Experiences of primary healthcare workers in Australia towards women and girls living with female genital mutilation/cutting (FGM/C) : a qualitative study

Female genital mutilation/cutting (FGM/C) is a harmful cultural practice with significant health consequences for affected women and girls. Due to migration and human mobility, an increasing number of women with FGM/C are presenting to healthcare facilities of western countries (including Australia) where the practice is non-prevalent. Despite this increase in presentation, the experiences of primary healthcare providers in Australia engaging and caring for women/girls with FGM/C are yet to be explored. The aim of this research was to report on the Australian primary healthcare providers’ experiences of caring for women living with FGM/C. A qualitative interpretative phenomenological approach was utilised and convenience sampling was used to recruit 19 participants. Australian primary healthcare providers were engaged in face-to-face or telephone interviews, which were transcribed verbatim and thematically analysed. Three major themes emerged, which were: exploring knowledge of FGM/C and training needs, understanding participants’ experience of caring for women living with FGM/C, and mapping the best practice in working with women. The study shows that primary healthcare professionals had basic knowledge of FGM/C with little or no experience with the management, support, and care of affected women in Australia. This impacted their attitude and confidence to promote, protect, and restore the target population’s overall FGM/C-related health and wellbeing issues. Hence, this study highlights the importance of primary healthcare practitioners being skilled and well-equipped with information and knowledge to care for girls and women living with FGM/C in Australia

Jordanian women's experiences and constructions of labour and birth in different settings, over time and across generations : a qualitative study

Background: Overwhelmingly, women in Middle Eastern countries experience birth as dehumanising and disrespectful. Women’s stories can be a very powerful way of informing health services about the impact of the care they receive and can promote practice change. The aim of this study is to examine Jordanian women’s experiences and constructions of labour and birth in different settings (home, public and private hospitals in Jordan, and Australian public hospitals), over time and across generations. Method: A qualitative interpretive design was used. Data were collected by face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan (12 had given birth in the last five years and eight had birthed over 15 years ago) while seven were living in Australia (with birthing experience in both Jordan and Australia). Interview data were transcribed verbatim and analysed thematically. Results: Women’s birth experiences differed across settings and generations and were represented in the four themes: ‘Birth at home: a place of comfort and control’; ‘Public Hospital: you should not have to suffer’; ‘Private Hospital: buying control’ and ‘Australian maternity care: a mixed experience’. In each theme, the concepts: Pain, Privacy, the Personal and to a lesser extent, Purity (cleanliness), were present but experienced in different ways depending on the setting (home, public or private hospital) and the country. Conclusions: The findings demonstrate how meanings attributed to labour and birth, particularly the experience of pain, are produced in different settings, providing insights into the institutional management and social context of birth in Jordan and other Middle Eastern countries. In the public hospital environment in Jordan, women had no support and were treated disrespectfully. This was in stark contrast to women birthing at home only one generation before. Change is urgently needed to offer humanised birth in the Jordanian maternity system

From the world to Western : a community-engaged teaching strategy to enhance students’ learning of cultural issues relevant to healthcare

Using the transformational learning theory and action research method, this study captured the experiences of students from health-related disciplines in the cultural immersion program From the World to Western. A total of nine students participated in the pilot program with four host families from Culturally and Linguistically Diverse (CALD) backgrounds, and four cultural facilitators who connected the host families and students. The findings of this research showed that it was beneficial for students in health-related disciplines to engage in the cultural immersion program to further prepare them for culturally competent care in their future roles as healthcare professionals. In addition, the students indicated the need for the cultural immersion program to be part of the curriculum for future students to develop cultural skills, awareness and encounters with diverse populations

Co‑designed, culturally tailored cervical screening education with migrant and refugee women in Australia : a feasibility study

Background: Participation of culturally and linguistically diverse (CALD) women from migrant and refugee backgrounds in cervical screening is crucial to eliminate cervical cancer as a public health problem within the next 20 years. However, CALD women report low participation in cervical screening. Barriers to participation can be addressed with culturally tailored, community-based programs. There is a need for research to explore the process, feasibility, acceptability and barriers to cultural tailoring in the delivery and evaluation of cervical screening health education. Methods: CALD community health workers took part in a 2 day training program then co-designed, culturally tailored and co-facilitated cervical screening health promotion forums within their communities. Forums were delivered to a total of seven groups, involving 12 sessions and 71 CALD women. The forums were evaluated for feasibility, acceptability, implementation and effectiveness using a survey, interviews and observations. Data were collected from CALD women, facilitators and researchers. Results: The co-design and co-delivery of cervical screening health promotion forums was time and resource intensive however allowed for deeper cultural tailoring resulting in engagement with ‘hard to reach’ CALD women, improved health literacy and intention to screen. Flexibility in the intervention implementation was crucial to ensure forums were responsive to community interests and needs. Online delivery of the forums in response to the COVID-19 pandemic was acceptable to most groups. Conclusions: Co-designed, culturally tailored cervical screening health promotion forums are feasible and acceptable to CALD women, in both face-to-face and online formats. Adjustments to the intervention protocol were recommended to improve future implementation

Meaning of health : migration experience and health seeking behaviour of West African women in Australia

Health concepts strongly influence people’s health seeking behaviour. In an increasingly multicultural Australia, the cohort of patients presenting for health care services are from cultural backgrounds that may have different concepts of health from that of the health care providers. West African immigrant women are among the recent immigrants to Australia who may have a different notion of health from the dominant western philosophy that guide health care provision in Australia. Understanding the meaning of health for these women and its influence on their health seeking behaviour will assist nurse in effective healthcare delivery. This qualitative study explored the meaning of health and the impact of this meaning on West African women’s health seeking behaviour. Guided by constructivist assumptions, participants were recruited through the snowballing technique. Twenty-one West African women living in Australia and willing to participate in the study were engaged in face-to-face audio-taped interview. Through continuous interplay of data collection and data analysis, four emerging themes namely being healthy, being spiritual, being a migrant and encountering health care system were identified. Findings revealed that West African women’s meaning of health incorporated biomedical ideas, belief in mystical forces and the participants’ social positioning as women. The women waited for physical symptoms of illness before presenting at health care facilities. Most of them believe that mystical forces such as witches, wizards and evil eye can cause illness. Patriarchal subservient positioning encouraged by traditional African culture subjected these women to domestic violence experience and overwork. Furthermore, the study revealed that West African women’s meaning of health was the major determinant of these women’s health seeking behaviour. It determined the type of health care services used by these women. The findings from this study demonstrate that meaning of health, migration experience and the participants’ personal experiences with the health care system are fundamental to their health seeking behaviour. The women’s meaning of health is subjective, dynamic and it is influenced by a combination of world views. Despite a high level of educational achievement as well as occupation of most of the women, belief in higher mystical forces was a significant cultural framework supporting their explanations of health. As immigrants these women experienced isolation and they had positive and negative experiences as they encountered the health care system in their new country. Influenced by their cultural belief and their experiences of settling in a new country, these women underutilised health care services in Australia and delayed access. It is suggested that provision of health care services aimed at meeting these women’s health care needs should incorporate these women’s meaning of health to enhance their participation. Implication of the study for nursing practice and recommendation for further research were also suggested

Female genital mutilation (FGM) : Australian midwives’ knowledge and attitudes

Female genital mutilation (FGM) is a women's health and human rights issue attracting global interest. My purpose in this qualitative study was to report the knowledge and attitudes of Australian midwives toward FGM. Verbatim transcription and thematic analysis of semistructured interviews with 11 midwives resulted in these themes: knowledge of female genital mutilation and attitude toward female genital mutilation. Significant gaps in knowledge about FGM featured prominently. The midwives expressed anger toward FGM and empathy for affected women. Recommendations include increased information on FGM and associated legislation among midwives and other health providers in countries where FGM may be encountered

Becoming a new parent : pregnancy, birthing and parenting experiences of refugee mothers and fathers in New South Wales

Health care providers are in the forefront of health provision for the world’s growing number of refugees, many of whom are of child-bearing age. Becoming a parent in an unfamiliar cultural environment presents challenges for women and men who are newly arrived refugees in contrast to the experiences of mainstream parents. In Australia and internationally, there is growing recognition of the need to understand the experiences and service needs of women and men who are either humanitarian or economic migrants and are becoming parents for the first time or are now raising their children in a new country. Using a qualitative interpretive design informed by Heideggerian hermeneutic phenomenology, 26 parents took part in face-to face, digitally recorded interview between February to November, 2016. An analysis of findings yielded three themes namely: being a burden, living in two worlds; being supported. Many parents in the study were not sure of what to expect from the Australian health system. Not knowing the physiological changes in the mothers’ bodies made pregnancy difficult and parenting was negotiated through a blend of parenting practices in the participants’ countries of birth and that of Australia. The challenges of becoming pregnant and parenting in a new country can be overcome through professional support from the health care providers

Australian midwives' perspectives on managing obstetric care of women living with female genital circumcision/mutilation

Female genital mutilation (FGM) or female circumcision is a global health issue with increasing international migration of affected women and girls to countries unfamiliar with the practice. Western health care providers are unfamiliar with FGM, and managing obstetric care presents challenges to midwives who are in the forefront of care provision for the women. The participants in this Heideggerian qualitative interpretive study elucidated the strategies they used in overcoming the particular physical, emotional, and gynecological health issues with which mutilated women present. Ongoing emphases on women-centered, culturally competent maternity care are germane to optimal maternity care of circumcised women

Understanding the dilemma of de-infibulation for women living with female genital mutilation

Female genital mutilation (FGM) also known as female circumcision (FC) is a global and women’s health issue that is of a particular concern to Australia due to an increasing migration of women and girls from countries where the practice is prevalent (World Health Organization (WHO 2011). It is a cultural practice which refers to a range of procedures intended at partial or total removal of the female genitalia for nontherapeutic reasons (Ball 2008). FGM involves the narrowing of the vaginal opening and presents a peculiar healthcare challenge to healthcare providers in western countries such as Australia who are unfamiliar with the practice. Studies have identified a knowledge gap among western healthcare providers caring for women living with female genital mutilation. Understanding the ordeal faced by circumcised women undergoing de-infibulation will bridge this gap particularly for the inexperienced healthcare nurses and midwives who may encounter these women in the course of care provision