Abstract
The United States (U.S.) resident Marshallese population is growing rapidly. Subsequent to this growth, Marshallese patients experience language and cultural barriers when attempting to access medical care in the U.S. This study: (a) documents how the Marshallese refer to biological and adopted family members; (b) identifies barriers encountered by Marshallese when seeking medical care; and (c) describes effective communication strategies for healthcare providers to use when treating Marshallese patients. Six key informant interviews were conducted in English with bicultural (U.S. and native Marshallese) informants, the majority of whom were women who worked in a healthcare setting. Participants were recruited through the Center for Pacific Islander Health in Arkansas and through personal contacts within the Marshallese community. Based on the study findings, examples of how providers can make genetic services more accessible and meaningful for Marshallese patients are also provided. This study is particularly relevant to genetic counselors as the number of Marshallese patients and families needing their services is growing.
Highlights
Obtaining an accurate, multigenerational, family health history (FHH) is an essential component of the genetic evaluation
Participants explained that language barriers can be an issue for many Marshallese patients, which was unsurprising, after the 2005 study by Williams and Hampton reported the same information. This is important for genetic counselors, since, as mentioned before, this study identified certain barriers that are directly applicable to family relationships
This study identified that privacy is very important to the Marshallese community, including withholding personal and family health information from healthcare providers who have not yet earned the patient's trust
Summary
Multigenerational, family health history (FHH) is an essential component of the genetic evaluation. Minority and immigrant populations may be less likely than others to receive a comprehensive FHH as health disparities are well documented in these populations (Armstrong, Ravenell, McMurphy, & Putt, 2007; Gamble, 1997; Williams & Hampton, 2005). Health disparities among these populations are perpetuated by a lack of insurance and the inability to pay for healthcare, language barriers, distrust, cultural differences, and providers’ lack of cultural competency training. The FHH could help to overcome some of these barriers by providing a snapshot of the family's overall health burden and informing the presenting patient about his or her own health issues, and focusing attention on areas of health concerns across the family, which may influence other family members’ decisions to seek healthcare services
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