Spiritual Coping Among Families of Children With Cancer: A Qualitative Study

The impact of a childhood cancer diagnosis precipitates caregiver's engagement in spiritual coping. This study aimed to explore spirituality among Malaysian Muslim caregivers of children with acute lymphoblastic leukemia. A total of 13 eligible caregivers participated in this qualitative semi-structured interview via purposive sampling. Each interview was audio recorded, transcribed verbatim, and analyzed using NVivo 12 via thematic analysis. Three main themes revolved around hope through the act of praying and recitation (du'ā' and dhikr), acceptance of God's will (redha), and faith toward God as the Provider of sustenance (rezeki). The findings of this study contribute to a holistic supportive care system in pediatric oncology as it informs health care providers the role of spirituality in mitigating the emotional impact of a cancer diagnosis and promoting psychological adaptation. As a multicultural country, future studies may explore spirituality in other cultures and religion in the country.

Congruent Communication: Addressing Culture and Care for a Seriously Ill Rohingya Infant

Pediatric palliative care teams seek to collaboratively promote the quality of life for children with serious medical illness in the context of the values expressed by the patient and family. Especially for infants with high medical fragility, shared decision making can be a complex task that often requires flexibility to respond to the clinical circumstances at hand, as well as contextualization within the family culture. In this paper, we present the case of an infant with a severe congenital brain malformation who was born in an American hospital to a Rohingya-speaking, Burmese family whose care preferences seemed to oscillate between comfort-focused and life-prolonging without clear acknowledgement of the consequences of shifting between treatment plans. Discussion of this case helps to illustrate the cultural factors, ethical challenges, and systems-level issues that can arise for medical teams in seeking to promote patient-centered care that respects family values while also honoring the principle of nonmaleficience.

'Food and medicine continuum' in the East and West: Old tradition and current regulation

Food-medicine products are important materials for daily health management and are increasingly popular in the global healthy food market. However, because of the biocultural difference, food-medicine knowledge may differ among regions, which hinders the global sharing of such health strategies. Aim at bridging the food-medicine knowledge in the East and West, this study traced the historical roots of food and medicine continuum of the East and West, which was followed by a cross-cultural assessment on the importance of food-medicine products of China, thereafter, the current legislative terms for food-medicine products were studied using an international survey. The results show that the food and medicine continuum in the East and West have their historical roots in the traditional medicines since antiquity, and the food-medicine knowledge in the East and West differs substantially; although the food-medicine products have common properties, their legislative terms are diverse globally; with proofs of traditional uses and scientific evidence, food-medicine products are possible for cross-cultural communication. Finally, we recommend facilitating the cross-cultural communication of the food-medicine knowledge in the East and West, thus to make the best use of the traditional health wisdom in the globe.

Communication Management Processes of Dentists Providing Healthcare for Migrants with Limited Japanese Proficiency

Low health literacy results in health inequity are linked with poor adherence to medical care. In the globalized Japanese context, the number of migrants with Japanese as a second language is increasing year after year. Since limited Japanese proficiency may pose a greater health risk, dentists are expected to manage cross-cultural communication and provide dental care to foreign patients. This study explored dentists' experiences of treating patients with limited Japanese proficiencies. Semi-structured interviews were conducted with 11 community dentists and the qualitative data were analyzed through a thematic analysis approach. Their major challenges were classified into three themes-linguistic aspect (e.g., complicated explanation regarding root canal treatment), sociolinguistic aspect (e.g., communication with foreign residents with limited dental knowledge), and sociocultural aspect (e.g., cultural differences in their dental aesthetics and insurance treatment system). Several management strategies were employed, including linguistic accommodation, avoidance of complexities, use of various communication tools, and getting help from others. However, they were unsatisfied with their practice because they could not understand the patients' psychosocial aspects due to incomplete communication. These findings provided insights into dentists' practice in the globalized context.

Attitudes Toward Euthanasia: A Longitudinal Analysis of the Role of Economic, Cultural, and Health-Related Factors

CONTEXT

It is crucial that physicians understand differing attitudes toward euthanasia and which factors to consider when discussing end-of-life decisions with patients and families from diverse backgrounds.

OBJECTIVES

To investigate how attitudes toward euthanasia differ among countries, how they change, and how economic, religious, and health-related factors affect these attitudes.

METHODS

We analyzed attitudes toward euthanasia and economic, religious, and health-related indicators using longitudinal (1981-2018) World Values Survey (WVS) data. They included 62 countries with at least a 15-year, three-wave, time series (total n = 389,243 participants). Each national survey interviewed representative samples of adults (mean = 1405).

RESULTS

In the latest wave, The Netherlands had the most favorable views of euthanasia (10-point scale with 1 = least justifiable: mean = 7.47) and Jordan the least (mean = 1.50). Residents of 23 of 24 high-income countries came to view euthanasia as more justifiable, while residents of 12 of 38 middle- and low-income countries came to view it as less justifiable over time. The higher GDP per-capita at the time of survey, the more euthanasia was accepted (r = 0.703; P< 0.0001); the more important respondents viewed religion as being, the less euthanasia was accepted (r = -0.834; P< 0.0001); the higher life expectancy and the lower infant mortality were, the more euthanasia was accepted (r = 0.669; P< 0.0001/r = -0.716; P< 0.0001).

CONCLUSION

Euthanasia-related attitudes differ widely depending on the cultural context; changes over time varied in both directions; euthanasia-related attitudes were associated with economic, religious and health-related factors. With globalization increasing cultural diversity, these findings can inform physicians' communication about end-of-life decisions with patients and families from diverse backgrounds.

Implementation of the Mental Health Gap Action Programme (mhGAP) in Kosrae State in the Federated States of Micronesia

Improving access to mental health care is a global health priority, and a significant treatment gap exists in Pacific Island Countries. One strategy to bridge the gap is the World Health Organization's Mental Health Gap Action Programme (mhGAP), which provides evidence-based guidance for managing mental, neurological, and substance abuse conditions. mhGAP has been implemented in more than 90 countries, but there has been limited training within many Pacific Island countries. We describe implementation of mhGAP training in Kosrae, a state within the Federated States of Micronesia. mhGAP training was conducted with 18 members of the Kosrae Community Health Center (KCHC). Our training model included 2 helpful modifications: (1) participants attended a combination of online sessions and a 1-week in-person training, which allowed for more time and flexibility in delivering training; and (2) longitudinal support posttraining, which has been identified as an important factor in successful implementation of mhGAP.

Cultural awareness training for dental students

OBJECTIVES

This study aimed to assess the impact of a full-day workshop on increasing cultural awareness among incoming first-year (DDS-I) and post-doctoral (PGY-I) dental students at the Columbia University College of Dental Medicine.

METHODS

The workshop focused on developing students' cultural awareness regarding dimensions of identity, recognition of power and privilege, importance of cross-cultural understanding and communication, and the role of self-reflection through direct teaching, interactive discussions, and reflective writing. A convenience sample of 83 DDS-I and 30 PGY-I students from the 2019 enrollment class were recruited. Assessments included pre- and post-workshop surveys, facilitator interviews, and a formal workshop evaluation. Descriptive and bivariate analyses of students' responses were performed to assess cultural awareness within and between student groups. Facilitator interviews and student feedback were analyzed qualitatively to identify emerging themes.

RESULTS

Global cultural awareness among both student groups was higher in the post-workshop survey (for DDS-I, mean = 3.46, SD = 0.38; for PGY-I, mean = 3.47, SD = 0.30) than in the pre-workshop survey (for DDS-I, mean = 2.98, SD = 0.34; for PGY-I, mean = 2.90, SD = 0.47), which represented a statistically significant difference (p < 0.001 for both comparisons). Quantitative analysis revealed that the workshop provided a platform to discuss sensitive topics, increased cultural awareness among students and faculty, and provided faculty with different perspectives about culture awareness.

CONCLUSIONS

The full-day workshop achieved its goals of increasing dental students' self-perceived cultural awareness and capacity to establish cross-cultural professional relationships.

'Tausi Feagaiga: Impacting Health Care in an Island Nation

The 'Tausi Feagaiga (Covenant Keeper) project was a partnership between community organization Pacific Youth and Community Development, faith-based organization Roman Catholic Diocese of Samoa-Pago Pago, and higher learning institute University of Hawaii John A. Burns School of Medicine. Over the course of 5 years from 2016 - 2020, 125 caregivers were trained in family caregiving. Fa'a Samoa, or the Samoan way supports traditional values of tausi matua encouraging caring for your elders. Training was conducted through an intensive workshop followed by practicum at Hope House, Catholic Diocese home for the aged. Confidence in caregiving increased following the training and feedback was extremely positive. Competence in geriatric syndromes was improved after attending the workshop (p<0.0001). Technical assistance was provided to create jobs for newly trained caregivers and sustainability through reimbursement from government health insurance Medicaid. Hope House received the designation of Medicaid Assisted Living Facility provider. 'Tausi Feagaiga transformed the lives of the residents of Hope House and elders in the community.

Emblem Gestures Improve Perception and Evaluation of Non-native Speech

Traditionally, much of the attention on the communicative effects of non-native accent has focused on the accent itself rather than how it functions within a more natural context. The present study explores how the bodily context of co-speech emblematic gestures affects perceptual and social evaluation of non-native accent. In two experiments in two different languages, Mandarin and Japanese, we filmed learners performing a short utterance in three different within-subjects conditions: speech alone, culturally familiar gesture, and culturally unfamiliar gesture. Native Mandarin participants watched videos of foreign-accented Mandarin speakers (Experiment 1), and native Japanese participants watched videos of foreign-accented Japanese speakers (Experiment 2). Following each video, native language participants were asked a set of questions targeting speech perception and social impressions of the learners. Results from both experiments demonstrate that familiar—and occasionally unfamiliar—emblems facilitated speech perception and enhanced social evaluations compared to the speech alone baseline. The variability in our findings suggests that gesture may serve varied functions in the perception and evaluation of non-native accent.

Medicine in Mandarin: Introducing Native Language Training in a Medical School Curriculum

This article was migrated. The article was marked as recommended. Background:Chinese Americans are one of the fastest growing populations in the United States. However, 41% of Chinese Americans are not English proficient. Methods:In 2014, Medicine in Mandarin was established by the University of Michigan Medical School (UMMS) as a pre-clinical elective taught by a nationally certified healthcare Mandarin interpreter. A 32-hour curriculum was developed, including both didactics and interactive elements. Assessments included quizzes, standardized patient interviews, and a final exam. An evaluation was administered upon course completion, and a post-course survey was administered to graduates at least six months after course completion. Results:Between 2014 and 2017, the elective graduated 25 students, of whom 23 completed the course evaluation and 22 completed the post-course survey. Prior to the course, 9% of students felt comfortable practicing medicine in Mandarin. This increased to 78% of students post-course. When asked about subsequent clinical experiences, 82% of students reported having applied medical Mandarin skills. Overall, 96% rated the course as very good or excellent. Conclusion:A Medicine in Mandarin elective was well-received by students and improved their comfort in providing medical care in Mandarin. Additional study is warranted to examine the potential clinical impact of this course.

Interprofessional communication in a socio-hierarchical culture: development of the TRI-O guide

Objectives

Interprofessional education (IPE) and collaborative practice are essential for patient safety. Effective teamwork starting with partnership-based communications should be introduced early in the educational process. Many societies in the world hold socio-hierarchical culture with a wide power distance, which makes collaboration among health professionals challenging. Since an appropriate communication framework for this context is not yet available, this study filled that gap by developing a guide for interprofessional communication, which is best suited to the socio-hierarchical and socio-cultural contexts.

Materials and methods

The draft of the guide was constructed based on previous studies of communication in health care in a socio-hierarchical context, referred to international IPE literature, and refined by focus group discussions among various health professionals. Nominal group technique, also comments from national and international experts of communication skills in health care, was used to validate the guide. A pilot study with a pre–posttest design was conducted with 53 first- and 107 fourth-year undergraduate medical, nursing, and health nutrition students.

Results

We developed the “TRI-O” guide of interprofessional communication skills, emphasizing “open for collaboration, open for information, open for discussion”, and found that the application of the guide during training was feasible and positively influenced students’ perceptions.

Conclusion

The findings suggest that the TRI-O guide is beneficial to help students initiate partnership-based communication and mutual collaboration among health professionals in the socio-hierarchical and socio-cultural context.

Cross-Cultural Adaptation of Research Tools: A Study on the Cultural Intelligence Scale Adaptation in Slovenian

The article examines the cross-cultural transferability of a widely accepted cross-cultural assessment tool - the Cultural Intelligence Scale (CQS) - using research conducted in Slovenia and insights from the American and Slovenian researchers who translated the tool into Slovene and adapted it for use in Slovenia. In the context of a qualitative focus group based study, the researchers look at the specific characteristics of CQS perceptions within the Slovenian sample (two focus groups - one in the capital and the other in the south of the country) and identify barriers to these perceptions and the specific characteristics of the perceptions of Slovenian citizens regarding cross-cultural interaction.

Does Having a Culturally Competent Health Care Provider Affect the Patients' Experience or Satisfaction? A Critically Appraised Topic

Clinical Scenario: The level of cultural competence of health care providers has been studied. However, limited scholarship has examined whether the cultural competence of the health care provider affects patient satisfaction. Focused Clinical Question: Does cultural competence of health care providers influence patient satisfaction with their experience with their provider? Summary of Key Findings: Having a culturally competent health care provider, or one who a patient perceives as culturally competent, does increase patient satisfaction. Clinical Bottom Line: Cultural competence in health care plays an important role in patients being satisfied with their providers, as well as patients willingly and actively participating in their treatment. Strength of Recommendation: Questions 1 to 5 and 9 of the critical appraisal skills program were answered "yes" for all studies in the critically appraised topic. Thus, the authors strongly support the findings.

Coproduction of healthcare service with immigrant patients: protocol of a scoping review

INTRODUCTION

Immigrant patients often meet barriers to patient-centred healthcare in their new host countries. Given the heterogeneity of patients from ethnic minorities, established strategies for patient centredness might not work in their case. The concept of coproduction provides a new perspective on how to collaboratively create the highest possible value for both the patient and the healthcare system. The concept acknowledges that all service is coproduced and directs attention to the relationship between patient and care provider. Coproduction is still a new concept in healthcare and its use with vulnerable groups of patients requires further study. This protocol outlines a scoping review to be conducted on the current knowledge on coproduction of service by immigrants and their service providers in the healthcare sector.

METHODS AND ANALYSIS

We will use Joanna Briggs methodology for scoping reviews. The data will stem from the following databases: PubMed, Scopus, Ovid EMBASE, EBSCO CINAHL, EBSCO PsycINFO, Cochrane Library and Web of Science. We will also screen the websites of national authorities and research organisations for publications and review the literature lists of the identified articles for relevant references. We will include all types of literature on coproduction of healthcare or social service by immigrants and service providers, including their relationship with one another, communication and collaboration. Two reviewers will independently screen eligible publications and extract data using a checklist developed for this scoping review.

ETHICS AND DISSEMINATION

The results of the study will provide an innovative perspective on the coproduction of value in healthcare service by immigrant patients and care providers. We will present the results at national and international conferences, seminars and other events with relevant stakeholders and immigrant patients, and publish them in a peer-reviewed journal.

Improving socially constructed cross-cultural communication in aged care homes: A critical perspective

Cultural diversity between residents and staff is significant in aged care homes in many developed nations in the context of international migration. This diversity can be a challenge to achieving effective cross-cultural communication. The aim of this study was to critically examine how staff and residents initiated effective cross-cultural communication and social cohesion that enabled positive changes to occur. A critical hermeneutic analysis underpinned by Giddens' Structuration Theory was applied to the study. Data were collected by interviews with residents or their family and by focus groups with staff in four aged care homes in Australia. Findings reveal that residents and staff are capable of restructuring communication via a partnership approach. They can also work in collaboration to develop communication resources. When staff demonstrate cultural humility, they empower residents from culturally and linguistically diverse backgrounds to engage in effective communication. Findings also suggest that workforce interventions are required to improve residents' experiences in cross-cultural care. This study challenges aged care homes to establish policies, criteria and procedures in cross-cultural communication. There is also the challenge to provide ongoing education and training for staff to improve their cross-cultural communication capabilities.

Cultural hegemony? Educators' perspectives on facilitating cross-cultural dialogue

BACKGROUND

We live in an age when education is being internationalized. This can confront students with 'cultural hegemony' that can result from the unequal distribution of power and privilege in global society. The name that is given to awareness of social inequality is 'critical consciousness'. Cross-cultural dialogue provides an opportunity for learners to develop critical consciousness to counter cultural hegemony. The purpose of this research was to understand how learners engage with cross-cultural dialogue, so we can help them do so more effectively in the future.

METHOD

The setting for this research was an online discussion in an international health professions educator fellowship program. We introduced scenarios with cultural references to study the reaction of participants to cultural conversation cues. We used an inductive thematic analysis to explore power and hegemony issues.

RESULTS

Participants reflected that personally they were more likely to take part in cross-cultural discussions if they recognized the context discussed or had prior exposure to educational settings with cultural diversity. They identified barriers as lack of skills in facilitating cross-cultural discussions and fear of offending others. They suggested deliberately introducing cultural issues throughout the curriculum.

CONCLUSION

Our results indicate that developing critical consciousness and cross-cultural competency will require instructional design to identify longitudinal opportunities to bring up cross-cultural issues, and training facilitators to foster cross-cultural discussions by asking clarifying questions and navigating crucial/sensitive conversations.

Perceptions of obstetrical interventions and female genital cutting: insights of men in a Somali refugee community

OBJECTIVES

Somali women are at increased risk of adverse pregnancy outcomes. Anxiety and perceived stigmatization toward female genital cutting (FGC) further fuels an atmosphere of miscommunication and distrust, contributing to poorer health outcomes. While the attitudes and experiences of Somali refugee women toward healthcare are widely known, the views of Somali refugee men are largely unknown. This study examines the perspectives of Somali men toward FGC and women's childbirth experiences in one refugee community in the USA.

DESIGN

Community-based participatory research partnerships with key stakeholders within the Somali refugee community incorporated qualitative methods comprising semi-structured focus groups and individual interviews to elicit male participants' perspectives on FGC, experiences during childbirth, and the perception of increased cesarean deliveries among Somali women. Qualitative analyses involved a framework and team-based approach using grounded theory and conventional content analysis.

RESULTS

Acculturation influenced changes in traditional gender roles fostering new dynamics in shared decision-making within the household and during childbirth. Participants were aware of FGC-related morbidity, ongoing matriarchal support for FGC, and were generally not supportive of FGC. They perceived health-care providers as being unfamiliar with caring for women with FGC fueling profound aversion to cesarean deliveries, miscommunication, and distrust of the health-care system.

CONCLUSION

Our work yields new insights into Somali reproductive healthcare through Somali men, namely: strong matriarchal support of FGC, discomfort in men's presence during delivery, and a strong aversion to cesarean delivery. Our findings support the need for advocacy to engage Somali women, their partners/spouses, and health-care providers in facilitating greater continuity of care, building greater trust as men become engaged throughout the spectrum of care in the decision-making process while respecting traditional norms. Cultural health navigators should bridge communication and support between providers and patients. Our work provides foundational knowledge to inform culturally appropriate health interventions within a Somali refugee community.

A tool for assessing cultural competence training in dental education

Policies exist to promote fairness and equal access to opportunities and services that address basic human needs of all U.S. citizens. Nonetheless, health disparities continue to persist among certain subpopulations, including those of racial, ethnic, geographic, socioeconomic, and other cultural identity groups. The Commission on Dental Accreditation (CODA) has added standards to address this concern. According to the most recent standards, adopted in 2010 for implementation in July 2013, CODA stipulates that "students should learn about factors and practices associated with disparities in health." Thus, it is imperative that dental schools develop strategies to comply with this addition. One key strategy for compliance is the inclusion of cultural competence training in the dental curriculum. A survey, the Dental Tool for Assessing Cultural Competence Training (D-TACCT), based on the Association of American Medical Colleges' Tool for Assessing Cultural Competence Training (TACCT), was sent to the academic deans at seventy-one U.S. and Canadian dental schools to determine best practices for cultural competence training. The survey was completed by thirty-seven individuals, for a 52 percent response rate. This article describes the use of this survey as a guide for developing culturally competent strategies and enhancing cultural competence training in dental schools.

The environment modifies the relationship between social networks and secondhand smoke exposure among Korean nonsmokers in Seoul and California

This study compared risks of secondhand smoke exposure (SHSe) among Korean nonsmokers in Seoul, South Korea and California, United States. Social networks were hypothesized to contain more smokers in Seoul than in California, and smokers were hypothesized to produce more secondhand smoke in Seoul than California, as Seoul's policies and norms are less restrictive. Telephone interviews were conducted with Korean adults in Seoul (N = 500) and California (N = 2830). In all, 69% (95% confidence interval [CI] = 64-74) of Koreans and 31% (95% CI = 29-33) of Korean Americans reported any SHSe. A total of 44% (95% CI = 40-47) of Korean family members smoked versus 29% (95% CI = 28-30) of Korean American family members (t = 7.84, P < .01). A 25% to 75% increase in the proportion of family members that smoked corresponded with a 13% (95% CI = 5-21) higher probability of any SHSe among Koreans compared with 6% (95% CI = 2-10) among Korean Americans. Network interventions in combination with policies and/or health campaigns may help reduce SHSe globally.

Factors related to condom use behavior among club-working women in South Korea: importance of subjective norms and customer-related attitudes

The primary aim of this study was to understand factors associated with condom use behavior among club-working women and identify the most influential factors to be addressed in future health programs. A total of 158 club-working women were surveyed from 3 midsize cities in South Korea from July to September 2004. Survey questionnaires were developed based on the theory of planned behavior. A total of 7 distinct themes emerged: Health aspects, Customer related, Pleasure related, Finance related, Societal norm, Occupational norm, and Perceived control. The results indicated that the Customer-related theme, Societal norm, and Occupational norm were statistically significant factors affecting condom use. On the other hand, self-related factors such as health, pleasure, and finance are not significantly related to the condom use behavior of club-working women in South Korea, suggesting that the currently used knowledge-focused education programs may not be sufficient for this population.

Refugees' perspectives on barriers to communication about trauma histories in primary care

Objective This study explores refugees' perspectives regarding the nature of communication barriers that impede the exploration of trauma histories in primary care.Method Brief interviews were conducted with 53 refugee patients in a suburban primary care clinic in the Midwest USA. Participants were asked if they or their doctors had initiated conversations about the impact of political conflict in their home countries. Qualitative data analysis was guided by grounded theory. Peer debriefings of refugee healthcare professionals were incorporated into the analysis.Results Two-thirds of refugee patients reported that they never shared how they were affected by political conflict with their doctors and that their doctors never asked them about it. Most refugees stated that they would like to learn more about the impact of trauma on their health and to discuss their experiences with their doctors.Conclusion Refugees are hesitant to initiate conversations with physicians due to cultural norms requiring deference to the doctor's authority. They also lack knowledge about how trauma affects health. Physicians should be educated to inquire directly about trauma histories with refugee patients. Refugees can benefit from education about the effects of trauma on health and about the collaborative nature of the doctor-patient relationship.

General practitioners' views on consultations with interpreters: a triad situation with complex issues

OBJECTIVE

To study a group of general practitioners' (GPs) views on cross-cultural consultations through interpreters in primary healthcare in Sweden.

DESIGN

Two group interviews and three personal interviews with experienced GPs regarding clinical consultation through interpreters were carried out. The interviews were transcribed and analysed and the text was categorized according to content analysis.

SETTING

Primary healthcare.

SUBJECTS

Eight GPs were interviewed.

MAIN OUTCOME MEASURES

The response and opinions of the GPs.

RESULTS

In the analysis it appeared that an optimal clinical encounter demands an active role by all participants involved in the consultation. The interpreter has to strive after being a stable neutral information bridge, and has a balancing role between the GP and the patient. The GP has to be open to cultural inequalities and recognize consultation through an interpreter as a part of her/his job. The patient needs to be an active and visible participant, not hiding behind the interpreter. Common obstacles and imperfections to reach the best possible triad were discussed. Additionally, practical assets in the encounter were delineated. Accurate physical placing of the persons in the room, adequate length of consultation time, and using the same interpreter from one visit to another were mentioned as factors influencing the outcome of the consultation.

CONCLUSION

Barriers in cross-cultural communications could originate from all persons involved, the interpreter, the GP, and the patient, as well as from tangible factors. Ways to reduce misunderstandings in GP-patient encounters through interpreters are suggested.

Caring for Somali women: implications for clinician-patient communication

OBJECTIVE

We sought to identify characteristics associated with favorable treatment in receipt of preventive healthcare services, from the perspective of resettled African refugee women.

METHODS

Individual, in-depth interviews with 34 Somali women in Rochester, NY, USA. Questions explored positive and negative experiences with primary health care services, beliefs about respectful versus disrespectful treatment, experiences of racism, prejudice or bias, and ideas about removing access barriers and improving health care services. Analysis was guided by grounded theory.

RESULTS

Qualities associated with a favorable healthcare experience included effective verbal and nonverbal communication, feeling valued and understood, availability of female interpreters and clinicians and sensitivity to privacy for gynecologic concerns. Participants stated that adequate transportation, access to healthcare services and investment in community-based programs to improve health literacy about women's preventive health services were prerequisite to any respectful health care system.

CONCLUSION

Effective communication, access to healthcare services with female interpreters and clinicians, and community programs to promote health literacy are themes associated with respectful and effective healthcare experiences among Somali women.

PRACTICE IMPLICATIONS

Adequate interpreter services are essential. Patient-provider gender concordance is important to many Somali women, especially for gynecological concerns.