on-governmental agencies and activists and others. The various terminologies used to refer to it attest to differences in knowledge systems, perceptions, and lived experiences emerging from divergent cultures and ideologies. In the last two decades, these debates have evolved from a local matter to a global health concern and human rights issue, coinciding with the largest influx of African refugees to the Western nations. Various forms of female circumcision are reported in 28 countries in the African Continent; Somalia has one of the highest prevalence of female circumcision and the most severe type. The practice is antithetical to Western values and poses an ideological challenge to the construction of the normal body, its bodily processes and its existential being-in-the-world. From the global health perspectives, female circumcision is deemed to be a health hazard--especially during childbirth--though the scientific evidence is inconclusive from studies conducted in post-migration. Yet, Somali refugee women have higher childbearing disparities in host nations, including the U.S. They are also perceived as difficult patients and resistant to obstetrics interventions. Although their FGC status and "cultural" differences are often cited, there is a lack of adequate explanations as to why and how these factors shape patient-provider interactions and affect outcomes. The objectives of this dissertation study are to quantitatively and qualitatively explore these questions within and between Somali refugee women and their healthcare providers in Arizona. Two theoretical frameworks and methods--culture consensus and embodiment-- are applied to identify variations in childbearing knowledge and to explore how the cultural phenomenon of circumcision is subjectively and intersubjectively embodied in the context of childbearing. Culture consensus questionnaire (N=174) and ethnographic interviews (N=40) using phenomenology approach were conducted. Analyses suggest cross-cultural disagreement hinged on: faith in science versus God, pregnancy/childbirth interventions, language challenges, and control-resistance issues; intra-cultural disagreement underscores that Somalis are not culturally homogenous group. Preconceptions of female circumcision body as a cultural phenomenon has different and conflicting meanings that may adversely impact patient-provider interactions and outcomes.
Malawi, as a low and middle income country (LMIC), with one of the lowest per capita gross domestic products, faces challenges in the provision of healthcare to its citizens. According to the Centers for Disease Control (CDC), leading causes of death include but are not limited to, lower respiratory disease, stroke, cancer, neonatal disorders, and nutritional deficiencies. Feeding and swallowing disorders can present as a symptom to any of these medical diagnoses. Currently, there are no known studies focusing on the service provision for feeding and swallowing disorders in Malawi.
This pilot study was designed to provide a baseline on how feeding and swallowing disorders are currently being provided for in an emerging country like Malawi. Malawian healthcare professionals who see patients with feeding and swallowing disorders completed a survey and interview pertaining to their personal demographics, caseload, opinions, experiences, and treatment recommendations regarding the management of swallowing disorders (dysphagia).
Results indicate a wide range of occupations (Otolaryngoloists, Rehabilitation Technicians, Audiology Technicians, and Nurses) are involved in feeding and swallowing care. Participants expressed a high obligation to provide services for feeding and swallowing disorders, as well as a high concern for their patients. Generally, participants expressed high confidence in their treatment abilities, which did not correspond to knowledge of treatment recommendations that meet U.S. standards of care. Specifically, there was no variation in treatment recommendations across severities and a general lack of resources and tools for assessing and treating dysphagia. Treatment recommendations tended to align with resources currently available in Malawi.
Implications for the utilization of NGOs (non-governmental organizations) and the education of healthcare providers on feeding and swallowing disorders in the social and cultural contexts of this country are discussed.
During the COVID-19 pandemic, increased burdens have been placed on the Arizona healthcare system, and its healthcare providers. Using a survey with a sample of N=308 prescribing providers and nurses in the Arizona healthcare system, the impact of COVID-19 on the wellbeing of healthcare providers was assessed. The survey used measures to evaluate for physical and emotional wellbeing, burnout, stressors associated with COVID-19, and work-life experiences, and found an overall negative impact on the wellbeing of healthcare workers during the COVID-19 pandemic with increased levels of reported stress and tiredness, concern for the health of family and loved ones, concern for the hardships of patients, lack of alignment between organizational priorities and personal values, and low levels of support and appreciation from socially and from leadership at work.
Refugee women face many challenges to obtaining maternal, reproductive, and sexual health post-resettlement including the language barrier, navigating the healthcare system, finding childcare to attend appointments, and cultural mismatches between their beliefs and practices around the prenatal, childbirth, and postpartum periods and that of the healthcare system in which they resettle into. This cultural barrier poses a challenge to healthcare providers as well as it necessitates that they respect their patients’ cultural beliefs while still providing them with the highest standard of care. Cultural competency training has been used to assist providers in understanding and responding to cultural differences, but gaps still exist when it comes to navigating specific scenarios. The objective of this research was to conduct a literature review of studies pertaining to refugee maternal, reproductive, and sexual healthcare post-resettlement to investigate the following questions: how tensions between biomedically accepted best practices and cultural norms present themselves in these healthcare fields, how healthcare providers take into consideration their patients’ cultural beliefs and norms when providing maternal, reproductive, and sexual healthcare to refugee women, and what can be done to continue to improve the provision of culturally appropriate care to refugee women. Findings from twenty different studies that focused primarily on eight cultural groups identified that Cesarean sections, inductions, and certain family planning methods are significant points of contention regarding cultural norms for refugee women and that they prefer certain foods, birthing positions, and other cultural practices during the delivery. Healthcare providers consider their refugee patients’ cultural beliefs by creating relationships with them built on trust, utilizing community liaisons, and through attempts to accommodate cultural practices when possible. Some potential improvements offered to improve cultural competency were improved cultural competency training that focused on how healthcare providers ask questions and interact with their patients, increased partnership with refugee communities, and an emphasis on patient education surrounding interventions and procedures related to maternal and reproductive health that could cause hesitations. The results of this literature review accentuated the importance of relationships within the field of refugee women’s healthcare, between both refugee patients and their providers and refugee communities and the healthcare systems. Providing refugee women access to more culturally competent healthcare can increase their trust in the healthcare systems of the countries they resettle in and healthcare utilization that can contribute to improved health outcomes for refugee women and their children.
A non-experimental pre-posttest self-report survey design was used to assess the feasibility and preliminary efficacy of an online breastfeeding educational intervention for healthcare providers. The Theory of Planned Behavior (TPB) provided the framework for exploring the participants’ psychological and behavioral outcomes. The research questions were: (1) What is the feasibility of an online breastfeeding course for healthcare providers? (2) What are healthcare providers’ psychological and behavioral changes occurring after completion of an online course? (3) How do the post-intervention psychological and behavioral outcomes of the online format compare with those of the previous format (hybrid) of this breastfeeding course?
Although participants’ favorably assessed the feasibility (i.e., acceptability) of the 45-hour course, several factors contributed to participants’ satisfaction level: Previous online learning experience, connectedness with others, and the degree of structural support. Significant positive changes occurring in participants were increases in their knowledge and beliefs about breastfeeding; attitudes toward formula feeding; perceived behavioral control; perceptions about being able to perform breastfeeding supportive behaviors; and intentions to perform actions that are consistent with evidence-based breastfeeding supportive behaviors. Significant changes in the beliefs about formula feeding were not in the expected direction raising conceptual and pedagogical issues. Participants had negative perceptions about being able to implement what they learned in their workplaces or to affect policy. Findings support the use of online breastfeeding education programs for healthcare providers; changes at both individual and institutional levels are necessary to change provider practices.