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A Mixed-Methods Study of Immigrant Somali Women's Health Literacy and Perinatal Experiences in Maine.

INTRODUCTION
Research on health care provided to clients with limited English proficiency in the United States has revealed poor satisfaction and increased use of the health care system. This mixed-methods study explored health literacy and the perinatal experiences of Somali and Somali Bantu women living in Lewiston, Maine. The study also describes the development and validation of historietas (comic-book style health education brochure) used to increase knowledge and awareness of why emergency cesareans may be required and the symptoms of postpartum depression (PPD).


METHODS
During phase 1, a focus group to discuss the perinatal experiences of Somali women (n = 4) was undertaken and 2 historietas were developed to create greater understanding of emergency cesareans and PPD. In phase 2, Somali and Somali Bantu women (n = 19) completed a health literacy questionnaire and a perinatal experiences questionnaire. A focus group was also conducted during phase 2 to determine the perinatal experiences of the participants. Phase 2 participants validated the historietas developed in phase 1. Responses from focus groups were triangulated with data from the perinatal experiences questionnaire completed during phase 2.


RESULTS
Overall, none of the phase 2 participants demonstrated adequate health literacy. Problems with gudnin (Somali word for cutting) related to female genital mutilation/cutting and PPD yielded statistically significant results. Somali women expressed dissatisfaction with certain obstetric interventions, especially emergency cesareans. Phase 2 participants unanimously validated the usefulness of the historietas as a clinical teaching tool.


DISCUSSION
Poor health literacy due to language barriers may place Somali women living in the United States at risk for adverse outcomes during pregnancy and/or birth. Complications related to emergency cesareans and PPD were identified as significant problems for which Somali women require further knowledge. Historietas addressing knowledge gaps related to emergency cesareans and symptoms of PPD were validated by participants as useful teaching tools.