The Use of Focus Groups to Better Understand
Immigrant Somali Women’s Prenatal Needs
Nancy Hill, RN, BSN, Emmy Hunt, RN, MSN & Kristiina Hyrkäs PhD, LicNSc, MNSc, RN
Problem Statement
Delivering safe patient centered prenatal care to immigrant women is complex and challenging because of significant differences in cultural beliefs, habits, and attitudes. To enhance a more culturally sensitive prenatal program for Somali women, we endeavored to gain a deeper and richer understanding of the women’s beliefs about pregnancy and childbirth experiences.

Overview of the Literature

Few studies demonstrate how Somali womens’ beliefs about pregnancy and childbirth impact behavior and experiences in seeking care. Johnson et al. (2005) concluded even after migration Somali immigrants maintain their cultural attitudes, strategies, and habits during pregnancy and childbirth which contribute to a higher risk for perinatal complications. Wissink et al. (2005) determined lack of knowledge and understanding by healthcare providers of cultural differences regarding pregnancy and childbirth can be a barrier to improving their care. Methodology and design

Qualitative research was chosen as a means to attain an in-depth understanding of the Somali lived experience. Somali is traditionally an oral language and adult literacy rates for females is 13% (WHO 2002). Because of this, the focus group interview format was chosen as a data collection method. Our objectives were to (1) describe and understand how Somali women have experienced pregnancy care, and (2) identify the key factors which lead to patient dissatisfaction with current prenatal care services.

Data gathering strategy

Participants for the focus groups were selected by convenience sampling. A total of three focus group interviews were conducted with 18 women, for 2-3 hours each.

Data Analysis

The taped interviews were transcribed to yield 103 pages of written text. Both researchers verified the equivalence of the text and tapes. The thematic content analysis process entailed the researchers reading all the text repeatedly in order to gain an overall impression. Major themes emerged. Words, sentences and paragraphs were then identified as meaningful units of analysis which were abstracted to sub-themes and then themes.

Findings

Six major themes emerged from the focus group interviews: (1) Pregnancy, (2) Prenatal Care, (3) Delivery, (4) Breastfeeding, (5) Mental Health, and (6) Healthcare Systems. The themes and sub-themes illuminated (a) cultural beliefs, (b) religious beliefs, and (c) scientific beliefs of these Somali women.

Interpretation and implications for nursing practice/future research
The lack of healthcare staff’s understanding of Somali women’s cultural beliefs and preferences during pregnancy and childbirth as well as Somali women’s lack of understanding prenatal care and childbirth practices in a Western obstetrical care setting contribute to significant barriers to care and an increased perinatal risk. The findings from the research process have supported development of Somali-specific cultural competency workshops for healthcare providers. Somali liaisons are training to serve as educational assistants, advisors, interpreters, and culture brokers in the development of educational materials and prenatal educational sessions in the community. The liaisons will ensure improved communication and will support the credibility of the approach with Somali patients.