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Family Planning Services for Iowans from Diverse Cultures
Although some behaviors may be more characteristic of one ethnic group than another, behaviors that result from certain systems of belief often cross racial and ethnic boundaries. For this reason, these behaviors -- rather than the practices of specific ethnic groups - should be the focus. With that in mind, here are some suggestions that were found to be successful at Allen Women's Health Center. Recognize and learn about cultural differences among the people you serve. Then make changes in your practices that reflect what you have learned. Include qualified individuals on your staff who come from the cultures of the people you serve. This can raise the comfort level of people who come to you for care, for they will often view staff members from their own background as more approachable and empathetic. Family dynamics vary greatly from one culture to the next. In a number of cultures, the male head of household makes the decisions for the family. (Latinos, for example, refer to this as being "macho.") He may also expect to be present for the medical examinations of family members. Often, he will be the one to answer your questions. In these families, if the male is not present at a family planning exam, decisions about birth control or other family planning concerns may be delayed. So, you will want to include him for part of the exam, but also create an opportunity to talk with the woman alone, so that you can learn more about her personal concerns and beliefs. Contraception is a sensitive topic, even within a family. In some cases, visible or immediate birth control methods may not be acceptable. Other, more long-term methods, such as an intrauterine device or contraceptive injection, may be more satisfactory. For some people voluntary termination of pregnancy is preferred to contraception. In situations like this, talk with the individual to understand the belief system, and work within it to offer a variety of options. Punctuality does not have the same significance or value from one culture to the next. People sometimes feel it is acceptable to be late for appointments. Your scheduling may need to be more flexible. You may find that some patients are more likely to be on time for mid- to late afternoon appointments. People may also be better able to cancel an appointment they can't keep if that appointment occurs later in the day. Interpreter services Access to interpreters is becoming more essential in Iowa as our communities experience an influx of families who don't speak English. Many health care providers find they need to have an interpreter on staff or on call. Interpreters who are seen as part of the staff can facilitate assessment, treatment, and education. If a staff interpreter is not an option, a family member, such as an aunt or mother, may be able to translate. Children should not be asked to serve as interpreters. In many cultures reproductive issues are not discussed with the opposite sex, so for these women you will need to consider female interpreters for family planning. If no interpreter is available, you may need to reschedule the appointment for a time when an interpreter is on hand. Each patient should sign a consent form giving permission for the interpreter to be present. This, and all other medical consent forms, should be in the language of the person who signs them. The interpreter should sign each medical chart to indicate that interpretation was provided for the patient. Dialects within a language often vary, so speaking a language may not qualify a person to serve as an interpreter for all others who speak that language. An informal way to assess the skill of an interpreter is to ask the person to translate into English a document, written in their language, whose content is familiar to you. Local foreign language teachers or other multilingual people in your community may be willing to help you develop some simple tools to assess an interpreter's skills. These same multilingual resource people may be willing to translate the consent forms as well. The Division of Latino Affairs of the Iowa Department of Human Rights is currently developing a certification process for interpreters, but this is not yet available. Written material Communication cards are one way you can begin to bridge the language gap. Created with the help of an interpreter, each card has a specific question in the language of your patient, along with "yes" and "no" responses. Ask the patient the question, show them the card, and have them point to the appropriate response. Use these cards, for example, to assess previous methods of birth control. Similar cards can be prepared for other purposes, such as intake, billing, and laboratory services. To see sample cards in Bosnian, contact the Iowa Healthy Families line at 800-369-2229 (voice) or 800-735-2942 (TTY). Signage in the office should give directions in the languages used by your patients. Educational materials should be available in an individual's first language, even if the person speaks English. This is especially important in the area of preventive health care. Individuals often fail to comply with recommendations because they lack a clear explanation of why something is recommended. One source of printed materials in Spanish and 11 other languages is the online Ethnic Health Resource Center. A resource for creating health care materials is the University of Iowa Translation Laboratory. For more information about both of these services, see "Resources," below. Collaboration with other "credible voices" in your community, such as faith-based organizations, ethnic retailers and other merchants, and other culturally based groups can improve your ability to serve the diverse families. Resources Family planning, women's health: Your local Maternal Health Center, family planning agency, or call 1-800-383-3826. Latino information and interpreters of Spanish: Latino Affairs, Iowa Department of Public Health, 515-281-4080. Multicultural healthcare:
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