. 2024 Feb 13;8(Suppl 2):e014075. doi: 10.1136/bmjgh-2023-014075

Table 1.

Review findings and CERQual grading for theme 1 ‘resources and access’

Review finding	Contributing papers	Supporting quote	CERQual grade*
Language issues, including need for interpretation Language was identified by most women in most studies as a big barrier in accessing services. Even when interpretation was available, it was not always easy to find interpreters with time availability and women mentioned difficulties in building rapport with interpreters. At times, their partners, friends or family members acted as interpreters, meaning oftentimes they were the de facto decision-makers, and even if they too were not fluent, which could result in unwanted interventions. At others, providers attempted to communicate using simple language. Some women highlighted the benefit of having the same interpreter work with them during different encounters. Even among women who were fluent in the language of their new host country, they felt their understanding was limited when it came to ‘medical’ terms and that providers had difficulties understanding them. Other women relied on finding providers who spoke their language to adequately communicate with them	21 studies: Akhavan and Edge,⁴¹ Alshawish et al,⁴² Chu,⁴³ Crowther and Lau,⁴⁴ Davies and Bath,⁴⁵ Gurman and Becker,⁴⁶ Higginbottom et al,⁴⁷ Higginbottom et al,⁴⁸ Hoang et al,¹¹ Hoban and Liamputtong,⁴⁹ Kim et al,²⁸ Lam et al,⁵⁰ McLeish,⁵¹ Origlia Ikhilor et al,⁵² Phillimore,⁵³ Riggs et al,⁵⁴ Riggs et al,⁵⁵ Renzaho and Oldroyd,⁵⁶ Sami et al,⁵⁷ Wikberg et al,⁵⁸ Yelland et al⁵⁹	‘When he was born, I got a pocket book and they told me to do something. But I couldn’t understand because it was in Korean’. (Kim et al²⁸ immigrants from several African countries in South Korea) ‘… the nurse came to my house to visit me and she talk about lots of things but I didn’t understand … so whatever she asked me, I said, yeah, yeah, yeah. I just wanted to say, oh, you just leave’. (Higginbottom et al⁴⁸ immigrants from several countries in Canada)	High
Inadequacy of services Women stated that it was at times hard finding a physician because they were either not taking new clients or physicians were so busy, appointments or referrals were given with lengthy delays. In addition to difficulties in obtaining appointments, women in one study highlighted differences between services depending on location. Others mentioned too brief encounters or feeling rushed with their physicians. Women from one study mentioned inadequacy relating to culturally competent (or culturally safe) care	6 studies: Almeida et al,⁶⁰ Alshawish et al,⁴² Grewal et al,⁶¹ Higginbottom et al,⁴⁸ Riggs et al,⁵⁴ Shafiei et al⁶²	‘It’s hard to find a family doctor because I phoned everyone … it took me for a while, and then you can’t go with him because his appointment [book] was full. I phoned a lot of clinics and then they cannot accommodate’. (Higginbottom et al⁴⁸ immigrants from several countries in Canada) ‘But here, a specialist appointment may take a year, and in the Ukraine … it could occur tomorrow!’ (Almeida et al⁶⁰ immigrants from several countries in Portugal)	Moderate
Uncertainty around services available due to legal status Women, mainly from studies with a heterogeneous population of individuals with diverse legal statuses, went to great lengths to avoid immigration officers, hindering their access to services. Other women expressed frustration at differences in services according to legal status; other referred the process of legalisation as a barrier in access to healthcare. Women described confusion as to what services were available to them and in one case, a woman did not know that services would be free	4 studies: Almeida et al,⁶⁰ Kim et al,²⁸ Phillimore,⁵³ Sami et al⁵⁷	‘I think the main barrier was not having the healthcare users’ card’. (Almeida et al⁶⁰ immigrants from several countries in Portugal)	Moderate
Limited personal resources/cost of services Some women, mainly from studies with a heterogeneous population of women with diverse legal statuses, including asylum seekers and refugees, described not having the essentials to care for themselves and their babies and needing to rely on charity or voluntary organisations for support. Other women reported difficulties in accessing housing services or needing to share housing with others, challenging providing care for their newborns. Women also mentioned cost of services as a barrier to accessing them. Women from one study stated they had to skip meals to save for transportation costs. Other women mentioned difficulties with having the appropriate equipment for bottle sterilisation	7 studies: Higginbottom et al,⁴⁸ Hoban and Liamputtong,⁴⁹ Kim et al,²⁸ McLeish,⁵¹ Phillimore,⁵³ Qureshi and Pacquiao,⁶³ Riggs et al⁵⁵	‘The midwives were nice except one, who I asked to leave the room. She was asking why don’t I have the special equipment to clean the bottles? I don't have money to buy special equipment. I have four bottles and I boil them, so that’s the only way I can sterilise them. She didn’t like it’. (McLeish⁵¹ immigrants from several countries in the UK) ‘If there was rain, water leak into the house. Especially in winter, rain made the house much colder. It was hard to sleep and eat, and the stress made hypertension. The cost of baby’s diaper was very expensive and I put my sanitary pad to my baby instead of diaper. The formula milk was too expensive so I gave soybean milk to my baby after I could not produce breast milk’. (p140) (Kim et al²⁸ immigrants from several African countries in South Korea)	High
Difficulty navigating healthcare system Women from several studies described difficulties navigating the healthcare system, including how to reach their appointments due to transportation issues (cost, distance and time). Women also mentioned confusion around what is included within maternal and child health services or what services should be accessed where and specificities of the country’s healthcare service organisation. It also included difficulties after discharge from the hospital and the services needed and available to them. They often found out about services by word of mouth from other immigrants	15 studies: Almeida et al,⁶⁰ Alshawish et al,⁴² Chu,⁴³ Higginbottom et al,⁴⁸ Hill et al,⁶⁴ Kim et al,²⁸ Lee et al,⁶⁵ Origlia Ikhilor et al,⁵² Phillimore,⁵³ Quereshi and Pacquiao,⁶³ Reitmanova and Gustafson,⁶⁶ Renzaho and Oldroyd,⁵⁶ Riggs et al,⁵⁴ Sami et al,⁵⁷ Wikberg et al⁵⁸	‘And you write it somewhere on the paper if you forgot, its hard sometimes to remember where and when is your appointment … they should call you to remind you [if] they miss the appointment because they can’t, they forget to write [the appointment information] in the [child health record] book and they [the mother] forget to call back to make another appointment’ (Riggs et al⁵⁴ immigrants from several countries in Australia) ‘I could not go to any nearby hospital I needed, instead I had to take subway with my young daughter. It takes very many hours to go and come back’. (Kim et al²⁸ immigrants from several African countries in South Korea)	High

*High, moderate, low or very low.