This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.
Approximately 13% of the total Australian midwifery workforce is internationally qualified. Although the internationally qualified midwives (IQMs) play a significant role in the Australian midwifery system, there is limited understanding of their transitional experiences.
The objective of this study protocol is to explore the transitional experiences and views of IQMs practicing in Australia, through the investigation of demographic profiles and key challenges that influence a smooth transition.
This paper presents an explanatory sequential mixed methods study protocol. This protocol incorporates an e-survey and individual interviews. The e-survey in the first phase will be distributed to IQMs in Australia via the website e-bulletins of the Australian Nursing and Midwifery Federation and the Australian College of Midwives. Additionally, potential respondents will be recruited via social media (ie, Twitter and Facebook) and associated snowball sampling. Data from the e-survey will be statistically analyzed. At the end of the e-survey, respondents will be asked whether they are willing to take part in an interview. The results of the e-survey and relevant literature review will help to develop a guideline for interview questions for the second phase. In phase two, a purposeful sample of participants will be recruited using the same selection criteria as for the e-survey. Semistructured interviews will provide a deeper insight into the transitional experiences of IQMs. Data from the interviews will then be thematically analyzed.
An integration of the e-survey results (phase one) and interview findings (phase two) will be synthesized to explore and better understand the transitional experiences of this group of midwives. It is anticipated that data collection and analysis will be completed by June 2019 and results will be disseminated through peer-reviewed publications in late 2019.
This research protocol may generate new knowledge about the transition of IQMs in Australia. These findings could be used to formulate recommendations to inform the transition of future IQMs in Australia.
DERR1-10.2196/13406
Australia is a multicultural country with 49% of the Australian population (24.77 million) either born overseas or having at least one parent who was born overseas [
Differences in nursing practices, along with a lack of familiarity with local technologies, policies, and guidelines, are reported as major challenges for IQNs [
Proceeding on the basis of Cooper's Taxonomy [
Although midwifery is an internationally mobile profession, there appears to be a global gap in literature that explores the transition experiences of IQMs moving between countries [
Given the identified gap in the literature, this study aims to explore the transitional experiences and views of IQMs practicing in Australia. The objectives of this study are to investigate demographic profiles of IQMs in Australia and to explore the key challenges that promote or hinder a smooth transition into this workforce. The research questions for this study are as follows:
What are the demographic characteristics of IQMs practicing midwifery in Australia?
What challenges do IQMs face during their transitional process into the Australian midwifery workforce?
How do IQMs practicing midwifery in Australia perceive the level of:
peer support?
peer respect?
peer acceptance?
The researchers will use an explanatory, sequential, mixed methods design, incorporating two phases to provide valid and credible outcomes [
This research protocol incorporates an e-survey and individual interviews. Phase one includes an e-survey study that is currently being undertaken to capture IQMs’ demographic profiles, their transitional experiences, and positive and negative factors contributing to their transition during the first year of their practice in Australia. The exploratory nature of the second phase requires a qualitative approach to identify and describe the transitional experiences and views of individual IQMs. Hence, qualitative descriptive design based on semistructured interviews will be used for phase two to provide a detailed description of the experiences and views of IQMs in language similar to their own forms of expression [
The results from the e-survey will assist in determining questions for the interviews to explore, clarify, and affirm the experiences and perspectives of IQMs [
The target population for this study is a sample of midwives who obtained their midwifery qualifications outside of Australia, who practiced for a minimum of 12 months in the countries in which they obtained their midwifery qualifications, and who are presently practicing as midwives in Australia. In order to maximize recruitment opportunities, a specific length of time of employment in Australia will not specified. It is beyond the scope of this research to consider the experiences of midwives who obtained their midwifery qualifications within Australia.
IQMs will be invited to participate in this study nationally within Australia.
IQMs practicing in Australia are being accessed via a nonprobability sample design, which also incorporates factors such as convenience and snowball sampling. The Nursing and Midwifery Board of Australia was approached at the beginning of respondent recruitment, with a request made to access the contact details of all registered IQMs in Australia. This request was denied due to the Board’s privacy policy. There are no other official organizations or bodies that collect contact details of IQMs in Australia. A nonprobability sampling framework and an opt-in e-survey are being used, as a random sample cannot be accessed.
As such, the most effective method to recruit as many IQM respondents as possible is via the Australian Nursing and Midwifery Federation and Australian College of Midwives websites. The e-bulletins of these midwifery professional bodies are advertising and distributing the e-survey, which is linked to SurveyMonkey, a Web-based survey platform. Other approaches being used to recruit potential respondents include snowball sampling and social media platforms, such as Facebook and Twitter.
Calculation of the potential sample size is not feasible for this e-survey study, due to using a nonprobability sampling framework and undertaking an opt-in e-survey, and this is acknowledged as a current limitation of the study. Furthermore, a response rate cannot be calculated due to the inability to identify the contact details of IQMs and the associated absence of a sampling frame [
The data collection tool was developed by adapting pre-existing and relevant questionnaires used by Giegerich [
The adapted descriptive questionnaire is comprised of the following elements:
A total of 26 closed-ended questions designed to collect IQMs’ demographic characteristics and their current working arrangements in Australia.
A total of 12 7-point Likert-scale questions to capture the multidimensional perspectives of the IQMs’ transitioning experiences during their first 12 months of working in Australia.
Two open-ended questions to offer IQMs the opportunity to further share their experiences.
Prior to administration of the e-survey, the adapted questionnaire was assessed for content and face validity by a panel of three experts who had survey development expertise or experience of working with IQMs in Australia. The e-survey is hosted via SurveyMonkey and presented over 10 pages; it will allow respondents to review and change their answers prior to completion. Once the e-survey has been completed, respondents will not be able to change their responses nor will they be able to complete the e-survey again. The e-survey will be administered in English; the estimated time to complete the questionnaire is approximately 15-20 minutes (see
The consolidated criteria for reporting qualitative studies (COREQ), a 32-item checklist, will be followed in this phase to ensure all aspects of the study methods, analysis, findings, and interpretations are considered [
The interview guidelines will be developed based on the e-survey results and relevant literature and will then be reviewed by all authors, three of whom are experienced researchers (MS, RV, and MC). Questions will be open-ended with a broad focus to explore the transitional experiences of IQMs. Semistructured interviews—face-to-face or telephone interviews—will be digitally audio recorded with the prior consent of the participants and each will last approximately 30-45 minutes. All interviews will be professionally transcribed for analysis by using a consistent template to obtain consistency between the transcripts.
Although we are not able to specify the sample size needed to reach data saturation, it is estimated that we will need to interview approximately 6-12 participants, based on evidence published by Guest et al [
The aim of this e-survey study is to provide descriptive results for the research questions by analyzing the e-survey responses [
Qualitative analysis of the two open-ended questions in the e-survey will be conducted manually. Summative content analysis [
Interviews will be analyzed thematically, following the six-step approach explained by Braun and Clarke [
Findings from the e-survey study and interviews will be drawn together and compared in order to synthesize the final results and to reach an overall interpretation. To integrate data,
To promote integrity and quality in this mixed methods study, appropriate strategies will be applied during each phase of the study as follows [
This study has obtained ethical approval from the University of South Australia Human Research Ethics Committee on July 4, 2017 (protocol number: 0000036397). All information about the nature and aim of the study, confidentiality, anonymity, voluntary nature of participation and withdrawal, potential benefits and risks of the study, contact details of a person designated to receive complaints, and contact details of the research team will be provided to participants of this study, according to ethical guidelines [
Motivational factors underpinning the migration of internationally qualified health professionals (IQHPs) to developed nations have been highlighted in the literature, with these factors including the desire for an increased standard of living, higher education, professional experiences, and opportunities to achieve better pay [
Migrating to a new country with differences in midwifery and nursing practices, different workplace cultures, and the presence of bullying and discrimination may be confronting for IQMs and IQNs. This could create further challenges during the process of their integration into a foreign midwifery and nursing clinical workforce [
An intrinsic barrier for IQNs attempting to adjust to a new health care system is a lack of familiarity with the culture of local health practice [
The literature highlights that IQNs face cultural impositions and multidimensional discrimination in some health care systems of their host countries [
The process of migrating to Australia and working as a midwife can be a complex and challenging one [
The adapted questionnaire.
consolidated criteria for reporting qualitative studies
internationally qualified health professional
internationally qualified midwife
internationally qualified nurse
We acknowledge the contributions of the IQMs taking part in this study: we thank you. This study would not be possible without the support of the Australian Nursing and Midwifery Federation and Australian College of Midwives, who agreed to distribute the e-survey on their professional websites. We acknowledge the Australian Federal Government for awarding the first author (MJ) with an Australian Postgraduate Awards scholarship to undertake this doctoral work.
None declared.