Development and evaluation of a culturally-sensitive educational video to improve access to and utilization of antenatal care services among Afghan women migrants and refugees in France – NAFIS

Antenatal care (ANC) is crucial for promoting maternal and newborn health, particularly among migrants, asylum seekers and refugees, who often face disparities in healthcare access and outcomes compared to local populations. In France, where Afghans represent the largest community of refugees and asylum seekers, emerging evidence indicates that Afghan women refugees have limited access to ANC services due to various individual and structural barriers, including language difficulties and unfamiliarity with the available healthcare resources. Digital health education tools (e.g., video-based learning modules) hold promise to provide socio-culturally and linguistically-tailored health information and resources to address health inequities experienced by women migrants and refugees. Our proposed participatory-based research aims to develop and evaluate a series of culturally-sensitive educational videos to improve access and utilization of ANC services for Afghan women migrants and refugees in France.

The proposed 18-month research objectives are to:
1. Design and develop a culturally-sensitive series of videos on ANC services for Afghan women migrants and refugees living in France
2. Assess acceptability and satisfaction of Afghan women migrants and refugees with the designed videos
3. Mobilize our consortium’s capacities to inform key stakeholders on digital health tools that can help improve access to and utilization of ANC services for women migrants, refugees and asylum seekers

To accomplish these objectives, we will establish a new participatory-based research consortium to bring together Afghan women migrants and refugees, community leaders, healthcare providers, representatives from governmental agencies (e.g., members of the Office for Immigration and Integration) and non-governmental organizations supporting Afghan refugee communities, and researchers to ensure the proposed videos are relevant and useful. A local group of Afghan artists and designers will also participate in the consortium to design and create a series of three videos focus on 1) educating Afghan women refugees about the importance of ANC visits, 2) guiding them on when and where to access these services, and 3) informing them about what to expect during their ANC visits. First meetings of this consortium will focus on identifying key features for the videos, testing draft versions, and developing tailored promotion strategies (Objective 1).
To address Objective 2, we will conduct a mixed-methods evaluation study to obtain a comprehensive understanding of the perceptions of Afghan women migrants and refugees about the videos. First, we will conduct an online survey to assess the degree of acceptability and intention to access ANC services, and level of satisfaction regarding the videos among 200 Afghan women migrants and refugees. Second, we will invite 15 Afghan women refugees with low literacy levels to participate in a semi-structured interview to gather their insights into usability and cultural relevance of the designed videos. Data will be discussed and analyzed in consultation with the consortium.
Lastly, we will organize a full-day participatory and planning summit with key stakeholders, including policymakers, ANC providers, and community members (Objective 3) to discuss our research findings and identify a set of actionable recommendations for improving access and utilization of ANC services among Afghan women migrants and refugees in France (e.g., integration of the videos into existing support programs).
This proposed research will facilitate the dialogue between Afghan refugee communities and ANC services to provide culturally relevant health information and resources for Afghan women migrants and refugees. These findings will also inform the development of digital health education tools to improve access to and utilization of healthcare services across diverse migrant and refugee communities in France and beyond.