Elsevier

Women's Health Issues

Volume 25, Issue 5, September–October 2015, Pages 501-508
Women's Health Issues

Original article
Bosnian, Iraqi, and Somali Refugee Women Speak: A Comparative Qualitative Study of Refugee Health Beliefs on Preventive Health and Breast Cancer Screening

https://doi.org/10.1016/j.whi.2015.06.005Get rights and content

Abstract

Introduction

The low uptake of preventive services in disadvantaged communities is a continuing challenge to public health. Women refugee communities are particularly vulnerable populations, and disparities in both preventive care and breast cancer screening have been documented sparsely. The objective of this qualitative study was to explore Bosnian, Iraqi, and Somali women refugees' beliefs about preventive care and breast cancer screening to inform future community interventions and best practices.

Methods

In an urban community health center, 57 interviews with Bosnian, Somali, and Iraqi women refugees were conducted by native language speakers. Interview transcripts were coded and analyzed according to best practices for thematic and content analysis. The responses of three groups were compared.

Findings

Similarities across participants included barriers to care such as fear of pain and diagnosis, modesty, and work and childcare commitments; facilitative factors such as outreach efforts, appointment reminders, and personal contact from health providers; perceptions of how the American medical infrastructure compared with inadequacies in their home countries; and positive attitude toward U.S. health professionals. Differences that emerged among groups were: varying degrees of medical exposure to doctors in home countries, the impact of war on health systems; and understanding preventive breast care.

Conclusion

Taken together, duration of time in United States and prior exposure to Western medicine account for differences in refugee women's knowledge of preventive care. Understanding population-specific health beliefs, health information, and behavior are crucial for designing tailored prevention programs for refugee women.

Section snippets

Methods

This qualitative, descriptive study used a semistructured interview guide (Figure 1) developed previously for in-depth, one-to-one patient interviews (Saadi et al., 2012). Participants represented a convenience sample from the MGH Chelsea refugee database, supplemented by snowball sampling. Inclusion criteria included women refugees, 18 to 75 years old, self-identifying as Bosnian, Somali, or Iraqi, and receiving care at MGH Chelsea. The interviewers invited these women to participate either in

Study Participants

Table 1 shows sociodemographic characteristics of the 57 interviewed women. The Bosnian women were older than the Somali and Iraqi women (Table 1). Iraqis had been in the United States for the shortest period of time (<1 year, compared with Bosnian and Somali women who had been in the United States for a mean of 10.1 and 6.8 years, respectively). Most Somali and Iraqi women did not speak English. We present the result of our thematic and content analyses separately.

Thematic Analysis

The key thematic categories

Discussion

This study revealed key differences and similarities in Bosnian, Somali, and Iraqi refugee women's knowledge and beliefs about preventive health, with consequent implications for public health-oriented programming. Despite identifying barriers to care and screening, women across groups indicated willingness to overcome systemic barriers and personal fears of pain or bad news. Women noted facilitators to obtaining care, including someone who spoke their language and could explain what was

Conclusion

The refugee women's perspectives on preventive health and perceived barriers to breast cancer screening reported in this qualitative study provide insights on intergroup differences in these three populations. If public health initiatives are to succeed in providing support to refugee women, with the ultimate goal of increasing equity in health care, a deep understanding of these intergroup differences needs to be incorporated in development of population-specific, cost-effective prevention

Acknowledgments

The authors acknowledge the significant contribution to this project of the MGH Chelsea Healthcare Center Community Health Team, especially Kaftun Ahmed and Jelena Katadzic, as well as their director Sarah Oo.

Funding: This work was funded by Susan G. Komen MA Affiliate foundation and MGH Center for Community Health Improvement. Dr. Percac-Lima is supported in part by Cancer Control Career Development Award for Primary Care Physicians, CCCDAA-14-012-01-CCCDA from the American Cancer Society and

Altaf Saadi, MD, is a resident physician in the Partners Neurology program at Massachusetts General Hospital and Brigham and Women's Hospital. Her area of research and clinical interest is health care needs of immigrant and refugee populations.

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      Information provided in healthcare settings was reported as not meeting the needs of culturally and linguistically diverse clients (Ingram and Potter, 2009, Poureslami et al., 2011, Sheikh-Mohammed et al., 2006, Sime, 2014, Swe and Ross, 2010, Stapleton et al., 2013), using difficult medical terminology (Im, 2018, Clark et al., 2014, Seo, 2018), or causing confusion in understanding advice and information (Jiwrajka et al., 2017). New migrants reported obtaining knowledge and information about health services through GPs (Baker et al., 2019, Kue et al., 2017, Donnelly et al., 2011, Mumtaz et al., 2014), health centres and clinics (Lee et al., 2014), settlement service providers (Parajuli et al., 2019), classes (Lee et al., 2014), seminars (Baird, 2015), outreach programs (Sheikh and MacIntyre, 2009, Saadi et al., 2015, Behnia, 2015), and other formal networks (Lee et al., 2014, Kaczkowski and Swartout, 2020, Chan et al., 2018, Schein et al., 2019, Sheikh and MacIntyre, 2009, Wahoush, 2009, Nkulu et al., 2010). Informal networks were also an important source of providing information (Drummond et al., 2011, Leduc and Proulx, 2004, Lee et al., 2014, Due et al., 2020, Im, 2018, Kumar, 2020, Worabo, 2017, Baker et al., 2019, Dastjerdi et al., 2012, Floyd and Sakellariou, 2017, Schein et al., 2019, Seo, 2018, Sheikh-Mohammed et al., 2006, Wahoush, 2009, Kim et al., 2017), with specific barriers regarding health information related to poor health literacy (Drummond et al., 2011, Baird, 2015, Kaczkowski and Swartout, 2020, McMichael and Gifford, 2009, McMorrow and Saksena, 2017, Sievert et al., 2018, Dastjerdi et al., 2012, Vermette et al., 2015, Amin and ElSalhy, 2017, Amin and Perez, 2012, Nkulu et al., 2010, Saadi et al., 2015, M'Zah et al., 2019, Posselt et al., 2017), mental health stigma (Power and Pratt, 2012, Vermette et al., 2015, Ahmed et al., 2017, Piwowarczyk et al., 2014, Posselt et al., 2017), sexual health stigma (Kaczkowski and Swartout, 2020, McMichael and Gifford, 2009), and cultural modesty (Carroll et al., 2007, Saadi et al., 2012, Saadi et al., 2015, Schuster et al., 2019).

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    Altaf Saadi, MD, is a resident physician in the Partners Neurology program at Massachusetts General Hospital and Brigham and Women's Hospital. Her area of research and clinical interest is health care needs of immigrant and refugee populations.

    Barbara E. Bond, MSW, EdD, is Associate Professor of Social Work at Bridgewater State University. Her research interests include health disparities with a focus on cancer prevention and psychosocial oncology.

    Sanja Percac-Lima, MD, PhD, is Assistant Professor of Medicine at Harvard Medical School. Her clinical and research activities focus on eliminating disparities in cancer care among vulnerable populations.

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