Insiders as outsiders: Bicultural research assistants describe their participation in the evaluation of an antenatal clinic for women from refugee backgrounds

Refugee populations are widely regarded as difficult to access for research purposes, often because of specific ethical sensitivities and practical challenges. Hence, research methods must be judiciously chosen and fine-tuned to ensure they are sufficiently sensitive and culturally appropriate. Bicultural Research Assistants, who typically share language and cultural similarities with respondents, may be gainfully employed to help address these challenges. By assuming a cultural ‘brokerage’ role, they are well positioned to advise the research team, helping to ensure culturally appropriate conduct throughout the study. Despite extensive use of participatory methods in qualitative studies, the experiences of Bicultural Research Assistants in research activities in tertiary hospital environments, particularly maternity care settings, are rarely reported. This paper addresses a deficit in the literature on this topic. It describes the roles and insights of five female Bicultural Research Assistants trained in basic research methods, and employed on an evaluation of a specialist antenatal clinic for women from refugee backgrounds. Their inclusion as members of the evaluation team was essential to successfully engaging (male) gatekeepers, recruiting eligible women, administering surveys, and conducting, transcribing, and translating interviews. Following the evaluation, the Bicultural Research Assistants contributed a one-off Focus group which explored their motivations for participating in the evaluation, and their experiences of occupying multiple roles as co-researchers, interpreters and respondents. Reported benefits included the acquisition of new skills, improved interprofessional relationships and greater acknowledgement of their roles and responsibilities by hospital staff and community stakeholders. Gender-related barriers were also described. Customary socio-cultural norms, which positioned women as relatively powerless and subservient, were frequently contravened by the Bicultural Research Assistants in their research roles.