Service design for improving pregnancy, childbirth, and childcare competency among North Korean refugee women in South Korea: a qualitative service-design study

PURPOSE: North Korean refugee women face multiple vulnerabilities during pregnancy and early childrearing due to fragmented support and limited familiarity with Korea's health and welfare systems. Existing research has examined isolated barriers. This study used a service design approach to explore their maternal-infant care experiences and identify structural discontinuities across the care pathway. METHODS: Data were collected from North Korean refugee mothers and service providers from April to August 2024. A service design approach using user journey mapping, thematic analysis, and service blueprinting was employed to examine user actions, emotional trajectories, frontline interactions, and backstage and interagency processes. RESULTS: Five structural issues were identified: fragmented information, cross-institutional access barriers, cultural and emotional isolation, discontinuity in interagency linkage, and provider resource constraints. These issues accumulated along the pathway, increasing emotional burden, delaying timely care, and reinforcing avoidance behaviors. Misalignment between user needs and multi-agency processes was also evident. CONCLUSION: Maternal and infant care challenges among North Korean refugee women stem from structural fragmentation rather than individual factors. Based on these findings, the NK Mom Care Navigator-a pathway-based, culturally responsive service design model-is proposed to strengthen continuity of care and enhance equitable maternal-infant support for vulnerable refugee families.