Healthy Moms, Healthy Babies Creating a CulturallySensitive Childbirth Education Video for Somali Re

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Healthy Moms, Healthy BabiesCreating 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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Abstract
Somali 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 womens 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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Somali Version
English Version
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Introduction
A 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 Research

• Literature 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
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

• Understand how Somali women have experienced
  pregnancy and childbirth here in Minnesota
• Determine the specific childbirth information
  needs of Somali women
• Determine the most appropriate format for
  childbirth education of Somali couples
• Determine the most promising ways to improve
  attendance at prenatal visits.

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Childbirth topics about which Somali women would
like more information7
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Preferred Formats for childbirth education chosen
by Somali women7
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Staff Interviews
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.

• Practical Tips
• Accurate communication
• Dos and donts of interactions
• Keeping appointments
• Talking with other family members
• Using interpreters
• Dealing with modesty

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

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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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Production
Minnesota 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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Video Clips
Graphic transitioning to five months of pregnancy
Nurse Sadia explaining pain medication to Faduma
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Video Clips
Fadumas friend Sahra expressing a common
misconception held by Somali women regarding diet
and pregnancy
Faduma meeting with Dr. Rose and the interpreter
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Video Dissemination
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

• 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

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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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References

• Davies, MM PA Bath. 2001. The maternity
  information concerns of Somali women in United
  Kingdom. Journal of Advanced Nursing, 36(2)
  237-245
• 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
• 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
• Fairview Health Services Perinatal Task Force.
  2000. A conversation from the Somali luncheon
  series. Fairview Hospital, Minneapolis, MN.
  September 27, 2000
• 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
• Reiger, K E. Sageman. 1998. The Northern
  Birthing Support Service Issues in
  Cross-Cultural Maternity Care. Birth Matters
  Journal, December 1998
• 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 [phone] Fax
612-230-3257 E-mail mkhaliq_at_mihv.org