“Healthy Moms, Healthy Babies”

Creating a Culturally-Sensitive Childbirth Education Video for Somali Refugee and Immigrant

Populations

Diana DuBois1 MPH/MIA, Laura Olevitch2

MS, Ellen Benavides3 MPH , Mahmooda Khaliq1 MHS, Nathaly Herrel1 MSc

Minnesota International Health Volunteers (MIHV) 1 Park Nicollet Institute2 Video Consultant3

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AbstractSomali refugees began arriving in Minnesota in the early 1990s to escape the civil war and the collapse of the government in Somalia. Today, Minnesota is home to more than half of all the Somalis living in the United States. There continues to be a great need to bridge the gap that exists between Somali patients and health providers by creating culturally appropriate health education materials. This is especially true for women’s health issues. For example, many Somali women are fearful of certain childbirth practices, such as caesarean sections. Minnesota International Health Volunteers (MIHV) partnered with the Park Nicollet Institute to create, disseminate, and evaluate a childbirth education video targeted to Somali patients. This 28 minute video is presented as the story of Faduma and Abdul, a young Somali couple, who experience their first pregnancy in the US. The goal of the video is to demystify the childbirth experience for new Somali parents while presenting accurate health information in a culturally appropriate manner. Some of the topics covered include: differences between midwives and physicians, pain medication options during childbirth, why C-sections are sometimes necessary, and why prenatal visits are important. The video is being widely disseminated through Somali community organizations and clinics, both nationally and internationally. This presentation will focus on the innovative approach of this public/private partnership, including initial focus group research, key informant interviews, a cultural panel of Somali experts, a clinical panel, and closely working with the Somali community.

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English Version

Somali Version

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IntroductionA Somali language video has been recommended by key informants in the Somali community as a highly desirable mode of communication to educate expectant Somali women on western medical practices surrounding pregnancy and childbirth. Interviews with Park Nicollet Health Services (PNHS) Clinic staff have indicated the need for public education addressing prenatal care, treatment for severe nausea and vomiting in early pregnancy, western labor and delivery practices, active labor management, and postpartum care. Focus group interviews with Somali women confirmed this need and indicated public interest in better understanding these issues prior to experiencing childbirth. A video format was suggested as the most desirable mode of communication so that Somali women and men could view the video on their own time in the privacy of their own home. This poster is a presentation of the development, evaluation and dissemination of this 28 minute Somali language childbirth preparation video, which addresses some of the critical needs mentioned above.

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Previous ResearchLiterature on the health care needs and barrier faced by Somali women is scarce and there are very few data available about their knowledge, experiences, beliefs and expectations surrounding pregnancy and childbirth. A few studies have been published in various countries with significant Somali immigrant and refugee populations such as the United States, Sweden, Australia and the United Kingdom. From these studies we have learned the following:

• Many Somali women experiencing childbirth outside of Somalia lack the strong support network of family and friends that they could rely on when they were in their home country 3, 4, 5

• The experience of childbirth in Western countries is changing traditional gender roles within the Somali immigrant community 2, 3, 4, 5, 6

• Somali women have expressed concerns about the skills of interpreters and issues relating to breaches in confidentiality1

• Somali women have expressed fear regarding delivery by C-Section3

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Focus Groups with Somali Women7

1. Understand how Somali women have experienced pregnancy and childbirth here in Minnesota

2. Determine the specific childbirth information needs of Somali women

3. Determine the most appropriate format for childbirth education of Somali couples

4. Determine the most promising ways to improve attendance at prenatal visits.

Two focus groups were conducted with 14 Somali women residents of the Cedar-Riverside Area who had given birth to one child in the United States. The aim of the study was to:

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Childbirth topics about which Somali women would like more information7

Topics Number of women who chose this topic

What happens in the delivery room 4

What are pain medications 4

Why prenatal visits are important 3

Services and care you can expect hospital nurses and staff to provide

3

How interpreters are used at the hospital 3

Explanation of medical procedures 2

What happens in the hospital after childbirth 2

How to get to the hospital 1

What happens during these visits 1

What happens to your body in pregnancy 1

How to reduce pain without medications 1

How to care for your newborn 0

Prenatal vitamins 0

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Preferred Formats for childbirth education chosen by Somali women7

Format Number of women who chose this format

Video tape to take home 6

Tours of the Hospital’s Birth Center in Somali 4

Audio tapes 3

Printed materials 3

Visit to your house before the birth by a Somali speaking educator

2

Education for your husband/partner 2

Web based program 2

One-on-one childbirth education counseling 1

Group classes in Somali at the hospital 0

Group classes in Somali outside the hospital 0

Video tape shown during the clinic visit 0

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Staff Interviews

Culture• Health care in Somalia• Religion• History of language• Civil strife• Family structure• Cesarean section• Diet

Practical Tips• Accurate communication• Dos and don’ts of

interactions• Keeping appointments• Talking with other family

members• Using interpreters• Dealing with modesty

To obtain staff perspectives at Park Nicollet Health Services (PNHS) of caring for the Somali patient throughout her pregnancy and childbirth, a series of in-person interviews were conducted with selected clinic and hospital clinical staff. Semi-structured interviews were conducted with volunteers in groups of four to six. Thirty (30) female staff members took part in the interviews. All hospital staff were from the Obstetrics unit. Following are the topic recommendations for staff education.

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The video is a vehicle for cross-cultural education for Somali women, their friends and families, and western

medical practitioners. The video is in Somali with English subtitles. The

underlying theme of the video is to promote shared learning and respect for the beliefs and practices of both cultures so that the childbirth experience can be

healthy, safe and positive.

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ProductionMinnesota International Health Volunteers (MIHV) worked collaboratively with Park Nicollet Institute (PNI) Health Education Division, physicians and staff from the Park Nicollet Clinics (PNC) Department of Obstetrics and Gynecology, and researchers from the PNI Health Research Center to develop the video. Prior to filming, the video script underwent medical and Somali community review.

MIHV organized a representative group of Somali women and community leaders to review and approve the video content and script for cultural and linguistic appropriateness. Physicians and staff from the PNHS Department of Obstetrics and Gynecology and Methodist Hospital Family Birth Center reviewed and approved the video content for clinical accuracy and appropriateness. Throughout the course of production two senior level Somali cultural liaisons were present to oversee the production and to ensure cultural appropriateness.

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Topics Addressed in Video•Beliefs about prevention and illness - ways of perceiving and interacting with the health care system

•Establishing open and honest communication between patient and practitioners

•Importance of family and friends as sources of information and support

•General information about hospital policies and practices

•Level and stages of labor management

•Type of pain medication

•Female circumcision (cutting) and its impact on pregnancy and childbirth

•C-sections and “assisted” delivery, including emergency procedures

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Graphic transitioning to five months of pregnancy

Nurse Sadia explaining pain medication to Faduma

Video Clips

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Faduma’s friend Sahra expressing a common misconception held by Somali women regarding diet and pregnancy

Faduma meeting with Dr. Rose and the interpreter

Video Clips

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Video Dissemination

•Hospitals and clinics

•Community based organizations

•Somali community leaders

•Public health departments

•Academic institutions

•Health Plans

•Multilingual Health Resources Exchange

•Individuals

•Broadcast on Somali TV and other related media sources

•Showcasing of video at Somali community health forums

•Viewing of video at local clinics and hospitals

The video is designed not only to serve the local patient population but the greater Somali community within Minnesota,the United States and Canada. Through established connections the video is being disseminated widely to the following groups:

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Acknowledgements

Production and dissemination of the video was made possible through grants by the Lafferty Family Foundation, Charisma Foundation, and the Park Nicollet Foundation.

We would also like to thank our Somali Cultural Liaisons, Mr. Mohamed Mohamed (Shino) and Ms. Sadia Hussein and Clinical Advisor Dr. Deb Thorp. Also we extend our gratitude to writer/videographer Sandy Maliga, Director Kathleen Laughlin, actors and film crew and the clinical and cultural panelists.

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References1. Davies, MM & PA Bath. 2001. The maternity information concerns of Somali women

in United Kingdom. Journal of Advanced Nursing, 36(2): 237-245

2. Beine, K., Fullerton, J., Palinkas, L. & B. Anders. 1995. Conceptions of prenatal care among Somali women in San Diego. Journal of Nurse-Midwifery, 40(4): 376-381

3. Essen, B., Johsdotter, S., Hovelius, B., Gudmundsson, S., Sjoberg, N.-O., Friedman, J. & Ostergren, P.-O. 2000. Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden. British Journal of Obstetrics and Gynecology, 107: 1507-1512

4. Fairview Health Services Perinatal Task Force. 2000. A conversation from the Somali luncheon series. Fairview Hospital, Minneapolis, MN. September 27, 2000

5. Wiklunk H., Aden, AS, Hogberg, U., Wikman, M & L Dahlgren. 2000. Somalis giving birth in Sweden: A challenge to culture and gender specific values and behaviours. Midwifery, 16: 105-115

6. Reiger, K & E. Sageman. 1998. The Northern Birthing Support Service: Issues in Cross-Cultural Maternity Care. Birth Matters Journal, December 1998

7. Herrel, N., Olevitch, L., DuBois DK., Terry, P., Thorp, D., Kind, E., A Said. 2004. Somali Refugee Women Speak out About Their Needs for Care During Pregnancy and Delivery. Journal of Nurse-Midwifery. (In-Press)

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For More Information Contact

Minnesota International Health Volunteers (MIHV)

122 West Franklin Ave., Suite 522

Minneapolis, MN 55404

Tel: 612-230-3251

Fax: 612-230-3257

E-mail: mkhaliq@mihv.org