and linguistic diversity, including both established and recently-arrived migrants. The results of the feasibility evaluation will inform a pilot trial and a randomized controlled trial. We have used qualitative approaches to understand the experiences of women, caregivers, and other stakeholders; and to develop theory around mechanisms underpinning participant-identified outcomes; as well as to evaluate the process of implementing and researching a new model of care in order to make changes to the quantitative arm of our project. We have gathered a significant amount of data through pre- and postimplementation focus groups and interviews, and post-implementation observations. Managing the volume of data, and addressing a range of issues, has been challenging, and the workshop will give us a valuable opportunity to share our experiences and benefit from others expertise. We believe that our findings will contribute to an understanding of the benefits of a group approach to antenatal care, and the mechanisms through which this is advantageous to migrant and other 13

14 disadvantaged women. We hope our approach will also illustrate the importance of qualitative enquiry in informing quantitative work. 12. Childbirth education as a midwifery intervention Authors: Sari Haapio, RM, PhD, University of Tampere, Senior Lecture, Metropolia University of Applied Sciences, Finland Marja Kaunonen, RN, PhD, Professor of Nursing Science, University of Tampere, Faculty of Social Sciences, Finland; Pirkanmaa Hospital District, General Administration, Tampere, Finland Päivi Åstedt-Kurki, RN, PhD, Professor of Nursing Science, University of Tampere, Faculty of Social Sciences, Finland; Pirkanmaa Hospital District, General Administration, Tampere, Finland Background: The fear of childbirth is a general problem, which causes inconvenience to first-time mothers during pregnancy. There is also inadequate knowledge of childbirth educations effectiveness in allaying the childbirth fears of mothers, and of its effectiveness to the use of maternity health-care services. Aim: To gather knowledge of parents-to-be experiences of childbirth education at maternity hospital and to test educations effectiveness in supporting firsttime mothers preparation for childbirth. Participants and methods: The qualitative data were collected by theme interviews from six couples, who participated in the childbirth education. The data were analysed by content analysis. The childbirth educations effectiveness was tested by comparing different ways trained first-time mothers (n=715) to each other by means of randomised controlled trial. Measurements were carried out at three different points and the data were analysed statistically. Results: The holistic way of getting to know the future place of birth was important for the parents-to-be. The childbirth intervention mitigated and reduced mothers childbirth-related fears. At the level of maternity services, the intervention lessened the frequency of attendance of other childbirth educational sessions. Conclusion: The understanding that childbirth education is a beneficial antenatal service for first-time mothers preparing for childbirth. 13. Multicultural family training experiences of professionals Author: Susanna Lepola, MNSc, University of Tampere. Faculty of Social Sciences / Nursing Science The increasing number of multicultural families in Finland are also customers of Finnish maternity and child care clinics. Family training for multicultural customers currently involves various actors in the public, private and third sectors. The purpose of this study was to describe the experiences of implementing multicultural family training from the point of view of health care professionals, and to offer perspectives of how to develop multicultural family training. The study aimed to produce topical information to support the work of health care professionals. The study employed a qualitative research approach, and 11 public, private and third sector professionals were interviewed in themed focus groups. The focus group interviews were conducted as theme interviews. The data were analysed using inductive content analysis. 14

15 The professionals' experiences contained a diverse range of implementations for individual multicultural families, and multicultural families that had special family training needs. The professionals highlighted the factors influencing the success of multicultural family training and had proposals for its further development. The challenges and problems of multicultural family training were also raised. The results show that it is essential to take multicultural families individual needs into account, and that the guidance of families need a diverse range of resources. The professionals had a wide range of multicultural family training abilities, and offered a range of views on the development of multicultural family training. Their experience showed that it is necessary to be aware of the challenges of multicultural family training when looking to develop it further and that dealing with multicultural families is a tangible phenomenon of current healthcare provision. It is therefore important to develop family training and nursing education in order to ensure professional s abilities to meet the needs of multicultural families. Keywords: multicultural, family training, multicultural family raining 14. Vaccination Competence Author: Anne Nikula PhD, University of Turku, Senior Lecture, Metropolia University of Applied Sciences The purpose of this two-phase study was to define the concept of vaccination competence and asses the vaccination competence of graduating public health nurse students (PHN students) and public health nurses (PHNs) in Finland, with the goal of promoting and maintaining vaccination competence and developing vaccination education. The first phase of the study included semistructured interviews with vaccination professionals, graduating PHN students and clients (a total of n=40), asking them to describe vaccination competence as well as the factors strengthening and weakening it. The data were analysed through content analysis. In the second phase of the study, the structured instruments were developed, and vaccination competence of PHN students in Finland (n=129) and working PHNs (n=405) was assessed using a self-assessment scale (VAS) and taking a knowledge test. The data were collected from five UAS s and seven health centres, located in various parts of the country. The data were collected using instruments developed for this study, and were analysed statistically. In the first phase, based on the results of a literature review and the interviews, vaccination competence was defined as a large multi-faced entity, including the concepts of competent vaccinator, competent implementation of the vaccination, and the outcome of the implementation. Semi-structured interviews revealed that factors strengthening and weakening vaccination competence were connected to the vaccinator, the client being vaccinated and the vaccination environment and vaccinator education. On the whole, factors strengthening and weakening vaccination were the opposite of each other. In the second phase, on the self-assessment of vaccination competence, students rated themselves as significantly lower than working professionals. On the knowledge test, the percentage of correct answers was lower for students than PHNs. When all background variables were taken into account 15

16 in multivariate analysis, there was no longer a significant difference between the students and PHNs on the self-assessment. However, in multivariate analysis, the PHNs still performed better than the students on the knowledge test. The development of the web-based vaccination competence education modules (Basics 2 ECTS, Advanced 1 ECTS) has been created to ensure high standard vaccination competence by three Nursing education units of University of Applied Sciences, UAS's and Medical Specialists of National Institute for Health and Welfare (THL). The modules include theory, assignments, video materials and lectures, online links to THL Vaccination web pages, portfolio and National Electronic Exams. Translating the modules to Swedish (second official language) was done The first Swedish pilot will be carried out in Novia UAS in autumn About 6300 bachelor students have completed the studies by The feedback of the modules has been collected every semester from students and teachers. The methods, content and virtual learning were perceived very successful. Students liked the possibility to do studies temporally flexible. Teacher s average estimate of the quality of the training modules (scale 1-5) was 4.6. Teachers gave some suggestions for the content and assessment criteria of the portfolio. During the spring semester 2017 the modules were piloted in two UAS s also by nurses (n=105) working in practice. 15. Metasynthesis as an approach in childbearing research Author: Terese Bondas Professor PhD, LicHSc, MHSc, RN, PHN, NORD University, Faculty of Nursing and Health Sciences, Bodø, Norway Metasynthesis is research on qualitative research, and various methods have been developed to synthesize qualitative studies in a field of interdisciplinary knowledge generation. Metasynthesis has been developed as a potentially fruitful methodological approach, doing synthesis research of qualitative research. There is a need to gather what is known through metasynthesis programs for the benefit of the human and societal development, and also for qualitative research findings to have a stronger impact on decision-making through integrating findings from different disciplines in an area of interest. Childbearing is one of the research areas where metasynthesis studies have flourished. The interest to further qualitative meta research in health, social and human sciences soon started a development in the field in the late 90 s, and there is now a body of knowledge based on metasynthesis of qualitative studies. However, metamethod studies and an ongoing scientific discussion show that there are validity problems in several metasynthesis studies that have been published. Metasynthesis as an umbrella term and the characteristics will be outlined, and some methodological variations will be presented. 16