How we created an evidence-based communication app for maternity care

  • torsdag / 23 maj / 2019
  • 13:30-14:00


This presentation describes how an app was developed in a multi-disciplinary research team in close collaboration with midwives to improve communication between midwives and non-Swedish speaking women. The project aims to improve equity of maternity care. In the years 2015 and 2016, Sweden received a record number of immigrants, almost 300,000 in two years (The Statistics Portal, 2018). A large number of these new immigrants were young Arabic speaking women (ASW) of child-bearing age. Qualified interpreters were not always available.

The research project began with a pilot study in 2015 (Axelsson, Byrman, Petersson, Skoglund, & Stevenson-Ågren, 2016). Midwives were invited to describe their work situation in light of the large number of immigrants who moved to Sweden that year. The pilot study demonstrated an untenable work situation for midwives and potential risks for pregnant immigrants who did not speak Swedish. The midwives expressed concern about the lack of Arabic-speaking interpreters and were concerned that misunderstanding occurred during interpretation. Studies have shown that immigrant women have poorer outcomes in pregnancy, including increased maternal and peri-natal mortality, pre-mature delivery, babies of low birth weight and congenital malformations (Bollini, Pampallona, Wanner, & Kupelnick, 2009).

The project used an innovative design, drawing on a combination of a sociotechnical approach and an iterative approach. There was a focus on end-user perspectives, in-depth understanding of work processes and effectively eliciting in-context user needs, to inform the design (Berg, 1999). Accuracy of content was assured by cross-checking that all material was validated by professional midwifery sources and midwives to verify the information.

There is a plethora of apps for healthcare but many fail to meet standards of safety, reliability and usability, or are not evidence-based. This presentation describes how informaticists, linguists and midwifery researchers in collaboration with midwives and pregnant women developed a bilingual app to use as a complement to interpreters in pre-natal care. A prototype of the app was tested in spring 2018 in Kalmar County Council. After revision the final version of the app was produced in December 2018. It is currently being used by midwives in pre-natal care.

Axelsson, C., Byrman, G., Petersson, G., Skoglund, A., & Stevenson-Ågren, J. E. (2016). “So much can go wrong”: Pilot study about midwives’ experiences of communication with pregnant women who do not understand Swedish. Retrieved from Kalmar/Växjö Linnaeus University:
Berg, M. (1999). Patient care information systems and health care work: a sociotehnical approach. International Journal of Medical Informatics, 55, 87-101.
Bollini, P., Pampallona, S., Wanner, P., & Kupelnick, B. (2009). Pregnancy outcomes of migrant women and integration policy: a systematic review of the international literature. . Soc Sci Med, 68, 452-461.
The Statistics Portal. (2018). Number of immigrants in Sweden from 2007 to 2017. Retrieved from

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