title: The sociocultural context of gynecological health among Haitian immigrant women in Florida: applying ethnographic methods to public health inquiry.
abstract: OBJECTIVE
  Twalet deba, a culturally mediated feminine hygiene practice, is widespread in Little Haiti, the predominately Haitian neighborhood in Miami, Florida. This practice may have important implications for susceptibility to sexually transmitted infections, including human papillomavirus, the principal cause of cervical cancer. Previous research has not examined the full context of twalet deba in consideration of cultural beliefs and norms about women's hygiene and sexual health.
  
  
  METHODS
  Ethnographic methods guided two phases of exploratory research. The first phase included observation, participant observation, and semi-structured in-depth interviews, which were conducted with key consultants (n=6) and a subsequent purposive sample of 35 women regarding gynecological health beliefs, hygiene practices, and associated home remedy agents. These data informed the second research phase, which involved observation and informal interviews with owners of botanicas in Little Haiti, Miami, FL, USA, to assess the availability of various ethnomedical remedies, their preparation, and preferred uses. All data were analyzed qualitatively to discern patterns in interview responses and using grounded theory to identify key themes.
  
  
  RESULTS
  Cultural constructions of gynecological health and illness were generally incongruent with the biomedical model and emphasized the control of self-defined non-specific vaginal infections through routine hygienic practices using ethnobotanical and commercial agents to avert illness, including cancer. Such practices also encourage vaginal tightness and dryness, characteristics desired by male sexual partners, on whom women were frequently economically dependent. Data from the second phase of research reinforced these findings and revealed a wide variety of feminine hygiene agents available for purchase in local botanicas.
  
  
  CONCLUSIONS
  The results suggest that cultural beliefs about gynecological health and dependence on male partners influence women's routine feminine hygiene practices. Botanicas are culturally salient sites for health information. Ethnographic methods were critical for collecting personal sensitive data that are necessary to inform future intervention.
authors.affiliation: Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Janelle
authors.initials: J
authors.lastname: Menard
authors.forename: Erin
authors.initials: E
authors.lastname: Kobetz
authors.forename: Joshua
authors.initials: J
authors.lastname: Diem
authors.forename: Martine
authors.initials: M
authors.lastname: Lifleur
authors.forename: Jenny
authors.initials: J
authors.lastname: Blanco
authors.forename: Betsy
authors.initials: B
authors.lastname: Barton
mesh_terms: D000328:Adult; D000884:Anthropology, Cultural; D054242:Emigrants and Immigrants; D005260:Female; D053566:Hygiene Products; D005431:Florida; D006205:Haiti / Q000208:ethnology; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic; D008297:Male; D012648:Self Care / Q000009:adverse effects* / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000208:ethnology* / Q000517:prevention & control; D044364:Vaginal Douching / Q000009:adverse effects / Q000523:psychology