Somali Refugee Women's Experiences and Perceptions of Western Health Care

Are People From Black Communities Proportionately Represented in UK and US Studies Examining Views on Screening and Diagnostic Genetic Testing in Pregnancy? A Scoping Review

BACKGROUND

Several studies have explored parent and public perspectives on screening and diagnostic genetic testing during pregnancy (prenatal testing). Little is known about how much people from Black communities have contributed to this research.

OBJECTIVE

To examine whether Black people's views on prenatal testing are proportionately represented in UK and US studies.

SEARCH STRATEGY

Searches were conducted in Medline (Ovid), PsycINFO (Ovid), CINAHL Complete (EBSCOhost), and Emcare (Ovid).

SELECTION CRITERIA

Primary experimental UK and US studies examining parental and public perspectives on prenatal testing, published between 2014 and 2024.

DATA COLLECTION AND ANALYSIS

After duplicate removal, titles and abstracts were independently screened by two reviewers. Full texts were then obtained, and data were extracted for analysis.

MAIN RESULTS

Seventy-six studies were included. 83% (n = 63) included Black participants; only 39% (n = 30) reported a sample meeting the respective national Black population. More studies in which Black participants met the population were from the UK (UK: 69% vs. US: 42%), though this difference did not reach significance (OR = 1.53; 95% CI: 0.52, 4.48; p = 0.431). Black participants were better represented in studies exploring views on prenatal testing for sickle cell than those on non-invasive prenatal testing and genomic technologies.

CONCLUSIONS

Whilst important for our understanding, efforts to include Black participants in studies examining views on prenatal testing should not be limited to those where the condition primarily impacts this population. Improved representation of Black people across a wider range of studies is essential for supporting health equity and minimising health disparities.

Thirty-Five Years of Knowledge in Transcultural Nursing: A Bibliometric Analysis of Journal of Transcultural Nursing

INTRODUCTION

This bibliometric analysis aims to examine articles published in Journal of Transcultural Nursing (JTCN), between 1989 and 2024.

METHOD

This study analyzed 1,675 JTCN publications from 1989 to 2024 using Scopus as a data source. Performance analysis and scientific mapping techniques were used for bibliometric metadology. Analyses were performed with VOSviewer and Bibliometrix software.

RESULTS

In total, 1,675 articles were included in the study. The most prolific authors are Leininger, M., Boyle, J.S., Pacquiao, D.F., and Zoucha, R. The leading countries in terms of number of publications are the United States, Canada, and Australia. According to the co-occurrence analysis, six research themes emerged. In addition, it was determined that "nursing care," "COVID-19," "social determinants of health," "health equity," and "refugees" were trending topics.

DISCUSSION

Our findings can provide nurses and academicians with ideas on the subject by identifying trending topics and leading researchers in JTCN.

Considerations for specialized maternal-fetal care in the Somali-American community

OBJECTIVE

This study describes the perceptions, personal and community experiences, and barriers to care of Somali-American families regarding specialized maternal-fetal care from their viewpoint.

STUDY DESIGN

We conducted a semi-structured focus group study of Somali-American women (March 2023). We used qualitative analysis techniques to identify and report thematic findings.

RESULTS

Fifty Somali-American women were interviewed in focus groups. Five themes were identified: 1) adherence to religious belief (namely Islamic) was paramount, including devotions of predestination (e.g. divine will) and permissibility of fetal intervention, 2) participants valued consensus among clinicians and were guided by prior experiences, 3) confidence in the medical team was important, and included the need to communicate effectively with clinicians and concerns regarding the accuracy of diagnosis, 4) decisional factors prioritized saving the life of the baby, and 5) treatment considerations included reluctance to intervene before birth.

CONCLUSIONS

For the Somali-American participants, their faith identity was central when considering their medical needs, including a hesitance to treat a baby before birth due to Islamic belief in divine will. In addition, these community members highlighted the importance of trustworthy interpretation, cultural competence, clinician consensus, prior pregnancy experiences as well as experiences of other community members as having an impact on their trust in their medical care and diagnosis.

Understanding Refugees Health Experiences in Host Countries: Three Theoretical Perspectives

Healthcare providers working with forcefully displaced populations often have limited knowledge and skills regarding the care of this population. The reasons are twofold. First, most of the research on refugee health does not consider refugees' adaptive skills, diversity of experiences, and daily life context. Second, healthcare providers' knowledge of how the sociopolitical environment shapes health research and practice in the context of refugee care is often limited. This work aims to specify gaps in refugee healthcare and research by applying a relational approach to three theoretical frameworks. The relational approach supports a pragmatic, in-depth understanding of healthcare practices by shifting the focus of the inquiry from description of social structures toward exploration of processes and relations that propagate and sustain such structures. The focus is on the threefold interaction between refugees, healthcare providers, and healthcare institutions. The three theoretical frameworks are as follows: First, using concepts from the Theory of Practice by Bourdieu, we examine how gaps in care can result from a mismatch between the dispositions and skills that refugees develop through life experience and the cultural-professional practices of healthcare providers in host countries. Second, the Cultural Determinants of Help Seeking by Saint Arnault is applied to posit that gaps in care can result from differences in the meanings that healthcare providers and refugees assign to their interactions. Finally, we use the concept of Othering as described in nursing by Canales to explain how power dynamics inherent in the interaction between refugees and healthcare systems can affect refugee healthcare and research. This relational approach helps to elucidate some of the culture-bound mechanisms of health maintenance and help-seeking and brings attention to the sociopolitical context that shapes the way we care to refugees.

Maternal and Perinatal Health Disparities Among Middle Eastern and North African Women and Children in the United States

INTRODUCTION

Few studies have evaluated the health of Middle Eastern and North African (MENA) women and children in the United States. Objectives were to determine the odds of well-visits, preventive behaviors during pregnancy, and low birthweight among foreign-born non-Hispanic MENA women and children compared to their US- and foreign-born non-Hispanic White counterparts after adjusting for covariates (hereafter, reported as MENA and White).

METHODS

We analyzed 2000-2018 National Health Interview Survey data (411,709 women, 311,961 children). Outcomes included well-woman visits (past 12 months); dentist visits (past 6 months) and current smoking among pregnant women; and low, moderately low, and very low birthweight among children. Covariates included age, family income, and health insurance for children. Education and marital status were also evaluated among women.

RESULTS

Over half (53.4%) of foreign-born MENA women were of childbearing age (ages 18-45) compared to 47.7% US-born and 43.2% foreign-born White women. The odds of completing a well-women visit were 0.73 times lower (95% CI = 0.38-0.89) among foreign-born MENA women compared to US-born White women after adjusting for age, education, and marital status. There was no statistically significant difference in dental visits between groups. No foreign-born MENA pregnant women reported current smoking. Foreign-born MENA children had higher odds of low (OR = 1.65; 95% CI = 1.16-2.35) and moderately low birthweight (OR = 1.78; 95% CI = 1.19-2.66) compared to US-born White children in adjusted models.

DISCUSSION

MENA women and children are classified as White by the federal government. Our results highlight that the health of foreign-born MENA women and children differ from their White counterparts.

Refugee Family Health Brokers' (FHBs') Experiences with Health Care Providers: A Thematic Analysis

BACKGROUND

The resettlement and post-resettlement quality of life of refugees is often marred by chronic health/mental health conditions. To adequately care for refugees suffering these conditions, a promising strategy is the use of refugee Family Health Brokers (FHBs). FHBs are safe and trusted family members functioning as intermediaries between one's family and health care providers. Although FHBs are known to positively influence health care utilization in their families, little is known about them and this aspect of their family caregiving role and experiences, particularly with health care providers, necessitating further research.

METHODS

Fourteen Bhutanese and three Bosnian refugee FHBs participated in a 2-hr focus group discussing their experiences with health care providers after being surveyed about their FHB role.

RESULTS

Thematic analysis yielded five themes centered around perceptions, knowledge, communication, behavior, and responsibilities reflective of FHBs' experiences, which can be understood as symptoms of existing structural inequalities.

CONCLUSIONS

FHBs primarily conveyed problems, struggles, and dilemmas they experienced more so than rewarding aspects of being an FHB. Suggestions are provided on how to avert these negative experiences from occurring and becoming barriers to developing allyship with FHBs in the context of existing structural inequalities.