Faith and culture in health care: Using collaborative relationships to address critical concerns -- A Roundtable Discussion

Minnesota is home to an estimated 100,000 immigrant Muslims from diverse cultures, yet little is known about health needs and access to health services for the Muslim communities. This lack of data has resulted in health programs for Muslims that are uninformed rather than need-based. With a rapidly growing Muslim population, this information gap needs to be addressed. A qualitative study was designed as a first step towards understanding the contextual factors such as perceptions, experiences, barriers and facilitators that affect immigrant South Asian Muslim women’s access to perinatal care.

Data were collected over 6 months, through one-hour personal phone interviews and two focus group discussions of 8 Urdu speaking immigrant women from Pakistan, recruited by convenience sampling method. Women who gave birth in Minnesota within the last 2 years and were living in the United States for five or fewer years were included. Phone interview questions were about demographics, access experiences, and satisfaction. Focus group discussions sought to obtain data about barriers and facilitators, experiences of accessing health services as Muslim women, and recommendations to improve culturally-appropriate health services for Muslim women. Data were translated from Urdu (women’s native language) to English, transcribed, and analyzed for major content themes and descriptive statistics. University of Minnesota’s Human Subjects Committee reviewed the study.

Women’s age ranged from mid-twenties to mid-thirties; 75% were first-time mothers. All women had high “Functional Access” which means that they received adequate prenatal care through spousal or personal health insurance coverage. “Cultural Access”, however, was determined to be moderate to low. Barriers including gaps in receiving client-centered, culturally-relevant care were reported. Definite cultural preference for female providers was articulated for Ob/Gyn services and unavailability of female providers was associated with dissatisfaction with services. Women also reported unmet perinatal health education needs, especially re-interpreting their cultural practices of self and newborn care within the context of current evidence and recommendations. The greatest dissatisfaction was reported with the use of revealing hospital gowns. Low literacy about navigating the complex health system also caused frustration and prevented access to the needed resources. Women recommended improvement in consumer education, need for better understanding of clients’ cultural and religious origins and preferences, and provisions of more female providers. The study reveals that the more women’s cultural and religious needs and preferences were integrated into the health care delivery, the better their experiences of access and the greater their satisfaction with care.

Findings of the study underscore the need for continued advocacy to improve health services for immigrant communities and for further in-depth studies of health access issues with the South Asian and Muslim populations. Future access surveys should include culturally-appropriate perception and behavior indictors of consumer groups with inadequate access.