title: Bosnian, Iraqi, and Somali Refugee Women Speak: A Comparative Qualitative Study of Refugee Health Beliefs on Preventive Health and Breast Cancer Screening.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Partners Neurology Residency, Massachusetts General Hospital and Brigham and Woman's Hospital, Boston, Massachusetts. Electronic address: asaadi@partners.org.
authors.forename: Altaf
authors.initials: A
authors.lastname: Saadi
authors.affiliation: Bridgewater State University, School of Social Work, Bridgewater, Massachusetts.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bond
authors.affiliation: Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, Massachusetts.
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
mesh_terms: D000328:Adult; D017522:Bosnia and Herzegovina / Q000208:ethnology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000517:prevention & control; D003466:Cultural Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007407:Interviews as Topic; D007493:Iraq / Q000208:ethnology; D007514:Islam / Q000523:psychology; D008327:Mammography / Q000523:psychology*; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data; D036301:Qualitative Research; D012036:Refugees / Q000523:psychology*; D012068:Religion and Medicine; D012998:Somalia / Q000208:ethnology; D014505:Urban Population; D055815:Young Adult