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Heath Care Providers' Perceptions of the Reproductive Challenges And San Jose State University SJSU ScholarWorks Doctoral Projects Master's Theses and Graduate Research Spring 5-1-2015 Heath Care Providers’ Perceptions of the Reproductive Challenges and Experiences among Asian Indian Women Living in Silicon Valley Olga Alexandra Libova Northern California Consortium, Doctor of Nursing Practice Program, California State University, Fresno and San José State University Follow this and additional works at: https://scholarworks.sjsu.edu/etd_doctoral Part of the Maternal, Child Health and Neonatal Nursing Commons, and the Nursing Midwifery Commons Recommended Citation Libova, Olga Alexandra, "Heath Care Providers’ Perceptions of the Reproductive Challenges and Experiences among Asian Indian Women Living in Silicon Valley" (2015). Doctoral Projects. 6. DOI: https://doi.org/10.31979/etd.5nn2-r6ap https://scholarworks.sjsu.edu/etd_doctoral/6 This Doctoral Project is brought to you for free and open access by the Master's Theses and Graduate Research at SJSU ScholarWorks. It has been accepted for inclusion in Doctoral Projects by an authorized administrator of SJSU ScholarWorks. For more information, please contact [email protected]. HEATH CARE PROVIDERS’ PERCEPTIONS OF THE REPRODUCTIVE CHALLENGES AND EXPERIENCES AMONG ASIAN INDIAN WOMEN LIVING IN SILICON VALLEY by Olga Alexandra Libova A doctoral project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice in the California State University, Northern California Consortium, Doctor of Nursing Practice Program, California State University, Fresno April 2015 ABSTRACT HEATH CARE PROVIDERS’ PERCEPTIONS OF THE REPRODUCTIVE CHALLENGES AND EXPERIENCES AMONG ASIAN INDIAN WOMEN LIVING IN SILICON VALLEY Objective: To identify common reproductive challenges among Asian Indian (AI) women living in Silicon Valley as perceived by healthcare providers (HCP). Design: A 71-item investigator-developed survey Setting: The survey was available on-line to all HCPs in California Santa Clara county, 75% of respondents were affiliated with El Camino Hospital Mountain View. Participants: Convenience sample of 78 respondents: 34% mother-baby nurses, 24% labor-delivery nurses, 21% OB/GYNs, 7% CNMs, 14% other HCP; 89% female; 55% Caucasian, 24% Asian. Methods: Likert-type scales comparing prevalence of certain reproductive challenges among AI women and women from other race-ethnic groups and open- ended questions regarding HCPs’ experience caring for AI women. Results: AI women seeking reproductive services in Silicon Valley are more likely than women from other race ethnic groups to experience unconsummated marriages, vaginismus, and difficulty tolerating pelvic exams. They are also more likely to lack of knowledge about sex and reproduction. AI women exhibited increased anxiety around pregnancy, birth, breastfeeding, newborn care, as well as reluctance to enroll in classes or prepare a birth plan. Nurses found clients’ lack of understanding of the training and function of the nurses in the United States, as well as AI patients’ families’ large role decision- making, to be obstacles to establishing therapeutic relationship with AI patients. Conclusion: HCPs need to be aware of prevalence of vaginismus in AI women. Culturally competent prenatal classes addressing identified reproductive challenges of AI women need to be developed and expectant parents and family members need to be encouraged to participate. HCPs need to be educated on culturally competent care to AI patients. AUTHORIZATION FOR REPRODUCTION OF DISSERTATION X I grant permission for the reproduction of this thesis in part or in its entirety without further authorization from me, on the condition that the person or agency requesting reproduction absorbs the cost and provides proper acknowledgment of authorship. Permission to reproduce this thesis in part or in its entirety must be obtained from me. Signature of thesis author: DEDICATION This dissertation is dedicated to my parents Dr. Lucy Libova and Dr. Alexander Leyzerovich, who were working on their dissertations all through my childhood and instilled the belief that a dissertation is just something that you do at some point of your life. They supported me and took care of my kids through my journey from an engineer to a DNP-prepared midwife and nursing faculty, trusting me to make the right decisions for myself and my family. ACKNOWLEDGMENTS First, I would like to thank my family, especially my daughter Ari, my biggest cheerleader, for their support and encouragement during this long journey. I would like to thank my program advisor Ruth Rosenblum, DNP, my project chair Deepika Goyal, PhD and my doctoral committee members Mary Buxton, LCSW and Ken Weber, MD for their guidance and support. I would like to thank my colleagues who answered the survey and provided me with valuable information for this research. TABLE OF CONTENTS Page LIST OF TABLES ................................................................................................. vii! CHAPTER 1: INTRODUCTION ......................................................................... 1! Population of Interest ........................................................................................ 3! Setting ............................................................................................................... 5! Problem Statement ............................................................................................ 6! CHAPTER 2: LITERATURE REVIEW ................................................................. 8! Asian Indian Women: Experiences of Health Care Providers .......................... 8! Asian Indian Women: Marital and Sexual Relationships ............................... 11! Asian Indian Women: Pregnancy, Birth, and Breastfeeding .......................... 15! Theoretical Framework ................................................................................... 21! CHAPTER 3: METHODOLOGY ......................................................................... 23! Sample and Setting ......................................................................................... 23! Measures ......................................................................................................... 23! Data Collection Procedure .............................................................................. 24! Data Analysis .................................................................................................. 25! CHAPTER 4: RESULTS ....................................................................................... 27! Research Question 1: Description of AI Patients in Silicon Valley ............... 29! Research Question 2: Prevalence of Certain Challenges and Experiences in AI Women Compared to Women from Other Race-Ethnic Groups .................................................................................................. 30! Research Question 3: What are Specific Challenges for Healthcare Professionals Caring for Asian Indian Women in a Reproductive/Perinatal Setting. ........................................................... 43! CHAPTER 5: DISCUSSION AND CONCLUSION ............................................ 48! Perception of Asian Indian patients and their families ................................... 48! vi vi Page Vaginismus and Unconsummated Marriage ................................................... 48! Prenatal Education .......................................................................................... 49! The Role of the Nurse ..................................................................................... 51! CONCLUSION ............................................................................................... 52! REFERENCES ....................................................................................................... 54! APPENDICES ........................................................................................................ 62! APPENDIX A: INVITATION TO PARTICIPATE IN THE STUDY ................. 63! APPENDIX B: PROVIDER SURVEY ................................................................. 66! LIST OF TABLES Table 1: Sample Characteristics (N=76) ................................................................ 37 Table 2. Percentage of AI Patients in Respondents’ Practice ................................ 39 Table 3. Distribution of Answers to Four Sections by Professional Role. ............ 39 Table 4. Most Significant Trends in Likert-scale Questions .................................. 40 REPRODUCTIVE CHALLENGES OF ASIAN INDIAN WOMEN CHAPTER 1: INTRODUCTION In a 2001 report, “Crossing the Quality Chasm,” the Institute of Medicine identified patient-centered care as one of the six core needs of the U. S. healthcare system. Initiatives to promote patient-centered care focus on improving the relationship between patients and health care providers (HCPs) and making the healthcare system more responsive to patients’ needs and preferences. To deliver individualized patient-centered care, a provider must be aware and respectful of the diversity of patients’ perspectives. In 2002, the Institute of Medicine emphasized the importance of cultivating cultural competence among healthcare providers in order to eliminate racial/ethnic disparities in healthcare. Beach, Saha, and Cooper (2006) concluded that cultural competence enhances the ability of health care systems and providers to address individual patients’ preferences and goals, and Campinha-Bacote (2011) suggested that
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