Barriers to Adherence to the Maternal Healthcare in Immigrant Moroccan Women in Spain. A Qualitative Study

Aims: to explore the barriers to adherence to maternal healthcare services in Spain, as reported by immigrant Moroccan women, healthcare professionals and cultural mediators, in the context of the pregnancy care program Design: A qualitative design under a phenomenological approach was undertaken in this study using interviews and discussion groups. Methods: Qualitative interviews and discussion groups were conducted with 30 Moroccan immigrant women, 35 health care professionals and 2 intercultural mediators. Interviews and groups were transcribed and analyzed following an ad hoc structure of categories. (2014-2015). Results: The study shows that women and professionals agree on some barriers to adherence, such as language competence or accessibility. There are some additional barriers described by professionals or by women which are clearly different. In the professionals' view, women lack any interest in the maternal healthcare; they consider that pregnancy is a natural process, so they do not need to attend the meetings. Women explain that they do not understand the medical words (even those language-competent), they feel invaded in their privacy, and they consider that professionals do not know or understand their culture. Intercultural mediators, which were bilingual Moroccan women working in the National Health System, work as a connection between the two realities and are perceived as very valuable by women and professionals. Conclusion: Adherence to maternal health care is low in Moroccan immigrant women. Professional's intents to improve should be designed with a more comprehensive view targeting the factors that are important for women under their own perceptions. Impact  What Problem did the Study Address? • Immigrant women have delayed and irregular attendance at prenatal care. Resources to increase adherence and minimize identified barriers are not perceived as really useful. • Studies to describe adherence have mainly described and quantified the effect, but the underlying factors of this appearance remain unclear.  What were the Main Findings? • Barriers to adherence to prenatal care are not shared between women and professionals • Language and lack of interest are the main obstacles to professionals' vision. • The lack of cultural knowledge of the healthcare professionals and the quality of the interaction are the main barriers for women. • Cultural competence should be the basis for improving adherence to prenatal care in immigrant women.  Where and on Whom will the Research have Impact? • Healthcare professionals should receive training to effectively address cultural conflicts and culturally competent communication in the care of perinatal health of immigrant women. • Some actions can be implemented to inform the immigrant population about the structure, organization of the National Health System and its care offer • Intercultural mediation in health environments is an important asset to solve the conflicts that may arise during the health interaction, due to the linguistic and cultural differences.