Experiences and perceptions of Iraqi muslim refugee women and health care providers in the health care encounter

Research indicates that health disparities persist for minorities in the U.S. Sources of health disparities may stem from differences (linguistic, cultural, religious, gender, education) between health provider and patient. This qualitative study explored perceptions and experiences between Iraqi Muslim women with refugee backgrounds and primary health care providers in the context of the health encounter. Study design was based on critical ethnography and postcolonial feminism that guided semistructured interviews. Participants were purposefully selected from 4 urban clinics and included 15 Iraqi Muslim women patients with refugee backgrounds and 10 primary health care providers. All 10 provider and 5 patient interviews were conducted in English; 10 Iraqi patient interviews were conducted in Arabic, transcribed in Arabic, and translated into English for analysis. Arabic transcriptions and recordings were verified and the English translations were translated back to Arabic. Supportive methods included field notes, and discussions with key informants. The data were coded and categories were formed from repetition of main ideas. Through analysis and interpretation of the data, themes emerged from the categories for each participant group. Results describe how Iraqi Muslim women face many barriers in seeking health care that are both health system and health provider based. Likewise, health providers are limited in their ability to bridge differences and encounter knowledge deficits about patients as individuals. Both participant groups had expectations of the health encounter constructed on culturally-based perceptions and expectations. The health encounter is limited by time and inadequate interpretive services that narrow opportunities for clear communication and understanding between provider and patient. These factors combined with individual perceptions and expectations open an avenue for misinterpretation, misdiagnosis, and stereotyping. Recommendations are given for improving health services to refugees. These include comprehensive changes to the usual confines of the health encounter and avenues for increasing awareness and education of state agencies, health administration, and health providers about the barriers faced by Iraqi Muslim women. In light of the continued health disparities for minority groups, future research is recommended in order to identify the interpersonal elements that contribute to health disparities for patients who are newly arrived to the U.S.