Listening to Muslim Women with Refugee Backgrounds in the Health Encounter

Abstract

IntroductionResearch indicates that health disparities persist for people who are minorities in the United States. Sources of health disparities may stem from differences (eg, linguistic, cultural, religious, gender, education) between health care provider and patient. The perspective of Muslim women in the health care encounter is relatively uninvestigated. Qualitative research methods uniquely explore perceptions and experiences of women that are not captured by other research methods. Through use of a critical ethnography lens and framed by a post‐colonial feminist framework, the study aimed to understand and uncover the relationship between patients (Iraqi Muslim women) and health care providers within the health encounter, specifically in the context of how the intersection of race‐ethnicity, gender, and religion shape the encounter. The framework accounts for a broader context of care that includes the influence of historical, political, and societal discourse, and personal conceptualizations of the other.MethodsParticipants were purposefully selected from 4 urban clinics and included 15 Iraqi Muslim women patients with refugee backgrounds and 10 primary health care providers. All 10 provider and 5 patient interviews were conducted in English; 10 Iraqi patient interviews were conducted in Arabic, transcribed in Arabic, and translated into English for analysis. Supportive methods included field notes and discussions with key informants. From inductively coded data, categories were formed according to the repetition of main ideas. Through analysis and interpretation of the data, themes emerged from the categoriesResultsIraqi Muslim women face many barriers in seeking health care that are both health system and health provider based. Themes from the study point toward barriers to care, Muslim female identity, and data collection that can be culturally distressing. Expectations for the visit are embedded in past experiences and highlight women's ideas of their role, gender norms, religious values, and language. Providers will benefit from remembering that although Muslim, women vary greatly and providers who inquire about women's preferences can adjust care accordingly. Health system challenges include time limitations and inadequate interpretive services that narrow opportunities for clear communication and understanding between health care providers and women. Family and friends can be supportive if allowed to accompany the woman in the visit, as she desires. The health encounter is a complex interplay of individual perceptions and expectations that can open an avenue for misinterpretation, misdiagnosis, and stereotypingDiscussionKnowledge of Muslim women's experiences can give guidance to certified nurse‐midwife/certified midwife practice. To decrease cultural distress for patients, recommendations include assessment of routine questions used in the health encounter, increasing time for the visit if interpretation is needed, preserving modesty in the visit, and creating a woman‐centered environment to foster psychological support and empathy. It is recommended that women should be offered a voice in educating health care providers about their care and cultural concerns.