“They Can’t Understand It”: Maternity Health and Care Needs of Immigrant Muslim Women in St. John’s, Newfoundland

Objectives The purpose of this qualitative study was to document and explore the maternity health care needs and the barriers to accessing maternity health services from the perspective of immigrant Muslim women living in St. John’s, Canada. Methods A purposive approach was used in recruiting six individuals to participate in in-depth semi-structured interviews. Data were analyzed using a two-step process of content analysis. Three metathemes were identified and compared to previous research on maternity health and the care needs of immigrant women. Results Women experienced discrimination, insensitivity and lack of knowledge about their religious and cultural practices. Health information was limited or lacked the cultural and religious specificity to meet their needs during pregnancy, labor and delivery, and postpartum phases. There were also significant gaps between existing maternity health services and women’s needs for emotional support, and culturally and linguistically appropriate information. This gap was further complicated by the functional and cultural adjustments associated with immigration. Conclusions Maternity health care information and practices designed to meet the needs of mainstream Canadian-born women lacked the flexibility to meet the needs of immigrant Muslim women. Recommendations for change directed at decision makers include improving access to culturally and linguistically appropriate maternity and health related information, developing the diversity responsiveness of health care providers and the organizations where they work and establishing social support networks and partnerships with immigrant communities. Changes that address the needs of immigrant Muslim women have the potential to create more inclusive and responsive maternity health services for all Canadian women.     

Cultural Background and Socioeconomic Influence of Immigrant and Refugee Women Coping with Postpartum Depression

Postpartum depression is a serious condition that can have long lasting traumatic effects on women and their families. Until recently postpartum depression research has focused more on the population as a whole rather than refugee and immigrant women. Informed by Kleinman’s explanatory model and the postcolonial feminist perspective, 30 immigrant and refugee women were interviewed to find out what factors influenced them in seeking postpartum care and what strategies would be helpful in prevention and treatment of postpartum depression. We found that the immigrant and refugee women in our sample: (a) were influenced by both cultural background and socioeconomic factors in seeking support and treatment; (b) were influenced by cultural differences and social stigma when making decisions about health care practices; and (c) employed numerous coping strategies to deal with postpartum depression. Recommendations are provided for more culturally appropriate and equitable mental health care services for immigrant and refugee women living in Canada.     

Student utilization of health services at a university hospital in Turkey.

This paper gives the results of the first pilot study of health care utilization by Turkish university students who receive much of their student health-related services from an affiliated university hospital. The survey was distributed to 393 students and a response rate of 59.8% was obtained. In general students did not report satisfaction with the health services they received. This finding is significant because the hospital concerned is considered 'state of the art' in Turkey. Significant levels of dissatisfaction were noted across several treatment and provider variables, and comparisons with American health services are made. Suggestions for improving the student health services in the country are generated and future research recommendations are highlighted.     

Health care utilization patterns of Russian-speaking immigrant women across age groups

The collapse of the Soviet Union in 1989 substantially increased the numbers of refugees and immigrants to the United States from the former Soviet Union. Little research has been conducted with this population although studies found that immigrant's access to health care services are based on patterns of utilization in their countries of origin. The purpose of this study was to learn about the experiences of immigrant women from three former Soviet Republics (Belarus, Russia, and Ukraine) with women's health care services. Three focus groups of women were formed; ages 20–30, 37–46, and 60 and above. A focus-group guide was used to learn about their health care experiences. These immigrant women did access health care services based on patterns of utilization in their countries of origin. Greater understanding of immigrant populations' cultural patterns of health care utilization is needed to improve access and delivery of health care services to these populations.     

Knowledge among German and Turkish women about specifically female bodily functions, contraception, preventative medical examinations and menopause

The legally binding consent of a patient to surgical operations of certain diagnostic measures during hospitalisation is actually guaranteed only in cases where the medical information is oriented to the individual level of understanding of the patient. The real extent of actual knowledge about health relevant aspects is not always known. Immigrant women constitute a large portion of the patients in big German cities. In most clinics the difficulties in communication caused by persistent language barriers are not presently being solved in a satisfactory manner. In light of this situation, it seemed necessary to ascertain the knowledge of German and Turkish women with respect to specifically female bodily functions, contraception, preventative medical examinations and menopause. The study included a total of 320 German and 262 Turkish patients of both gynaecological units at the Virchow Women's Clinic in Berlin during the 1 1/2-year inquiry period (1997/98). The questionnaire we used was laid out in multiple choice format, whereby each question was provided with a list of possible answers (level of significance p < 0.05). Only a small portion of the general female populace (approximately 13% of the study population, 22% of German patients) is well-to-very-well informed about 'specific female bodily functions, anatomy, preventative health care and contraception', and this proportion is even smaller among Turkish female patients (3% of Turkish women surveyed). While the understanding demonstrated by immigrants who possessed strong writing skills in German is nearly as great as that of the German group, the proportion of patients who demonstrated less sophisticated understanding was still twice as high with 32.5% as compared to that of the German group (15%). According to the opinion of approximately one-third of the Turkish immigrants (German women 8.2%) surveyed, there are no (increased) health risks associated with menopause.     

Access to oral care and attitudes to the dentist by German and Turkish parents

The aim of this study was to collect information on the attitude to dentists and access to dental care by German and Turkish parents. To meet this aim, 829 parents attending a school medical inspection received a questionnaire. 811 (97.8%) questionnaires were returned and 778 (93.8%) could be used for analysis. Compared to German parents Turkish parents had a more negative attitude to the dentist. In particular, communication with the dentist was assessed more negatively by Turkish parents. Clearly more Turkish than German parents agreed that their dentist frequently made them feel guilty because of poor oral hygiene (31.2 vs. 5.6%). 7.7% of German but 23.9% of Turkish parents thought that their dentist did not give them enough information. Among the Turkish interviewees, language problems rather played a minor role in communication problems. 12.6% of German and 19.3% of Turkish interviewees thought they could not believe everything what the dentist said. Only 54.0% of the German and 28.9% of the Turkish parents knew that fissure sealants were paid by the statutory sickness fund. Dentists should be better trained in dealing with patients with a different social or cultural background. Also, dentists should be taught to consider health problems rather from a social than from an individual aspect. To improve cost transparency, dentists should publish the list of services not covered by the statutory sickness fund. Moreover, an independent patient consultation service should be offered.     

The healthcare experiences of Arab Israeli women in a reformed healthcare system

Arab Israeli women are subject to unique social stresses deriving from their status as part of an ethno-political minority and from their position as women in a patriarchal community. Collectively, their health profiles rate poorly in comparison to Jewish Israeli women or to women in the vast majority of developed countries. OBJECTIVES: To examine the experiences of Arab Israeli women in the contemporary Israeli healthcare system, following implementation of the National Health Insurance Law (NHIL). METHODS: The study combined quantitative and qualitative research methodologies. A telephone survey utilizing a structured questionnaire was conducted during August-September 1998 among a random national sample of 849 women, with a response rate of 83%. Between the months of January and July of 2000, qualitative data was attained via participant-observation, long and short semi-structured interviews, and focus groups in one large Muslim Arab Israeli village. FINDINGS: Arab Israeli women in the national survey reported poorer self-assessed health, lower rates of care by a woman primary care physician, lower satisfaction ratings for primary care physicians and more frequently foregoing medical care than did native or immigrant Jewish Israeli women. Three major factors contributing to Arab Israeli women's healthcare experiences were elucidated by the qualitative study: (1) the threat of physical and social exposure (2) difficulties in communicating with male physicians and (3) the stifling effect of family politics and surveillance on healthcare. DISCUSSION: We discuss our findings in relation to structural changes associated with the recent reform of the Israeli health care system. We conclude by suggesting policy measures for better adapting primary care services to the needs of Arab Israeli women, and note the relevance to other systems that aim to provide service to cultural and ethno-political minorities, in which healthcare delivery is shaped by unique local circumstances.     

Inequalities in mental health care and social services utilisation by immigrant women

Background: The basic assumption of public health policy forimmigrants is that they ought to have equal access to healthservices compared to other population groups In Dutch society.However, little research is done on the actual use of mentalhealth services by immigrants and literature seems to indicateinequalities in services utilisation by immigrant women. Methods:This study was conducted in Amsterdam, The Netherlands. Dataon service utilisation were drawn from patient registers andcame from care providers who were asked to keep up registrationfor some time to count the number of immigrant women referredto and in treatment. Results: Surinamese, Antillean, Turkishand Moroccan women made considerably less use of mental healthcare services than native-born women. On the other hand, immigrantwomen more frequently used social work facilities and womencrisis intervention centres. Overall, they consulted the latterorganizations nearly 1.5 times more frequently than mental healthcare services. The differences in service utilisation betweenthe four immigrant groups are also discussed. Conclusions: Thisstudy explores the reasons for the ethnic differences in serviceutilisation. It argues that cultural and supply factors arelargely responsible for the ethnic differences in use of mentalhealth services. The differential use of social services ismainly ascribed to the socioeconomic status of the women concerned.The results imply that a care policy may improve the accessibilityof mental health services for immigrant women. The most promisingmeasure is by employing more ethnic and bilingual care providers.     

Subjektiv erlebte Barrieren von Personen mit Migrationshintergrund bei der Inanspruchnahme von Gesundheitsma?nahmen

Aim

Analysis of barriers regarding attendance at the health care system under consideration of cultural and migration-related factors.

Method

Cross-sectional survey with immigrants from Turkey (n?=?77), Spain (n?=?67), Italy (n?=?95) and German resettlers from the former Soviet Union (n?=?196), recruited on migration and addiction services of the German Caritasverband, the Arbeiterwohlfahrt and migrant organizations.

Results

Spanish and Italian immigrants mainly search for help within their families and social environment. Immigrants from the former Soviet Union use home remedies and experience more linguistic difficulties as barriers for the use of health services, just like Turkish immigrants. Turkish immigrants reported feeling misunderstood regarding their cultural peculiarities by the expert staff as another main barrier. Other major influencing factors were German language proficiency and the subjective wellbeing in Germany.

Conclusion

The consideration of cultural-related as well as linguistic factors in health care services is an essential contribution for improving health care of immigrants.     

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors

Migration has become a profound global phenomenon in this century. In Canada, uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services, present barriers to immigrant women caregivers. The purpose of this paper is to share relevant insights from individual and group interviews with immigrant women family caregivers, service providers and policy influencers, and discuss these in relation to immigration, health and social policy, and programme trends in Canada. The present authors conducted individual interviews with immigrant women family caregivers (n = 29) in phase 1, followed by two group interviews with women family caregivers (n = 7), and two group interviews with service providers and policy-makers (n = 15) in phase 2. Using an inductive approach, the authors employed thematic content data analysis. Immigrant women experienced barriers to health and social services similar to Canadian-born family caregivers, particularly those who have low incomes, jobs with limited flexibility and heavy caregiving demands. These immigrant women family caregivers avoided certain formal services for a variety of reasons, including lack of cultural sensitivity. However, their challenges were compounded by language, immigration and separation from family in the home country. The identified barriers to support reinforce the importance of modifying and expanding policies and programmes affecting immigrant women's ability to care for family members with illnesses or disabilities within the context of Canadian society. Participants recommended changes to policies and programmes to deal with information, transportation, language, attitudinal and network barriers. The various barriers to services and programmes which were experienced by immigrant women caregivers underscore the importance of reviewing policies affecting immigration, caregiving, and access to health and social services. Intersectoral collaboration among agencies is essential to reduce the barriers identified in the present study, and to establish services which are linguistically and culturally appropriate.     

Patient satisfaction with hospital services: determinants and level in a hospital in Kuwait.

The present study used a well-tested patient satisfaction measuring instrument to identify the determinants of the level of overall satisfaction with hospital services, and to examine the level of satisfaction with attributes of 7 specific dimensions of hospital services. Using multiple regression analysis, it was found that out of 12 patient characteristics, age was the most important determinant of overall satisfaction, followed by gender. Perceived health status, clinical department, and expectations about the quality of services before admission were also significant but less important determinants of overall satisfaction. Marital status, level of education, nationality, and previous hospitalization in the study hospital, in Kuwait, or in a western country hospital, all had no significant effect on overall satisfaction. Concerning the effect of satisfaction with specific dimensions of hospital services on overall satisfaction, it was found that satisfaction with physicians was the most important determinant of overall satisfaction, followed by satisfaction with housekeeping and with nurses. Satisfaction with hospital environment and facilities and with admission process were also significant but less important determinants of overall satisfaction, while satisfaction with food and radiology services did not affect overall satisfaction. The level of overall satisfaction as well as satisfaction with specific dimensions of hospital services were quite high. Physicians' care was the most favorably rated dimension, followed by admission process and housekeeping, while nursing care was the least favorably rated dimension. Among the attributes of physicians' and nurses' care, technical care and courtesy were the most favorably rated items; while communication, particularly imparting of information, was the least favorably rated aspect. Several attributes of the hospital environment and facilities and of the food services were found to be dissatisfying to patients.     

Constructions and experiences of sexual health among young,heterosexual, unmarried Muslim women immigrants in Australia

Minority ethnic immigrant women are frequently vulnerable to poor sexual health outcomes, due to poor use of sexual health services, lack of knowledge and social stigma associated with the discussion of sexuality. This paper explores the sexual health accounts provided by a group of young, unmarried heterosexual Muslim women immigrants residing and studying in Sydney, an under-researched group in the Australian context. Ten semi-structured interviews were conducted, focusing on sex before marriage, spouse selection and contraceptive use. Feminist discourse analysis identified ‘purity versus corruption’ as the primary construction of women's sexuality, where women positioned their sexual behaviour as that of purity and uninvolvement or corruption through unwedded participation. The subthemes ‘maintaining ignorance and naivety’, ‘remaining virginal’, ‘sex segregation’ and ‘the fallen woman’ capture women's personal sexuality-related experiences and values within the context of their religious and cultural communities. Additional research with this community is needed to examine the effects of negative social constructions of sex on young sexually active Muslim women, as well as further research on young women's sexual health within immigrant communities.     

Explaining Women's High Satisfaction With Objectively Poor Quality Childbirth Services: Armenia as a Case Study

Despite documented low-quality care in Armenia, surveys document high ratings of patient satisfaction with health care services. We explored reasons for high satisfaction in Armenia despite poor quality. Twenty-five women who recently delivered participated in this qualitative study through in-depth interviews. Patients avoided critiquing health care services because of personal relationships with and respect for providers and fear of losing services. Although they shared an understanding of what quality care should be, many were satisfied because their low expectations were met. Further mixed methods research may explain this dissonance. Until then, patient satisfaction measures need careful, contextual interpretations.     

Health seeking behavior among pregnant women in rural Haiti

The purpose of this study was to further knowledge of health care seeking behavior among pregnant women in rural Haiti. Eighty-two pregnant women were interviewed to assess care seeking behaviors during pregnancy, satisfaction with services, reliance on social networks, and management of pregnancy-related illness. Twenty-five percent reported not seeking care in the formal health sector for a pregnancy-related illness; 32% delayed seeking care. Women relied primarily on their husbands and mothers for health care advice during pregnancy and times of illness, and coped with illness by lying down. Strategies for improving awareness and health care access are discussed.     

Discursos profesionales sobre la violencia del compañero íntimo: implicación en la atención de las mujeres inmigrantes en España

Objective1) to examine the discourses of professionals involved in the care of female victims of intimate partner violence (IPV), with emphasis on how they describe the immigrant women, the perpetrators and their own responsibility of care; and 2) to compare these discourses with the other professions involved in caring for these women (social services, associations and police and justice).MethodsQualitative study based on semi-structured interviews with 43 professionals from social services, associations and the police and judicial systems. A discourse analysis was carried out to identify interpretive repertoires about IPV, immigrant women and their aggressors, their culture and professional practices.ResultsFour interpretive repertoires emerged from professional discourses: “Cultural prototypes of women affected by IPV”, “Perpetrators are similar regardless of their culture of origin”, “Are victims credible and the perpetrators responsible?” and “Lack of cultural sensitivity of professionals in helping immigrant women in abusive situations”. These repertoires correspond to preconceptions that professionals construct about affected women and their perpetrators, the credibility and responsibility they attribute to them and the interpretation of their professional roles.ConclusionsThe employment of IPV-trained cultural mediators in the services responsible for caring for the female victims, together with cultural training for the professionals, will facilitate the provision of culturally sensitive care to immigrant female victims of intimate partner violence.     

Client satisfaction and quality of health care in rural Bangladesh.

OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more important than the technical competence of the provider. Furthermore, a reduction in waiting time (on average to 30 min) was more important to clients than a prolongation of the quite short (from a medical standpoint) consultation time (on average 2 min, 22 sec), with 75% of clients being satisfied. Waiting time, which was about double at outreach services than that at fixed services, was the only element with which users of outreach services were dissatisfied. CONCLUSIONS: This study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally care should be capable of meeting both medical and psychosocial needs, in reality care that meets all medical needs may fail to meet the client's emotional or social needs. Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth research on the determinants of client satisfaction in the respective culture.     

Strategies to Enhance Retention in a Cohort Study Among Adults of Turkish Descent Living in Berlin

Retention is important for statistical power and external validity in long-term cohort studies. The aims of our study were to evaluate different retention strategies within a cohort study of adults of Turkish descent in Berlin, Germany, and to compare participants and non-participants. In 2011–2012, a population-based study was conducted among adults of Turkish descent to primarily examine recruitment strategies. 6 years later, the participants were re-contacted and invited to complete a self-report questionnaire regarding their health status, health care utilization, and satisfaction with medical services. The retention strategy comprised letters in both German and Turkish, phone calls, and home visits (by bilingual staff). We calculated the response rate and retention rate, using definitions of the American Association for Public Opinion Research, as well as the relative retention rate for each level of contact. Associations of baseline recruitment strategy, sociodemographic, migration-related and health-related factors with retention were investigated by logistic regression analysis. Of 557 persons contacted, 249 (44.7%) completed the questionnaire. This was 50.1% of those whose contact information was available. The relative retention rate was lowest for phone calls (8.9%) and highest for home visits (18.4%). Participants were more often non-smokers and German citizens than non-participants. For all remaining factors, no association with retention was found. In this study, among adults of Turkish descent, the retention rate increased considerably with every additional level of contact. Implementation of comprehensive retention strategies provided by culturally matched study personnel may lead to higher validity and statistical power in studies on migrant health issues.