Ethnicity,education attainment,media exposure,and prenatal care in Vietnam

Objective. Prenatal care coverage in Vietnam has been improving, but ethnic minority women still lag behind in receiving adequate level and type of care. This paper examines ethnic disparities in prenatal care utilization by comparing two groups of ethnic minority and majority women.

Design. We examine the roots of ethnic disparity in prenatal care utilization, focusing on how education and media exposure change health behaviours and lessen disparities. We rely on the 2002 Vietnam Demographic and Health Survey to draw our sample, predictors and the three dimensions of prenatal care, including timing of onset, frequency of visits, and type of provider.

Results. Results from multinomial-, and binary-logistic regression provide evidence that ethnic minority women are less likely to obtain frequent prenatal care and seek care from professional providers than their majority counterparts. However, we find that ethnic minority women are more likely to obtain early care compared to ethnic majority women. Results for predicted probabilities suggest that education and media exposure positively influenced prenatal care behaviours with higher level of education and media exposure associating with accelerated probability of meeting prenatal care requirements.

Conclusion. Our results imply the needs for expansion of media access and schools as well as positive health messages being broadcasted in culturally competent ways.     

Racial/ethnic differences in perceived need for mental health care and disparities in use of care among those with perceived need in 1990–1992 and 2001–2003

Objectives: This study examines whether there are racial/ethnic differences in perceived need for mental health care among those with a mood and/or anxiety disorder in 1990–1992 and 2001–2003 in the US. Then among those with perceived need, we examine whether racial/ethnic disparities in use of mental health care existed in both time periods.

Design: Using data from the 1990–1992 National Comorbidity Survey (NCS) and 2001–2003 National Comorbidity Survey – Replication (NCS-R), the study analyzes whether whites differed from blacks and Latinos in rates of perceived need among those with a mood and/or anxiety disorder in 1990–1992 and 2001–2003. Then among those with a disorder and perceived need, rates of mental health care use for whites are compared to black rates and Latino rates in within the 1990–1992 cohort and then within the 2001–2003 cohort.

Results: There were no statistical racial/ethnic differences in perceived need in both time periods. Among those with perceived need in 1990–1992, there were no statistical racial/ethnic disparities in the use of mental health care. However, in 2001–2003, disparities in mental health care use existed among those with perceived need.

Conclusions: The emergence of racial/ethnic disparities in use of mental health care among those with a perceived need for care in 2001–2003 suggests that personal/cultural belief along with issues concerning access and quality of mental health care may create barriers to receiving perceived needed care. More research is needed to understand why these disparities emerged among those with perceived need in the latter time period and whether these disparities continue to exist in more recent years.     

A pilot study evaluating the prescribing of ceftriaxone in hospitals in Ghana: findings and implications

Background and Objectives: Widespread empiric use of antibiotics exists especially in developing countries. This is a concern since inappropriate use of antibiotics, including their extended inappropriate use, will increase resistance rates. Consequently, there is a need to evaluate antibiotic utilisation across healthcare sectors to improve future use. This includes ceftriaxone, widely used among hospitals including those in Ghana.

Methods: A cross-sectional study to evaluate the appropriateness of ceftriaxone prescribing in a leading hospital in Ghana. Ceftriaxone prescribing in patient-record cards was assessed using a modified WHO drug-utilization evaluation criteria as well as referencing the national standard treatment guidelines in Ghana and the ceftriaxone package insert.

Results: A total of 251 patients were assessed. Ceftriaxone was most commonly prescribed for comorbid malaria with bacterial infections, urinary tract infections, sepsis and gastroenteritis. The appropriateness of the indication was 86% (n = 218). The doses most prescribed were 1g (41%) and 2g (39%). Stat dose and once-daily dosage regimen constituted 51.4% and 84.5%, respectively. The most common duration of treatment was 1 (51.4%) and 2 days (35.1%). The overall appropriateness of prescribing was 93% against a pre-set threshold of 97%.

Conclusion: The appropriateness of ceftriaxone prescribing was high in this leading hospital in Ghana; however, there is room for improvement with targeted education initiatives, with further research planned.     

Changes in racial/ethnic disparities in the prevalence of Type 2 diabetes by obesity level among US adults

Objective. Ethnic minority status and obesity are two independent risk factors for Type 2 diabetes (T2D). There is no clear understanding of how they may have interacted and influenced disparities in T2D prevalence over time. This study examined the trends in racial/ethnic disparities in the prevalence of T2D by weight status among US adults.

Methods. We used nationally representative data from the National Health and Nutrition Examination Surveys I (1971–1975), II (1976–1980), and III (1988–1994), and 1999–2004 among 49,574 adults aged 20–74 years. The prevalences of diagnosed and undiagnosed T2D were estimated by race/ethnicity groups (non-Hispanic White, non-Hispanic Black, and Mexican American) and body mass index (BMI) groups (normal, 18.5–24.9; overweight, 25–29.9; obese, 30–34.9; severely obese, ≥35). We used logistic regression controlling for age, gender, and education to estimate the odds ratio of T2D across race/ethnicity and BMI groups.

Results. Trends in racial/ethnic disparities in prevalence of diagnosed T2D varied by BMI. Normal weight group saw increasing racial disparities. In the overweight group, ethnic disparities worsened as diabetes prevalence increased 33.3% in Whites, compared to 60.0% in Blacks, and 227.3% in Mexican Americans. Minimal racial/ethnic disparities were observed in obese and severely obese groups over time. In contrast to diagnosed diabetes, overall racial/ethnic disparities in undiagnosed T2D declined in all BMI groups.

Conclusions. Racial/ethnic disparities in diabetes prevalence have become most pronounced among normal and overweight groups. Eliminating racial/ethnic disparities in diabetes will require prevention efforts not only in obese minority individuals, but also in normal and overweight minority individuals.     

Workforce ethnic diversity and culturally competent health care: the case of Arab physicians in Israel

Objectives. In recent years, a growing body of literature has been calling for ethnic diversity in health systems, especially in multicultural contexts. Ethnic diversity within the health care workforce is considered to play an important role in reducing health disparities among different ethnic groups.

Methods. The present study explores the topic using quantitative data on participation of Arab employees in the Israeli health system and qualitative data collected through semi-structured interviews with Arab physicians working in the predominantly Jewish Israeli health system.

Results. We show that despite the underrepresentation of Arabs in the Israeli health system, Arab physicians who hold positions in Israeli hospitals do not perceive themselves as representatives of the Arab sector; moreover, they consider themselves as having broken through the ‘glass ceiling’ and reject stereotyping as Arab ‘niche doctors.’

Conclusions. We conclude that minority physicians may prefer to promote culturally competent health care through integration and advocacy of interaction with the different cultures represented in the population, rather than serving as representatives of their own ethnic minority population. These findings may concern various medical contexts in which issues of ethnic underrepresentation in the health system are relevant, as well as sociological contexts, especially those regarding minority populations and professions.     

Racial and ethnic differences in the relationship between antenatal stressful life events and postpartum depression among women in the United States: does provider communication on perinatal depression minimize the risk?

Objective: Multi-state population-based studies exploring the racial/ethnic differences in the prevalence and correlates of postpartum depression (PPD), which affects 10–20% of women in the US, are rare. The aim of this study was to examine the racial/ethnic disparities in the relationship between antenatal stressful life events and PPD among US women and to explore whether antenatal health care provider communication on perinatal depression was associated with a lower risk.

Methods: Data from the 2009–2011 Pregnancy Risk Assessment Monitoring System (PRAMS) were used. For each racial/ethnic group, the distribution of PPD was compared according to different levels of the stressors and socio-demographic, pre-pregnancy, antenatal, delivery, and neonatal characteristics. Multivariable logistic regression analyses were performed with PPD as the outcome and all variables that were significant in bivariate analyses as predictors.

Results: Eleven percent of 87,565 women met the criteria for PPD with the prevalence ranging from 7.9% among Asian/Pacific Islanders to 14% among American Indian/Alaska Natives. Irrespective of race/ethnicity, having many bills to pay and having more than usual arguments with husband/partner were risk factors for PPD. Among non-Hispanic black (NHB) women, having a husband/partner who did not want the pregnancy was associated with PPD (adjusted odds ratio [aOR]: 1.47; 95% confidence interval [CI]: 1.14, 1.90), and among non-Hispanic whites (NHWs), drug/drinking problems of someone close was associated with PPD (aOR: 1.37; 95% CI: 1.21, 1.55). Provider communication was inversely associated with PPD among NHWs (aOR: 0.77; 95% CI: 0.69, 0.85) and NHBs (aOR: 0.74; 95% CI: 0.60, 0.93).

Conclusion: The protective effect of provider communication on PPD suggests the benefit of a simple conversation about perinatal depression during antenatal care. Furthermore, risk factors for PPD varied by race/ethnicity suggesting that these vulnerabilities should be taken into consideration in identifying women at-risk for PPD.     

Ethnic differentials in under-five mortality in Nigeria

Objective. There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria.

Design. The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15–49 that had a total of 104,808 live births within 1993–2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI).

Results. The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37–0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55–0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64–0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05).

Conclusion. The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.     

Is channel segmentation necessary to reach a multiethnic population with weight-related health promotion? An analysis of use and perception of communication channels

Objective. To explore similarities and differences in the use and perception of communication channels to access weight-related health promotion among women in three ethnic minority groups. The ultimate aim was to determine whether similar channels might reach ethnic minority women in general or whether segmentation to ethnic groups would be required.

Design. Eight ethnically homogeneous focus groups were conducted among 48 women of Ghanaian, Antillean/Aruban, or Afro-Surinamese background living in Amsterdam. Our questions concerned which communication channels they usually used to access weight-related health advice or information about programs and whose information they most valued. The content analysis of data was performed.

Results. The participants mentioned four channels – regular and traditional health care, general or ethnically specific media, multiethnic and ethnic gatherings, and interpersonal communication with peers in the Netherlands and with people in the home country. Ghanaian women emphasized ethnically specific channels (e.g., traditional health care, Ghanaian churches). They were comfortable with these channels and trusted them. They mentioned fewer general channels – mainly limited to health care – and if discussed, negative perceptions were expressed. Antillean women mentioned the use of ethnically specific channels (e.g., communication with Antilleans in the home country) on balance with general audience-oriented channels (e.g., regular health care). Perceptions were mixed. Surinamese participants discussed, in a positive manner, the use of general audience-oriented channels, while they said they did not use traditional health care or advice from Surinam. Local language proficiency, time resided in the Netherlands, and approaches and messages received seemed to explain channel use and perception.

Conclusions. The predominant differences in channel use and perception among the ethnic groups indicate a need for channel segmentation to reach a multiethnic target group with weight-related health promotion. The study results reveal possible segmentation criteria besides ethnicity, such as local language proficiency and time since migration, worthy of further investigation.     

Inequalities in healthy life expectancy between ethnic groups in England and Wales in 2001

Objectives. We aim to develop robust estimates of disability-free life expectancy (DFLE) and healthy life expectancy (HLE) for ethnic groups in England and Wales in 2001 and to examine observed variations across ethnic groups.

Design. DFLE and HLE by age and gender for five-year age groups were computed for 16 ethnic groups by combining the 2001 Census data on ethnicity, self-reported limiting long-term illness and self-rated health using mortality by ethnic group estimated by two methods: the Standardised Illness Ratio (SIR) method and the Geographically Weighted Method (GWM).

Results. The SIR and GWM methods differed somewhat in their estimates of life expectancy (LE) at birth but produced very similar estimates of DFLE and HLE by ethnic group. For the more conservative method (GWM), the range in DFLE at birth was 10.5 years for men and 11.9 years for women, double that in LE. DFLE at birth was highest for Chinese men (64.7 years, 95% CI 64.0–65.3) and women (67.0 years, 95% CI 66.4–67.6). Over half of the ethnic minority groups (men: 10; women: 9) had significantly lower DFLE at birth than White British men (61.7 years, 95% CI 61.7–61.7) or women (64.1 years, 95% CI 64.1–64.2), mostly the Black, Asian and mixed ethnic groups. The lowest DFLE observed was for Bangladeshi men (54.3 years, 95% CI 53.7–54.8) and Pakistani women (55.1 years, 95% CI 54.8–55.4). Notable were Indian women whose LE was similar to White British women but who had 4.3 years less disability-free (95% CI 4.0–4.6).

Conclusions. Inequalities in DFLE between ethnic groups are large and exceed those in LE. Moreover, certain ethnic groups have a larger burden of disability that does not seem to be associated with shorter LE. With the increasing population of the non-White British community, it is essential to be able to identify the ethnic groups at higher risk of disability, in order to target appropriate interventions.     

Institutional racism,neighborhood factors,stress, and preterm birth

Objective. Racial/ethnic disparities in the risk of preterm birth may be explained by various factors, and previous studies are limited in examining the role of institutional racism. This study focused on the following questions: what is the association between preterm birth and institutional racism as measured by residential racial segregation (geographic separation by race) and redlining (black–white disparity in mortgage loan denial); and what is the association between preterm birth and reported stress, discrimination, and neighborhood quality.

Design. We used data from a clinic-based sample of pregnant women (n = 3462) participating in a stress and pregnancy study conducted from 1999 to 2004 in Philadelphia, PA (USA). We linked data from the 2000 US Census and Home Mortgage Disclosure Act (HMDA) data from 1999 to 2004 and developed measures of residential redlining and segregation.

Results. Among the entire population, there was an increased risk for preterm birth among women who were older, unmarried, tobacco users, higher number of previous births, high levels of experiences of everyday discrimination, owned their homes, lived in nonredlined areas, and areas with high levels of segregation measured by the isolation index. Among black women, living in a redlined area (where blacks were more likely to be denied mortgage loans compared to whites) was moderately associated with a decreased risk of preterm birth (aRR = 0.8, 95% CI: 0.6, 0.99).

Conclusion. Residential redlining as a form institutional racism and neighborhood characteristic may be important for understanding racial/ethnic disparities in pregnancy and preterm birth.     

Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women

Objective. To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.

Design. Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.

Participants. A total of 70 married Somali women aged 18–50 and mother of 2–10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.

Settings. Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.

Results. Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.

Conclusions. The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.     

Health problems,complex life,and consanguinity among ethnic minority Muslim women in Nepal

Background. Marriage between blood relatives is common among Muslim ethnic minority population in Nepal. Albeit, the adverse effects of such a consanguineous marriage on health are controversial.

Objective. To determine the prevalence, characteristics and health outcomes related to consanguineous marriage.

Design. A cross-sectional survey was carried out using a cluster sampling technique to select the respondents. A total of 400 women aged 15–49 years were interviewed from September 2011 to February 2012. A structured questionnaire was administered through face-to-face meetings. Adjusted odds ratios (AOR) were estimated by a stepwise likelihood ratio method with binary logistic regression.

Results. The overall prevalence of consanguinity was 36.7%. The median age at marriage and age at first childbirth was 15 and 18 years, respectively. The association of being in a consanguineous marriage among women whose husband's education level were secondary or higher was 3.35 (95% CI 1.56, 7.12) times greater than among those whose husbands were unable to read and write.

Woman who have consanguineous marriage were less likely to have (AOR 0.46, 95% CI 0.26, 0.82) used contraceptive than those who have non-consanguineous marriage. Women who have consanguineous marriage were more (AOR 1.80; 95% CI 0.90, 3.61) likely to have birth defect in their children than those who have non-consanguineous marriage. The association of having a history of death after live birth among women who experienced emotional violence was 2.60 (95% CI 1.36, 5.00) and physical violence 2.15 (95% CI 1.16, 3.93) times greater than among those who did not experience violence.

Conclusions. Several factors like husband's education and dowry practices are associated with consanguineous marriage. Further, these factors including consanguineous marriage and marital violence are also accountable for negative health consequences. Thus, multicomponent interventions are needed in order to improve the health condition of Nepalese Muslim community in rural area.     

Ethnic differences in tobacco use during pregnancy: findings from a primary care sample in São Paulo,Brazil

Objectives. Tobacco use during pregnancy is a global health concern. To date the majority of research originates in developed countries, thus we have a need to better understand factors related to maternal health in developing countries. We examine the prevalence and correlates of smoking by ethnicity in a sample of pregnant primary care patients in São Paulo, Brazil.

Design. Data were obtained from completed surveys during perinatal care visits in primary care clinics. We examine a sample of 811 pregnant women surveyed during 20–30 weeks of pregnancy. Multiple logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (95% CI).

Results. We found significant ethnic differences in smoking during pregnancy. Compared to White women, Black women were more likely to use tobacco during pregnancy (OR: 1.95; 95% CI: 1.16–3.27). In the fully adjusted model, when accounting for common mental disorders, differences in smoking during pregnancy by ethnicity remained (OR: 1.96; 95% CI: 1.14–3.36).

Conclusions. There are ethnic differences in tobacco use during pregnancy. Clinical implications including universal screening for tobacco use during pregnancy and culturally relevant approaches to smoking cessation are suggested.     

Cultural diversity in the Dublin maternity services: the experiences of maternity service providers when caring for ethnic minority women

Background. Ireland has seen an expansion of new migrant communities over the past decade and the country has struggled to cope with this new multi-culturalism, especially within the health services. The maternity services in particular have seen an increase in deliveries from ethnic minority women. Little research has been done exploring this issue with maternity service providers.

Methods. Using a grounded theory approach, this study sought to explore the experiences, understanding and perspectives of maternity service providers when working with ethnic minority women in the Dublin maternity services during 2002 and 2003.

Results. Four themes emerged from the study: Communication difficulties, knowledge and use of services, cultural differences and ‘Them and Us’. These encompassed a variety of issues including inadequacy of interpretation services, childcare issues, coping with labour, identification as different and racism. Ethnic minority women are expected to adapt to the system rather than the maternity services being responsive or adapting to the new multi-cultural population.

Discussion. These issues were relevant a decade ago internationally and are still pertinent today for not only Irish services but also for other European countries. There is an opportunity to improve the services for all women by learning from the experience of Dublin maternity service providers.     

Racial/ethnic disparities in self-reported short sleep duration among US-born and foreign-born adults

Objective. Racial/ethnic health disparities are infrequently considered by nativity status in the United States, although the immigrant population has practically doubled since 1990. We investigated the modifying role of nativity status (US- vs. foreign-born) on racial/ethnic disparities in short sleep duration (<7 h), which has serious health consequences.

Design. Cross-sectional data from 23,505 US-born and 4,326 foreign-born adults aged ≥ 18 years from the 2012 National Health Interview Survey and multivariable log-linear regression were used to estimate prevalence ratios (PR) for reporting short sleep duration and their corresponding 95% confidence intervals (CI).

Results. After controlling for sociodemographic covariates, short sleep was more prevalent among blacks (PR 1.29, 95% CI: 1.21-1.37), Hispanics (PR 1.18, 95% CI: 1.08, 1.29), and Asians (PR 1.37, 95% CI: 1.16-1.61) than whites among US-born adults. Short sleep was more prevalent among blacks (PR 1.71, 95% CI: 1.38, 2.13) and Asians (PR 1.23, 95% CI: 1.02, 1.47) than whites among the foreign-born.

Conclusion. Among both US- and foreign-born adults, blacks and Asians had a higher likelihood of short sleep compared to whites. US-born Hispanics, but not foreign-born Hispanics, had a higher likelihood than their white counterparts. Future research should aim to uncover mechanisms underlying these disparities.     

Culturally competent interventions in Type 2 diabetes mellitus management: an equity-oriented literature review

Objectives. Although, culturally competent (CC) interventions aim to reduce health inequalities for ethnic minorities, they have been criticized on the grounds that they increase prejudice and stereotyping. It remains unclear whether CC interventions really can reduce health inequalities among ethnic minorities. The purpose of this review is to assess whether CC interventions in the management of Type 2 diabetes mellitus (T2DM) match the recommendations to reduce health inequalities.

Design. We identified CC interventions relating to T2DM among ethnic minority patients in the literature published between 2005 and 2011. Data were analyzed according to an equity-oriented framework. Each study was given a score based on its congruence with the reduction of health inequalities amongst ethnic minorities.

Results. We reviewed 137 papers and found 61 studies that met the inclusion criteria. Most interventions focused on the individual level and the modification of patients' health behavior. Very few addressed the sociopolitical level. A minority of the studies acknowledged the role of socioeconomic deprivation in ethnic health inequalities. Half of the studies contained no information about the socioeconomic status of the patients. The patients receiving the interventions were socioeconomically deprived. Only 10 studies compared ethnic minority groups to majority groups. Thirty-three studies had a very low average congruence score. The highest score of congruence was achieved by one study.

Conclusion. Overall, CC interventions addressing T2DM are not congruent with the reduction of ethnic health inequalities. The future of CC interventions may involve going one step further and going back to basic tenets of cultural competence: the integration of difference, whatever its source, into the delivery of fair health care for patients.     

Patient–physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence

Objectives. To examine the associations between racial/ethnic concordance and blood pressure (BP) control, and to determine whether patient trust and medication adherence mediate these associations.

Design. Cross-sectional study of 723 hypertensive African-American and white patients receiving care from 205 white and African-American providers at 119 primary care clinics, from 2001 to 2005. Racial/ethnic concordance was characterized as dyads where both the patient and physician were of the same race/ethnicity; discordance occurred in dyads where the patient was African-American and the physician was white. Patient perceptions of trust and medication adherence were assessed with self-report measures. The BP readings were abstracted from patients' medical charts using standardized procedures.

Results. Six hundred thirty-seven patients were in race/ethnic-concordant relationships; 86 were in race/ethnic-discordant relationships. Concordance had no association with BP control. White patients in race/ethnic-concordant relationships were more likely to report better adherence than African-American patients in race/ethnic-discordant relationships (OR: 1.27, 95% CI: 1.01, 1.61, p = 0.04). Little difference in adherence was found for African-American patients in race/ethnic-concordant vs. discordant relationships. Increasing trust was associated with significantly better adherence (OR: 1.17, 95% CI: 1.04, 1.31, p < 0.01) and a trend toward better BP control among all patients (OR: 1.26, 95% CI: 0.97, 1.63, p = 0.07).

Conclusions. Patient trust may influence medication adherence and BP control regardless of patient–physician racial/ethnic composition.     

Pap smear receipt among Vietnamese immigrants: the importance of health care factors

Objective. Recent US data indicate that women of Vietnamese descent have higher cervical cancer incidence rates than women of any other race/ethnicity, and lower levels of Pap testing than white, black, and Latina women. Our objective was to provide information about Pap testing barriers and facilitators that could be used to develop cervical cancer control intervention programs for Vietnamese American women.

Design. We conducted a cross-sectional, community-based survey of Vietnamese immigrants. Our study was conducted in metropolitan Seattle, Washington, DC. A total of 1532 Vietnamese American women participated in the study. Demographic, health care, and knowledge/belief items associated with previous cervical cancer screening participation (ever screened and screened according to interval screening guidelines) were examined.

Results. Eighty-one percentage of the respondents had been screened for cervical cancer in the previous three years. Recent Pap testing was strongly associated (p<0.001) with having a regular doctor, having a physical in the last year, previous physician recommendation for testing, and having asked a physician for testing. Women whose regular doctor was a Vietnamese man were no more likely to have received a recent Pap smear than those with no regular doctor.

Conclusion. Our findings indicate that cervical cancer screening disparities between Vietnamese and other racial/ethnic groups are decreasing. Efforts to further increase Pap smear receipt in Vietnamese American communities should enable women without a source of health care to find a regular provider. Additionally, intervention programs should improve patient–provider communication by encouraging health care providers (especially male Vietnamese physicians serving women living in ethnic enclaves) to recommend Pap testing, as well as by empowering Vietnamese women to specifically ask their physicians for Pap testing.     

Ethnic minority women's experience of maternity services in England

Objectives. Provision for ethnic minority groups has been acknowledged as integral to good maternity care in England and ethnicity has been highlighted as an indicator of both poorer clinical outcomes and poorer experiences. Improving outcomes and services is dependent on understanding women's interaction with both service delivery and provision. The aim of this study was to explore Black and minority ethnic (BME) women's experiences of contemporary maternity care in England.

Design. A UK-wide survey which investigated core aspects of maternity care sought the views of BME women about their experiences. A random sample of women were selected by the Office for National Statistics from birth registration in England and invited to complete a questionnaire three months after the birth. In a secondary analysis, text responses to open-ended questions about their maternity care were analysed using thematic analysis.

Results. Sixty per cent of the 368 women who self-identified as BME responded with open text. Themes that emerged related to ‘feeling cared for,’ with subthemes of ‘expectations of care’ and ‘policies, rules and organisational pressures’; ‘staff attitudes and communication’ with sub-themes of ‘please believe me,’ ‘hospital as a safe place,’ ‘choices denied’ and ‘being sensitive and supportive would help,’ and ‘ethnicity and culture’ with sub-themes of ‘stereotyping’ and ‘improving the quality of care.’

Conclusion. The findings highlight issues affecting the quality of maternity care that BME women in England receive. Many issues are not unique to BME women; however, the findings reflect some seemingly enduring issues and coherence with other wider international findings, particularly in relation to post-natal care and staff attitudes. Actually being cared for and supported across their child-bearing experience are needs that women themselves identified as critical for care providers to recognise and respond to. The failures of care provision described should inform the development of services.