title: Factors associated with lack of adherence to antenatal care in African immigrant women and Spanish women in northern Spain: the role of social risk factors in combination with language proficiency.
abstract: OBJECTIVE
  to examine the association and interaction between language proficiency, social risk factors and lack of adherence to antenatal care in African immigrant women (AIW).
  
  
  METHODS
  retrospective cohort study. Two hundred and thirty-one AIW with delivery dates from 2007 to 2010 were identified, and data were collected on knowledge of Spanish, referral to a social worker because of social risk factors, and adequacy of antenatal care using the Kessner Index (KI) and the authors' own index (OI). The Spanish-born population sample was obtained by simple random sampling in a 1:3 ratio. Odds ratios (OR) were estimated by non-conditional logistic regression. The term 'language*referral to social worker' was included in the logistic models to study interaction.
  
  
  RESULTS
  eighty-four per cent of AIW had insufficient knowledge of Spanish, and 47% had been referred to a social worker. Of the AIW who had not been referred to a social worker, the association between poor knowledge of Spanish and inadequate antenatal care was weak and not significant (OR for KI 1.31). On the contrary, of the AIW who had been referred to a social worker, the association was stronger and significant (OR for KI 8.98; p interaction=0.026). Social risk factors were the main independent factors associated with inadequate antenatal care in Spanish women (adjusted OR 3.17; 95% confidence interval 1.42-7.06).
  
  
  CONCLUSIONS
  this study found that the main factor associated with inadequate antenatal care in AIW is insufficient language proficiency, but only in the presence of social risk factors, which have also been associated with worse antenatal care in Spanish women.
authors: Departamento de Enfermería, Universidad de Cantabria, Santander, Spain; IDIVAL-Instituto de Investigación Marqués de Valdecilla, Santander, Spain. Electronic address: santibanezm@unican.es.
authors: Miguel
authors: M
authors: Santibáñez
authors: Departamento de Enfermería, Universidad de Cantabria, Santander, Spain.
authors: Maria
authors: M
authors: Paz-Zulueta
authors: Hospital de Laredo, Servicio Cántabro de Salud, Santander, Spain.
authors: María
authors: M
authors: Ruiz
authors: Gerencia de Atención Primaria, Servicio Cántabro de Salud, Santander, Spain.
authors: Irene
authors: I
authors: Castro
authors: IDIVAL-Instituto de Investigación Marqués de Valdecilla, Santander, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Departamento de Salud Pública, Universidad de Cantabria, Santander, Spain.
authors: Javier
authors: J
authors: Llorca
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D003144:Communication Barriers; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D013030:Spain / Q000208:ethnology; D011795:Surveys and Questionnaires
keywords: Antenatal care; Health inequalities; Immigration; Neonatal; Pregnancy