title: Somali immigrant women and the American health care system: discordant beliefs, divergent expectations, and silent worries.
abstract: The civil war in Somalia resulted in massive resettlement of Somali refugees. The largest diaspora of Somali refugees in the United States currently reside in Minnesota. Partnering with three community organizations in 2007-8, we implemented the Community Connections and Collaboration Project to address health disparities that Somali refugees experienced. Specifically, we examined factors that influenced Somali women's health experiences. Utilizing a socio-ecological perspective and a social action research design, we conducted six community-based focus groups with 57 Somali women and interviewed 11 key informants including Somali healthcare professionals. Inductively coding, sorting and reducing data into categories, we analyzed each category for specific patterns. The categorical findings on healthcare experiences are reported here. We found that Somali women's health beliefs related closely to situational factors and contrasted sharply with the biological model that drives Western medicine. These discordant health beliefs resulted in divergent expectations regarding treatment and healthcare interactions. Experiencing unmet expectations, Somali women and their healthcare providers reported multiple frustrations which often diminished perceived quality of health care. Moreover, silent worries about mental health and reproductive decision making surfaced. To provide high quality, transcultural health care, providers must encourage patients to voice their own health explanations, expectations, and worries.
authors.affiliation: School of Nursing, University of California, 4-238 Factor Building, 700 Tiverton Avenue Box 956918, Los Angeles, CA 90095-6918, United States. Electronic address: cpavlish@sonnet.ucla.edu.
authors.forename: Carol Lynn
authors.initials: CL
authors.lastname: Pavlish
authors.affiliation: Fairview Health Services, 2450 Riverside Ave. So. Minneapolis, MN 55454, United States.
authors.forename: Sahra
authors.initials: S
authors.lastname: Noor
authors.affiliation: Department of Nursing, Augsburg College, Minneapolis, MN 55454, United States.
authors.forename: Joan
authors.initials: J
authors.lastname: Brandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health / Q000208:ethnology*; D055812:Community-Based Participatory Research; D054521:Cultural Competency; D003695:Delivery of Health Care; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D011369:Professional-Patient Relations; D012998:Somalia / Q000208:ethnology; D014481:United States; D055815:Young Adult