Abstract
This Q methodological study was conducted to examine the perspectives of health professionals in providing sexual and reproductive health (SRH) care to refugee and migrant women. Forty-seven health professionals rank-ordered 42 statements and commented on their rankings in subsequent open-ended questions. A bi-person factor analysis was performed and factors were extracted according to the centroid method with a varimax rotation. Seven factors each with a distinct and meaningful viewpoint were identified. These factors are: “Communication difficulties—hurdles to counselling”, “Lack of access to culturally appropriate care”, “Navigating SRH care”, “Cultural constraints on effective communication”, “Effects of the lack of cultural competency”, “Impacts of low income and language barrier” and “SRH services are accessible, but not culturally relevant”. A more culturally adaptive healthcare model that considers refugee and migrant women’s linguistic, cultural and socio-economic backgrounds; and engages health professionals on an ongoing process of building cultural competency is central to improve SRH access to these women.
Similar content being viewed by others
References
Department of Immigration and Boarder Protection. A History of the Department of Immigration and Boarder Protection-Managing Migration to Australia. https://www.border.gov.au/CorporateInformation/Documents/immigration-history.pdf: Department of Immigration and Boarder Protection, Australian Government 2015.
Department of Social Service. Settlement reports: gender by migration Stream. Canberra 2015.
Aminisani N, Armstrong BK, Canfell K. Cervical cancer screening in Middle Eastern and Asian migrants to Australia: a record linkage study. Cancer Epidemiol. 2012;36(6):e394–e400.
MCWH. Putting immigrant and refugee women’s health first-sexual & reproductive health data report. Melbourne 2010.
Ngum Chi Watts MC, Liamputtong P, Carolan M. Contraception knowledge and attitudes: truths and myths among African Australian teenage mothers in Greater Melbourne, Australia. J Clin Nurs. 2014;23(15–16):2131–41.
Mazza D, Harrison C, Taft A, Brijnath B, Britt H, Hobbs M, et al. Current contraceptive management in Australian general practice: an analysis of BEACH data. Med J Aust. 2012;197(2):110–4.
Mengesha Z, Dune T, Perz J. Culturally and linguistically diverse women’s views and experiences of accessing sexual and reproductive health care in Australia: a systematic review. Sexual Health. 2016.
Sheikh-Mohammed M, Macintyre CR, Wood NJ, Leask J, Isaacs D. Barriers to access to health care for newly resettled sub-Saharan refugees in Australia. Med J Aust. 2006;185(11–12):594–7.
Ussher J, Rhyder-Obid M, Perz J, Rae M, Wong TK, Newman P. Purity, Privacy and procreation: constructions and experiences of sexual and reproductive health in Assyrian and Karen women living in Australia. Sex Cult. 2012;16(4):467–85.
Murray SB, Skull SA. Hurdles to health: immigrant and refugee health care in Australia. Aust Health Rev. 2005;29(1):25–9.
Garrett PW, Dickson HG, Whelan AK, Whyte L. Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications. Austr N Z Health Policy. 2010;7:1.
Brown SR. Q Methodology and Qualitative Research. Qual Health Res. 1996;6(4):561–7.
Cross RM. Exploring attitudes: the case for Q methodology. Health Educ Res. 2005;20(2):206–13.
Watts S, Stenner P. Doing Q methodological research: theory, method and interpretation. London: London Sage Publications; 2012. p. 256.
Watts S, Stenner P. Doing Q methodology: theory, method and interpretation. Quali Res Psychol. 2005;2(1):67–91.
Risdon A, Eccleston C, Crombez G, McCracken L. How can we learn to live with pain? A Q-methodological analysis of the diverse understandings of acceptance of chronic pain. Soc Sci Med. 2003;56(2):375–86.
Stenner PH, Bianchi G, Popper M, Supeková M, Lukšík I, Pujol J. Constructions of sexual relationships: a study of the views of young people in Catalunia, England and Slovakia and their health implications. J Health Psychol. 2006;11(5):669–84.
Brown SR. Political subjectivity, applications of Q methodology in political science. New Haven, CT: Yale University Press; 1980.
Brown SR. A primer on Q-methodology. Operant subjectivity 1993.
Brown RD, Pirtle T. Beliefs of professional and family caregivers about the sexuality of individuals with intellectual disabilities: examining beliefs using a Q-methodology approach. Sex Educ. 2008;8(1):59–75.
Coogan J, Herrington N. Q methodology: an overview. Res Second Teacher Educ. 2011;1(2):24–8.
Stainton Rogers R. Q Methodology. In: Smith JA, Harre R, Van Langenhove L, editors. Rethinking methods in psychology. Thousand Oaks, CA: Sage; 1995.
Reber B, Kaufman S. Q-assessor: developing and testing an online solution to Q method data gathering and processing. Amsterdam: World Association for Public Opinion Research; 2011.
Stenner PH, Cooper D, Skevington SM. Putting the Q into quality of life; the identification of subjective constructions of health-related quality of life using Q methodology. Soc Sci Med. 2003;57(11):2161–72.
Newbold KB, Willinsky J. Providing family planning and reproductive healthcare to Canadian immigrants: perceptions of healthcare providers. Cult Health Sex. 2009;11(4):369–82.
McKeary M, Newbold B. Barriers to care: the challenges for Canadian refugees and their health care providers. J Refug Stud. 2010. doi:10.1093/jrs/feq038
Stenner P, Cross V, McCrum C, McGowan J, Defever E, Lloyd P, et al. Self-management of chronic low back pain: four viewpoints from patients and healthcare providers. Health Psychol Open. 2015;2(2):2055102915615337.
Degni F, Suominen S, Essen B, El Ansari W, Vehvilainen-Julkunen K. Communication and cultural issues in providing reproductive health care to immigrant women: health care providers’ experiences in meeting the needs of [corrected] Somali women living in Finland. J Immigr Minor Health. 2012;14(2):330–43.
Rogers C, Earnest J. A cross-generational study of contraception and reproductive health among Sudanese and Eritrean women in Brisbane, Australia. Health Care Women Int. 2014;35(3):334–56.
Riggs E, Davis E, Gibbs L, Block K, Szwarc J, Casey S, et al. Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers. BMC Health Serv Res. 2012;12(1):1–16.
Kreps GL, Kunimoto EN. Effective communication in multicultural health care settings. Thousand Oaks, CA: Sage; 1994.
Henderson S, Kendall E. Culturally and linguistically diverse peoples’ knowledge of accessibility and utilisation of health services: exploring the need for improvement in health service delivery. Aust J Primary Health. 2011;17(2):195–201.
Gilliam ML, Hernandez M. Providing contraceptive care to low-income, African American teens: the experience of urban community health centers. J Community Health. 2007;32(4):231–44.
Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O, 2nd. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports (Washington, DC : 1974). 2003;118(4):293–302.
Bischoff A, Perneger TV, Bovier PA, Loutan L, Stalder H. Improving communication between physicians and patients who speak a foreign language. Br J Gen Pract. 2003;53(492):541–6.
Erlen JA. Culture, ethics, and respect: the bottom line is understanding. Orthopedic nursing. 1998;17(6):79–82.
Thomas PE, Beckmann M, Gibbons K. The effect of cultural and linguistic diversity on pregnancy outcome. Aust N Z J Obstet Gynaecol. 2010;50(5):419–22.
Hatch M. Common threads: the sexual and reproductive health experiences of immigrant and refugee women in Australia. Melbourne: MCWH; 2012.
Murray L, Windsor C, Parker E, Tewfik O. The experiences of African women giving birth in Brisbane, Australia. Health Care Women Int. 2010;31(5):458–72.
Butow PN, Sze M, Dugal-Beri P, Mikhail M, Eisenbruch M, Jefford M, et al. From inside the bubble: migrants’ perceptions of communication with the cancer team. Support Care Cancer. 2010;19(2):281–90.
Lloyd N, Rafferty A. Black and minority ethnic families and sure start: findings from Local Evaluation Reports London: NESS, 2006.
Institute for Community Ethnicity and Policy Alternatives Victoria University. Review of Current Cultural and Linguistic Diversity and Cultural Competence Reporting Requirements, Minimum Standards and Benchmarks for Victoria Health Services Project Melbourne Victoria: Statewide Quality Branch, Victorian Government Department of Health, 2009.
Owens C, Dandy J, Hancock P. Migrant and refugee women’s experiences of the shared care service (Antenatal care service). Mirrabooka, Perth: Ishar—Multicultural Women’s Health Centre; 2014.
Acknowledgements
The authors would like to acknowledge Family Planning NSW and the Multicultural Centre for Women’s Health who assisted in the recruitment of participants, and the health professionals who provided their time and voices to this project.
Funding
This research has not received any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that there is no conflict of interest.
Ethical Approval
Ethical approval was received from the Human Research Ethics Committee of Western Sydney University with approval number H11034.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Mengesha, Z.B., Perz, J., Dune, T. et al. Challenges in the Provision of Sexual and Reproductive Health Care to Refugee and Migrant Women: A Q Methodological Study of Health Professional Perspectives. J Immigrant Minority Health 20, 307–316 (2018). https://doi.org/10.1007/s10903-017-0611-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10903-017-0611-7