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Immigrant women’s experiences of maternity-care services in Canada: a protocol for systematic review using a narrative synthesis

Gina M A Higginbottom1*, Myfanwy Morgan2, Jayantha Dassanayake3, Helgi Eyford4, Mirande Alexandre5, Yvonne Chiu6, Joan Forgeron4 and Deb Kocay7

Author Affiliations

1 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada

2 King’s College London, Primary Care & Public Health Sciences London, London, SE1 3QD, UK

3 School of Rural Health, Monash University, Bendigo, VIC, Australia

4 Lois Hole Hospital, Alberta Health Services, Edmonton, AB, T5H 3V9, Canada

5 Citizenship and Immigration Canada, New Multiculturalism Grants and Contributions Program, Canada Place, Edmonton, AB, T5J 4C3, Canada

6 Multicultural Health Brokers Co-operative, Edmonton, AB, T5H 2M6, Canada

7 Health Canada, Public Health Agency of Canada, Calgary, AB, T2G 4X3, Canada

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Systematic Reviews 2012, 1:27  doi:10.1186/2046-4053-1-27

Published: 31 May 2012



Canada’s diverse society and statutory commitment to multiculturalism means that the synthesis of knowledge related to the health care experiences of immigrants is essential to realize the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for tailoring of services to user needs. We are therefore assessing the experiences of immigrant women in Canada accessing maternity-care services. We are focusing on: 1) accessibility and acceptability (as an important dimension of access) to maternity-care services as perceived and experienced by immigrant women, and 2) the birth and postnatal outcomes of these women.


The aim of this study is to use a narrative synthesis, incorporating both a systematic review using narrative synthesis of reports of empirical research (qualitative, quantitative, and mixed-method designs), and a literature review of non-empirically based reports, both of which include ‘grey’ literature. The study aims to provide stakeholders with perspectives on maternity-care services as experienced by immigrant women. To achieve this, we are using integrated knowledge translation, partnering with key stakeholders to ensure topic relevancy and to tailor recommendations for effective translation into future policy and practice/programming. Two search phases and a three-stage selection process are being conducted (database search retrieved 1487 hits excluding duplicates) to provide evidence to contribute jointly to both the narrative synthesis and the non-empirical literature review. The narrative synthesis will be informed by the previous framework published in 2006 by Popay et al., using identified tools for each of its four elements. The non-empirical literature review will build upon the narrative-synthesis findings and/or identify omissions or gaps in the empirical research literature. The integrated knowledge translation plan will ensure that key messages are delivered in an audience-specific manner to optimize their effect on policy and practice change throughout the health service, and the public health, immigration and community sectors.


Narrative-synthesis methods of systematic review facilitate understanding and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socioeconomic status, and geographical location. They also enable understanding of the shaping of differences between reported outcomes and study designs related to childbearing populations, and the development and implementation of maternity services and health interventions across diverse settings.

PROSPERO registration

Number 2185.

Narrative synthesis; Immigrant women; Maternity-care experiences; Canada; Study protocol; Mixed research design review