RESUMO
OBJECTIVE: To explore health care administrators' perspectives on (a) institutional values, practices, and policies on the provision of patient- and family-centered and culturally appropriate reproductive health care for women from Somalia; (b) limitations imposed by these institutional values, practices, and policies; and (c) strategies to address these limitations. DESIGN: An exploratory single case study with in-person interviews and institutional document analysis guided by critical theory. SETTING: A Level 4 academic medical center on the West Coast of the United States. PARTICIPANTS: Eleven health care administrators employed at the study site. METHODS: Administrators participated in semistructured interviews after reading a prototypical vignette to contextualize the clinical encounter of a Somali woman with health care providers. Data from interviews were analyzed using a deductive structural coding process. Institutional documents were analyzed to identify values, policies, and practices regarding patient- and family-centered and culturally appropriate care for women from Somalia. RESULTS: The overarching theme was Our institution respects diversity and patient- and family-centered care. The subthemes that emerged were Current practices are important but difficult to institute, Current institutional policies are good but too nonspecific to follow, and Engagement between the provider and woman is of value but difficult to enact. Recommendations to address these contrasts fell into two categories: pragmatic planning and changing the paradigm of care. CONCLUSION: Cultural barriers, limitations caused by structural factors, and competing provider-patient paradigms contribute to challenges for many providers when caring for Somali women in some U.S. health care systems. Specific policies and training to provide culturally appropriate reproductive care for Somali women are imperative.
