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"In My Culture, We Don't Know Anything About That": Sexual and Reproductive Health of Migrant and Refugee Women. Int J Behav Med 2018. [PMID: 28620774 DOI: 10.1007/s12529-017-9662-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Migrant and refugee women are at risk of negative sexual and reproductive health (SRH) outcomes due to low utilisation of SRH services. SRH is shaped by socio-cultural factors which can act as barriers to knowledge and influence access to healthcare. Research is needed to examine constructions and experiences of SRH in non-English-speaking migrant and refugee women, across a range of cultural groups. METHOD This qualitative study examined the constructions and experiences of SRH among recent migrant and refugee women living in Sydney, Australia, and Vancouver, Canada. A total of 169 women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, India, Sri Lanka and South America participated in the study, through 84 individual interviews, and 16 focus groups comprised of 85 participants. Thematic analysis was used to analyse the data. RESULTS Three themes were identified: "women's assessments of inadequate knowledge of sexual and reproductive health and preventative screening practices", "barriers to sexual and reproductive health" and "negative sexual and reproductive health outcomes". Across all cultural groups, many women had inadequate knowledge of SRH, due to taboos associated with constructions and experiences of menstruation and sexuality. This has implications for migrant and refugee women's ability to access SRH education and information, including contraception, and sexual health screening, making them vulnerable to SRH difficulties, such as sexually transmissible infections and unplanned pregnancies. CONCLUSION It is essential for researchers and health service providers to understand socio-cultural constraints which may impede SRH knowledge and behaviour of recent migrant and refugee women, in order to provide culturally safe SRH education and services that are accessible to all women at resettlement irrespective of ethnicity or migration category.
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Hawkey AJ, Ussher JM, Perz J, Metusela C. Experiences and Constructions of Menarche and Menstruation Among Migrant and Refugee Women. QUALITATIVE HEALTH RESEARCH 2017; 27:1473-1490. [PMID: 27742765 DOI: 10.1177/1049732316672639] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Experiences and constructions of menarche and menstruation are shaped by the sociocultural environment in which women are embedded. We explored experiences and constructions of menarche and menstruation among migrant and refugee women resettled in Sydney, Australia, and Vancouver, Canada. Seventy-eight semistructured individual interviews and 15 focus groups comprised of 82 participants were undertaken with women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and varying South American countries. We analyzed the data using thematic decomposition, identifying the overall theme "cycles of shame" and two core themes. In "becoming a woman," participants constructed menarche as a marker of womanhood, closely linked to marriage and childbearing. In "the unspeakable," women conveyed negative constructions of menstruation, positioning it as shameful, something to be concealed, and polluting. Identifying migrant and refugee women's experiences and constructions of menarche and menstruation is essential for culturally safe medical practice, health promotion, and health education.
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Affiliation(s)
- Alexandra J Hawkey
- 1 Centre for Health Research,Western Sydney University, Penrith, New South Wales, Australia
| | - Jane M Ussher
- 1 Centre for Health Research,Western Sydney University, Penrith, New South Wales, Australia
| | - Janette Perz
- 1 Centre for Health Research,Western Sydney University, Penrith, New South Wales, Australia
| | - Christine Metusela
- 1 Centre for Health Research,Western Sydney University, Penrith, New South Wales, Australia
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Mengesha ZB, Perz J, Dune T, Ussher J. Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives. PLoS One 2017; 12:e0181421. [PMID: 28727833 PMCID: PMC5519071 DOI: 10.1371/journal.pone.0181421] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/08/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Australia only 2.2% of published health research has focused on multi-cultural health despite the increase of culturally and linguistically diverse populations. Research on the perceptions and experiences of health care professionals (HCPs) in engaging with refugee and migrant women is also lacking. Given the integral role of HCPs in providing sexual and reproductive health (SRH) care for these populations, an understanding of the challenges they experience is required. Therefore, this study sought to examine the perspectives and practices of Australian HCPs with regard to the provision of SRH care for refugee and migrant women. METHODS Employing qualitative methods, twenty-one semi-structured interviews were conducted with HCPs representing various professions, work experiences, cultural backgrounds, age and healthcare sectors. The interviews were analysed using thematic analysis and the socio-ecological model was utilised to interpret the data. RESULTS The complexities of HCP's engagement with refugee and migrant women were identified in three major themes: Being a Migrant; Gender Roles and SRH Decision-making; and Women in the Healthcare System. HCPs discussed the impact of accessing SRH care in women's country of origin and the influence of re-settlement contexts on their SRH knowledge, engagement with care and care provision. Perception of gender roles was integral to SRH decision-making with the need to involve male partners having an impact on the provision of women-centred care. Barriers within the healthcare system included the lack of services to address sexual functioning and relationship issues, as well as lack of resources, time constraints, cost of services, and funding. CONCLUSION Australian HCPs interviewed reported that migrant and refugee women do not have appropriate access to SRH care due to multifaceted challenges. These challenges are present across the entire socio-ecological arena, from individual to systemic levels. Multiple and multidimensional interventions are required to increase SRH utilisation and improve outcomes for refugee and migrant women.
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Affiliation(s)
- Zelalem B. Mengesha
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Janette Perz
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Tinashe Dune
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Jane Ussher
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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Mengesha ZB, Dune T, Perz J. Culturally and linguistically diverse women. Sex Health 2016; 13:SH15235. [PMID: 27209062 DOI: 10.1071/sh15235] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/08/2016] [Indexed: 02/28/2024]
Abstract
The proportion of women from culturally and linguistically diverse backgrounds is growing in Australia. Synthesising existing evidence concerning the views and experiences of these women in accessing sexual and reproductive health care is crucial to future policy and service development. A systematic review of scientific articles and grey literature published in English between 1990 and 2015 was conducted to identify the barriers and facilitators in accessing sexual and reproductive health care in Australia experienced by culturally and linguistically diverse women. The search strategy covered seven electronic databases (ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit) and websites. Thematic analysis methodology was used to analyse and interpret the data extracted from individual studies. From the 1401 potentially relevant articles identified, 22 articles that represent the views and experiences of 1943 culturally and linguistically diverse women in accessing sexual and reproductive health care in Australia were reviewed. The main barriers and facilitators identified were grouped into three major themes. These include personal level experiences of accessing health care, women's interaction with the healthcare system and women's experience with healthcare providers. Implications for clinical practice and future research are discussed based on the findings of the review.
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Small R, Roth C, Raval M, Shafiei T, Korfker D, Heaman M, McCourt C, Gagnon A. Immigrant and non-immigrant women's experiences of maternity care: a systematic and comparative review of studies in five countries. BMC Pregnancy Childbirth 2014; 14:152. [PMID: 24773762 PMCID: PMC4108006 DOI: 10.1186/1471-2393-14-152] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/09/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Understanding immigrant women's experiences of maternity care is critical if receiving country care systems are to respond appropriately to increasing global migration. This systematic review aimed to compare what we know about immigrant and non-immigrant women's experiences of maternity care. METHODS Medline, CINAHL, Health Star, Embase and PsychInfo were searched for the period 1989-2012. First, we retrieved population-based studies of women's experiences of maternity care (n = 12). For countries with identified population studies, studies focused specifically on immigrant women's experiences of care were also retrieved (n = 22). For all included studies, we extracted available data on experiences of care and undertook a descriptive comparison. RESULTS What immigrant and non-immigrant women want from maternity care proved similar: safe, high quality, attentive and individualised care, with adequate information and support. Immigrant women were less positive about their care than non-immigrant women. Communication problems and lack of familiarity with care systems impacted negatively on immigrant women's experiences, as did perceptions of discrimination and care which was not kind or respectful. CONCLUSION Few differences were found in what immigrant and non-immigrant women want from maternity care. The challenge for health systems is to address the barriers immigrant women face by improving communication, increasing women's understanding of care provision and reducing discrimination.
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Affiliation(s)
- Rhonda Small
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne VIC 3000, Australia
| | - Carolyn Roth
- Clinical Education Centre, Keele University, Newcastle Road, Staffordshire ST4 6QG, UK
| | - Manjri Raval
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne VIC 3000, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne VIC 3000, Australia
| | - Dineke Korfker
- TNO Institute, Wassenaarseweg, Leiden CE 56 2301, Netherlands
| | - Maureen Heaman
- Faculty of Nursing, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Christine McCourt
- School of Health Sciences, City University London, Bartholomew Close, London EC1A 7QN, UK
| | - Anita Gagnon
- McGill, Ingram School of Nursing & Department Ob/Gyn, MUHC Prog.Ob/Gyn, 3506 rue University, Montreal, Quebec H3A 2A7, Canada
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Boerleider AW, Francke AL, van de Reep M, Manniën J, Wiegers TA, Devillé WLJM. "Being flexible and creative": a qualitative study on maternity care assistants' experiences with non-Western immigrant women. PLoS One 2014; 9:e91843. [PMID: 24622576 PMCID: PMC3951471 DOI: 10.1371/journal.pone.0091843] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/14/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies conducted in developed countries have explored postnatal care professionals' experiences with non-western women. These studies reported different cultural practices, lack of knowledge of the maternity care system, communication difficulties, and the important role of the baby's grandmother as care-giver in the postnatal period. However, not much attention has been paid in existing literature to postnatal care professionals' approaches to these issues. Our main objective was to gain insight into how Dutch postnatal care providers--'maternity care assistants' (MCA)--address issues encountered when providing care for non-western women. METHODS A generic qualitative research approach was used. Two researchers interviewed fifteen MCAs individually, analysing the interview material separately and then comparing and discussing their results. Analytical codes were organised into main themes and subthemes. RESULTS MCAs perceive caring for non-western women as interesting and challenging, but sometimes difficult too. To guarantee the health and safety of mother and baby, they have adopted flexible and creative approaches to address issues concerning traditional practices, socioeconomic status and communication. Furthermore, they employ several other strategies to establish relationships with non-western clients and their families, improve women's knowledge of the maternity care system and give health education. CONCLUSION Provision of postnatal care to non-western clients may require special skills and measures. The quality of care for non-western clients might be improved by including these skills in education and retraining programmes for postnatal care providers on top of factual knowledge about traditional practices.
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Affiliation(s)
- Agatha W. Boerleider
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- * E-mail:
| | - Anneke L. Francke
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Merle van de Reep
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Judith Manniën
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Therese A. Wiegers
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Walter L. J. M. Devillé
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- National Knowledge and Advisory Center on Migrants, Refugees and Health (Pharos), Utrecht, The Netherlands
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Barriers and facilitators of social supports for immigrant and refugee women coping with postpartum depression. ANS Adv Nurs Sci 2012; 35:E42-56. [PMID: 22869217 DOI: 10.1097/ans.0b013e3182626137] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An emerging concern for health care providers is how to assist immigrant and refugee women adapt to a new milieu and to cope with postpartum depression (PPD). Thirty women were interviewed to find out their perspective on what factors influence their help-seeking behavior and decision making about postpartum care and what strategies would be helpful in PPD prevention and treatment. Findings reveal that (a) social support networks can be supportive or nonsupportive with widespread effects on physical and psychological health and well-being; (b) cultural background and socioeconomic factors influence seeking support; (c) health care relationship was viewed a critical determinant to seek and accept help for PPD.
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Disparities in patient-physician communication for persons with a disability from the 2006 Medical Expenditure Panel Survey (MEPS). Disabil Health J 2011; 2:206-15. [PMID: 21122761 DOI: 10.1016/j.dhjo.2009.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 05/29/2009] [Accepted: 06/22/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ineffective patient-physician communication has been shown to result in poorer health outcomes for various vulnerable populations. However, little research has been done on patient-physician communication issues as perceived by persons with disabilities. The purposes of this study are to determine if there is a relationship between disability and patient-physician communication and how disability affects the likelihood of effective patient-physician communication. The research questions for this study are: (1) Is there a significant difference in patient-physician communication for persons with disabilities compared to persons without disabilities? (2) Does having a disability influence the likelihood of ineffective patient-physician communication? METHODS Data were obtained from the 2006 Medical Expenditure Panel Survey (MEPS). Chi-square analyses were performed to determine if there a significant difference in patient-physician communication for persons with disabilities compared with persons without disabilities. A series of logistic regression analyses were conducted examining the likelihood of ineffective patient-physician communication with the independent variable of disability status. RESULTS Those with a disability are significantly more likely than persons without a disability to perceive that the physician does not listen to them, does not explain treatment so that they understand, does not treat them with respect, does not spend enough time with them, and does not involve them in treatment decisions. Regression analyses further revealed that persons with a disability are from 1.36 to 1.78 times as likely to perceive inadequate patient-physician communication. CONCLUSIONS This study revealed that persons with disabilities are at increased risk of experiencing ineffective patient-physician communication, compromising current health status and increasing the possibility of secondary health conditions. Several suggestions were made with regard to incorporation of "disability literacy" mechanisms such as physician training, health facility environmental assessment, and use of technologies such as telehealth and e-health. Further research in partnership with the disability community is needed to determine the effectiveness of these methods in improving patient-physician communication.
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Brotherton J, Taylor R, Ivanov O, Tewson R, Page A. "It's much easier than going to the dentist": high levels of satisfaction in a mammography screening program. Aust N Z J Public Health 2007; 31:353-9. [PMID: 17725016 DOI: 10.1111/j.1753-6405.2007.00086.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To develop a suitable instrument for measuring client satisfaction in the BreastScreen New South Wales (NSW) program and to use the instrument to measure client satisfaction. METHOD The survey was designed and administered to 2,091 women who attended mammography screening in the BreastScreen NSW program during 2001 (85% response rate). The survey evaluated experiences of making appointments, the screening environment, the screening procedure, and the receipt of results. Socio-demographic differentials in client satisfaction were examined using logistic regression models. RESULTS The majority of women were highly satisfied with their experience, with transport/parking, breast discomfort and time to results causing the most dissatisfaction (8-9%). The main source of dissatisfaction was during the appointment and related to discomfort during the mammogram (9%) and breast problems following the mammogram (9%). Predictors of dissatisfaction with screening (p<0.05) included high education level (OR=1.4), non-Australian born (OR=1.4), and aged 40-49 years (OR=1.6). CONCLUSIONS Although overall satisfaction was high, the survey indicated service functions where improvements could be made. IMPLICATIONS This research has developed an appropriate tool for assessing and monitoring client satisfaction with breast screening services.
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Kanotra S, D'Angelo D, Phares TM, Morrow B, Barfield WD, Lansky A. Challenges faced by new mothers in the early postpartum period: an analysis of comment data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Matern Child Health J 2007; 11:549-58. [PMID: 17562155 DOI: 10.1007/s10995-007-0206-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 02/20/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify challenges that women face 2-9 months postpartum using qualitative data gathered by the Pregnancy Risk Assessment Monitoring System (PRAMS). METHODS PRAMS is an on-going population-based surveillance system that collects self-reported information on maternal behaviors and experiences before, during, and after the birth of a live infant. We analyzed free text comment data from women in 10 states who answered the PRAMS survey in 2000. Preliminary analysis included a review of the comment data to identify major themes and a demographic comparison of women who commented (n = 3,417) versus women who did not (n = 12,497). Subsequent analysis included systematic coding of the data from 324 women that commented about postpartum concerns and evaluation to ensure acceptable levels of reliability among coders. RESULTS We identified the following major themes, listed in order of frequency: (1) need for social support, (2) breastfeeding issues, (3) lack of education about newborn care after discharge, (4) need for help with postpartum depression, (5) perceived need for extended postpartum hospital stay, and (6) need for maternal insurance coverage beyond delivery. CONCLUSION The themes identified indicate that new mothers want more social support and education and that some of their concerns relate to policies regarding breastfeeding and medical care. These results can be used to inform programs and policies designed to address education and continuity of postpartum care for new mothers.
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Affiliation(s)
- Sarojini Kanotra
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA.
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