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Health Care for Women International Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uhcw20
Beliefs, practices, and experiences of Korean women in relation to childbirth a
Kee‐Joung Yoo Park RN, MS & Leona M. Peterson RN, PhD a
b
University of Illinois Hospital ,
b
College of Nursing , University of Illinois , Chicago Published online: 14 Aug 2009.
To cite this article: Kee‐Joung Yoo Park RN, MS & Leona M. Peterson RN, PhD (1991) Beliefs, practices, and experiences of Korean women in relation to childbirth, Health Care for Women International, 12:2, 261-269, DOI: 10.1080/07399339109515946 To link to this article: http://dx.doi.org/10.1080/07399339109515946
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
BELIEFS, PRACTICES, AND EXPERIENCES OF KOREAN WOMEN IN RELATION TO CHILDBIRTH Kee-Joung Yoo Park, RN, MS University of Illinois Hospital
Leona M. Peterson, RN, PhD
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College of Nursing, University of Illinois at Chicago
Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.
Our purpose in conducting the present study was to describe Korean women's health beliefs, practices, and experiences and to derive practical suggestions for their health care. Koreans are a rapidly increasing immigrant group in the United States. In 1980, the Korean population in the United States numbered 354,529 (U.S. Department of Commerce,
We thank Professors Alice J. Dan, PhD, and Beverly J. McElmurry, RN, EdD, FAAN, for their assistance and valuable suggestions for this project. Health Care for Women International, 12:261-269, 1991 Copyright © 1991 by Hemisphere Publishing Corporation
261
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K.-J. Y. Park and L. M. Peterson
1981). In 1987, the Korean population in the metropolitan Chicago area alone was estimated at 60,000 (Hurh & Kim, 1987). An understanding of a client's health beliefs and practices enhances health-care professionals' decisions. In the care of Korean women, this sensitivity can foster ethnic identity, cultural practices, and assessments and interventions appropriate to the Korean culture, and it can affect an entire family's health care. There has been little research of Korean women as health-care clients despite the continuing immigration. Several sociological reports about Korean immigrant women were found in a study by Yu and Philips (1987). Urn (1987) conducted a study with Korean women of all ages in Chicago to identify perceptions of health problems and barriers to health care. In our study, 20 volunteer Korean women were recruited through notices posted at the Korean Self-Help Center. All potential participants were assured the interview could be terminated if they wished, and written consent of participants was obtained. A descriptive method was used with specific objectives and structured questions in interview questionnaire format (Parse, Coyne, & Smith, 1985). A structured interview guide, adapted from Al-Darazi's (1984) guide used with women in Bahrain, provided the framework. Probe items were introduced as needed after structured items were used. All interviews were conducted in Korean and audiotaped. Transcripts were typed and translated into English. Eleven women were interviewed in a private room at the center, and 9 were interviewed in their homes. All responses to a given item were listed and analyzed before moving to the next item. Each response was examined for content and meaning. Naturally occurring categories were formed as responses to an item were compared. After all categories had been formed for an item by Park, all responses were reviewed by Peterson for their fit in the category. Recurrent themes emerged as analysis progressed through the interview items. Demographic data for the 20 participants are summarized in Table 1. Interviewees' ages ranged from 26 to 32 years, with a mean age of 30 years. The number of people living in a household ranged from 3 to 6, with a mean of 3.8. All the women had had their last childbirth at a U.S. hospital. The mean number of months since the last childbirth was 27.8, with a range of 3 to 50 months. The women had been in the United States from 13 to 121 months (1 to 10 years), with a mean of 40.8 months (3.3 years). Caution must be used in generalizing the findings from this study to the entire population of Korean immigrants because of the small sample size and the nonrandom sampling procedure. However, there is no rea-
Korean Women's Childbirth Needs
263
Table 1. Demographic Data (N «= 20)
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Characteristic Highest education 9th grade High school 2 to 4 years college Graduate school Employment Full time or part time Unemployed Religion Protestant Catholic None Annual household income . < $ 10,000 $10,000-519,999 $20,000-$29,999 $30,000-539,999
n
1 8 9 2
5 40 45 10
9 11
45 55
15 3 2
75 15 10
5 7 4 4
25 35 20 20
.
son to believe our subjects' childbirth experiences were any different from those of other newly immigrated young Korean women living in a large metropolitan area. FINDINGS Health Beliefs All the interviews perceived health as positive, necessary, and pertinent to both body and mind. This view is close to the origin of the word health, or wholeness (Keller, 1981). It contrasts with a biological orientation and indicates that these women held a holistic view of individuals. Only half of the women rated their level of health as average or good. The other half described various problems, including emotional problems, bad colds, fatigue, rheumatoid arthritis, uteral disease, and oldage-related tuberculosis and poliomyelitis. There was a consensus that women's health worsens as they grow older. The causality of health was attributed to physical, psychological, and spiritual factors. The physical factors listed by the women included regular life-style, nourishment, good environment, and good health practices; the psychological factors included sound thinking, lack of stress,
264
K.-J. Y. Park and L. M. Peterson
successful stress management, and family harmony. Faith in God played a role in 45 percent of the women's beliefs about cause of health. An illness was perceived as something impeding ability to socialize or attend to activities of daily living. Most often (80%), the women referred to an impaired emotional state. Illness was perceived to be caused by factors such as worry and stress, eating an unbalanced diet, and overwork. Their beliefs about the cause of illness were comprehensive, with no folk causes of illness held by the women.
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Health Practices The interview guide elicited practices regarding Pap tests and breast self-examination. Only 1 woman regularly had a Pap test and did regular breast self-examination. All of the women attended prenatal care clinics. Eighteen took prescribed vitamin, iron, and calcium pills and reported eating well. Six of the 20 stated they could not drink milk. All of the women reported reading about child care and about educating children. They adopted some practices for the benefit of the fetus: listening to music, praying, refraining from watching terror films, keeping "peace of mind," talking to the fetus, and eating nicely decorated or perfectly shaped foods. All of the women did at least one of these. Sixteen of the women rested for 30 days after giving birth. The other 4 were unable to rest because of the unavailability of help. Rest and restriction of activity were reported to be encouraged in the culture and provided reason to hire household help. All of the women reported eating brown seaweed soup for about 20 days after childbirth. This food was highly valued by the women. They said their relatives encouraged their eating this because of the belief that it cleanses the blood and increases milk production. Families bringing this food into the hospital had created several disconcerting situations for the women and their families. They were not encouraged in this nor assisted in warming the soup by health-care providers. Seven had no bath or shower until 7 to 14 days after childbirth. Some women did not even touch cold water. The practice of avoiding cold also meant not eating refrigerated foods. Chicken or eggs were not considered desirable food. Five of the women took tonic herbs during the puerperium. Their purposes were to promote healing and health, relieve aching arms and legs, and stop dizziness. The cost of the herbal medicine from an herbal center was about $60 to $80 for a 10-day supply; some women spent $300 to $400. The rate of breast-feeding was 60%, slightly higher than the 51%
Korean Women's Childbirth Needs
265
reported as the U.S. in-hospital breast-feeding rate (Martinez & Nalenzienski, 1979). However, the women were unable to sustain breastfeeding (M = 38 days). They stated pumping breast milk was not feasible at work. Eight fed room-temperature or cold formula to their infants. Thirteen gave a sponge bath to the baby. Four gave a tub bath while the umbilical stump was still present because of misunderstanding classes held in English.
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Health-Care Experiences The women compared their health-care experiences in the United States and in Korea and questioned discrepancies. They expressed dissatisfaction because of a lack of English fluency and perceived a need to uphold a Confucian moral code that directed them to be nonassertive. Thus, they reported not asking for assistance when they needed it. Eighteen stated they had a language problem at the hospital. They were unable to describe their symptoms well, ask for what they wanted, or understand what was said to them. Nowhere was this more evident than in choosing the daily menu. The women reported they circled only the foods they recognized on the menu. One woman's husband, who could have given support and served as translator, was barred from the delivery room. DISCUSSION Beliefs The finding that only half of these women rated their health as average or good is related to their beliefs that health includes emotional health, not physical health alone. Life stresses were high in this population. Immigration is known as a stressful sociopsychological process of uprooting from the familiar, adjustment to the unfamiliar, and either accommodation of the two for creating a new synthesis or perpetual marginalization from the two (Turner, 1977). Living in an ethnic neighborhood did not alleviate stress in this sample. In addition to the stresses of immigration, this population was subject to the stresses of pregnancy and attainment of the maternal role (Lederman, Lederman, Work, & McCann, 1978). Stresses reported by this Korean population are similar in content to those of the Filipino women studied by Stern, Tilden, and Maxwell (1986). A system of neighborhood centers is needed as part of the greater health-care system. Korean health-care providers can introduce relaxa-
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tion methods and enable group discussions about problems of living as immigrants and as pregnant women. These discussions can ease stresses through increasing practical knowledge about their neighborhood and health-care services.
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Practices Only 1 person reported regular preventive health practices in this study. These findings indicate a need to increase teaching about preventive health-care practices among the younger age group of women and to make preventive therapies available. Health-care providers need to work with the natural leaders of the community to set forth a program of education. Practices during pregnancy indicated a high need for teaching about the use of dairy products other than milk, such as cheese and yogurt. The practices adopted for the benefit of the fetus follow Taekyo, traditional prenatal health care. Cho (1987), in her extensive study, also identified these practices among Korean women. She found that the traditional customs of Taekyo had been modernized in both diet and behavior. Rest during puerperium is a common practice in other cultures such as Chinese, Filipino, and Mexican cultures (Affonso, 1981; Kay, 1978; Rose, 1978). Self-care actions can be an affront to health professionals; however, Woolery (1983) stated the need for health professionals to recognize that the pregnant woman has a responsibility for decision making about self-care actions. Conflict between the self-care agent and the health professional was labeled "self-care paradox" by Stern and Harris (1986). Stern and Harris described four paradigms by which to test self-care in practice. They suggested that both cultural elasticity and showing respect are needed to overcome such conflict. Left without appropriate intervention, these conflicts can result in the client's withdrawal from the health-care situation. The practice of eating brown seaweed soup is recorded in the literature (Chung, 1977). Health-care providers' understanding of the importance of this food to entire families and provision of means by which to heat the soup would remove one of the most negative experiences of hospitalization shared by Korean women. Providing small cups for warming in a microwave oven would obviate this problem. Nurses who understand the practice of avoiding cold can ask a woman's preference because differences exist among individuals within the same culture. A warm sponge bath can be suggested in place of a shower if a woman believes showers are too cold. The water pitcher can be filled with lukewarm water instead of ice water.
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Anticipatory guidance sessions in which the women practice asking for help with their diet orders, asking for lukewarm water in their pitchers, asking that the soup be heated, and asking that they be allowed to take warm sponge baths would prepare them for hospitalization with confidence. The practice of using tonic herbs may be potentially harmful. Dual use of Western medicine and folk medicine is found in the Korean culture as it is in the Bahamian, Haitian, Puerto Rican, Cuban, and southern U.S. black cultures (Scott, 1974). Because herbal prescriptions may contain the same chemical ingredients as used in Western medicine, use of both herbal prescriptions and Western medicine may result in overdose or adverse reactions. Health-care providers should ask specifically about herbal medicines, separately from questioning about Western prescriptions, in order to have full information. Because all the women desired to prolong the duration of breastfeeding, this is a group of women who need education about pumping and freezing milk for storage. Working mothers must be identified during pregnancy so they can be taught techniques before delivery for safely storing their, milk. The absence of question-asking behavior and the lack of stating what is wanted in the hospital, whether a result of low assertiveness or poor English fluency, require that health-care professionals inquire explicitly regarding needs and do so frequently enough that the women recognize an accepting environment for questions and needs. These women can easily spend an entire hospitalization without the normal conversational teaching that fluent English speakers receive. Experiences The possibility of not having a husband for support during delivery can create even more anxiety for these women, because a husband also can assist with interpretation, thereby decreasing language problems. The profound language problem among Koreans has been well documented in the literature for many years (Hurh & Kim, 1984, 1987; Hurh, Kim, & Kim, 1976; Kim, 1975; Um, 1986). This problem is related to an emphasis in Korea on written, not oral, use of English. Despite the documentation many years ago, health-care services did not provide adaptations to help alleviate the problem for this sample of women. Limited language ability results in limited information and limited access to health care for Korean women. In conclusion, variations exist among individual Korean women as among persons of any culture. Therefore, health-care providers need to assess each client individually before deciding on a given plan of care. The following specific educationally related recommendations seem im-
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portant in view of the numbers of problems reported: (a) Korean healthcare providers can develop pamphlets in Korean about the U.S. healthcare delivery system and community health programs, (b) A bilingual pamphlet of medical terms is needed, (c) Health-care professionals should speak slowly in clear, simple sentences and show patience in listening, (d) Health-care professionals should visit patients often to give an increased opportunity to ask for assistance and ensure understanding of instructions, (e) An interpreter's help is needed, and the women's families can help in this, (f) Finally, health-care providers must explain about the foods on a menu, and short food dictionaries could be distributed. Women interviewed were appreciative of any time taken with them by professionals. Their own desire to do exactly as health-care providers ask can result in excellent health practices for them and their families, providing they have sufficient help in surmounting the language barrier. Health-care professionals must work with community leaders to facilitate group meetings about the health-care system. Finally, immigration is an important process in the United States, and the health-care system itself must be fashioned for access, with simpler, understandable guidelines. REFERENCES Affonso, D. D. (1981). The Philipino American. In A. L. Clark (Ed.), Culture: Childbearing health professional (pp. 129-153). Philadelphia: Davis. AI-Darazi, F. A. (1984). Health and illness cognition among Bahraini women. Unpublished master's thesis, University of Illinois at Chicago. Cho, D. S. (1987). A study on the Taekyo behavior of women who had given birth and the health professional's perception of Taekyo. Unpublished doctoral dissertation. Yonsei University, Seoul, Korea. Chung, H. L. (1977). Understanding the Oriental maternity patient. Nursing Clinics of North America, 12(1), 67-75. Hurh, W. M., & Kim, K. C. (1984). Korean immigrants in America: A structural analysis of ethnic confinement and adhesive adaptation. Cranbury, NJ: Fairleigh Dickinson University Press. Hurh, W. M., & Kim, K. C. (1987). Korean immigrants in the Chicago area: A sociological study of immigration and mental health (interim descriptive report for the National Institute of Mental Health). Hurh, W. M., Kim, H. C., & Kim, K. C. (1976). Cultural and social adjustment patterns of immigrants in the United States: A case study of Korean residents in the Chicago area. Unpublished manuscript, Illinois University, Macomb, Department of Sociology and Anthropology. Kay, M. A. (1978). The Mexican-American. In A. L. Clark (Ed.), Culture: Childbearing health professional (pp. 89-108). Philadelphia: Davis.
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Keller, M. J. (1981). Toward a definition of health. Advances in Nursing Science, 4(1), 43-52. Kim, B. L. C. (1975). Study of Asian Americans in Chicago: Their socioeconomic characteristics, problems, and service needs. Unpublished master's thesis, University of Illinois, Urbana. Lederman, R., Lederman, E., Work, B., & McCann, D. (1978). Relationship of psychological factors in pregnancy to progress in labor. Nursing Research, 28, 94-97. Martinez, G. A., & Nalenzienski, J. P. (1979). The recent trend in breastfeeding. Pediatrics, 64, 686-692. Parse, R., Coyne, A., & Smith, M. (1985). Nursing research qualitative methods (pp. 3-8). Bowie, MD: Brady. Rose, P. A. (1978). The Chinese American. In A. L. Clark (Ed.), Culture: Childbearing health professional (pp. 55-63). Philadelphia: Davis. Scott, C. (1974). Health and healing practices among five ethnic groups in Miami, Florida. Public Health Report, 89, 524-532. Stem, P., & Harris, C. C. (1986). Women's health and self-care paradox: A model to guide self-care readiness. In P. N. Stern (Ed.), Women, health, and culture (pp. 151-163). Washington, DC: Hemisphere. Stern, P., Tilden, V., & Maxwell, E. (1986). Culturally induced stress during childbearing: The Philipino-American experience. In P. N. Stern (Ed.), Women, health, culture (pp. 105-121). Washington, DC: Hemisphere. Turner, V. (1977). Dramas, fields, and metaphors. Ithaca, NY: Cornell University Press. Um, C. C. (1986). Perception of health problems and barriers of a selected Korean population. Unpublished master's thesis, University of Illinois at Chicago. Um, C. C. (1987). Perception of health problems and barriers for Korean married women in Albany Park. Unpublished manuscript. U.S. Department of Commerce. (1981). 7950 Census of population (Supplementary Rep. No. PC 80-S1-3). Washington, DC: U.S. Government Printing Office. Woolery, L. (1983). Self-care for the obstetrical patients—A nursing framework. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 12, 33-37. Yu, E. Y., & Philips, E. H. (Eds.). (1987). Korean women in transition: At home and abroad. Los Angeles: California State University, Center for Korean-American and Korean Studies.
Health Care for Women International Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uhcw20
Beliefs, practices, and experiences of Korean women in relation to childbirth a
Kee‐Joung Yoo Park RN, MS & Leona M. Peterson RN, PhD a
b
University of Illinois Hospital ,
b
College of Nursing , University of Illinois , Chicago Published online: 14 Aug 2009.
To cite this article: Kee‐Joung Yoo Park RN, MS & Leona M. Peterson RN, PhD (1991) Beliefs, practices, and experiences of Korean women in relation to childbirth, Health Care for Women International, 12:2, 261-269, DOI: 10.1080/07399339109515946 To link to this article: http://dx.doi.org/10.1080/07399339109515946
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
BELIEFS, PRACTICES, AND EXPERIENCES OF KOREAN WOMEN IN RELATION TO CHILDBIRTH Kee-Joung Yoo Park, RN, MS University of Illinois Hospital
Leona M. Peterson, RN, PhD
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College of Nursing, University of Illinois at Chicago
Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.
Our purpose in conducting the present study was to describe Korean women's health beliefs, practices, and experiences and to derive practical suggestions for their health care. Koreans are a rapidly increasing immigrant group in the United States. In 1980, the Korean population in the United States numbered 354,529 (U.S. Department of Commerce,
We thank Professors Alice J. Dan, PhD, and Beverly J. McElmurry, RN, EdD, FAAN, for their assistance and valuable suggestions for this project. Health Care for Women International, 12:261-269, 1991 Copyright © 1991 by Hemisphere Publishing Corporation
261
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K.-J. Y. Park and L. M. Peterson
1981). In 1987, the Korean population in the metropolitan Chicago area alone was estimated at 60,000 (Hurh & Kim, 1987). An understanding of a client's health beliefs and practices enhances health-care professionals' decisions. In the care of Korean women, this sensitivity can foster ethnic identity, cultural practices, and assessments and interventions appropriate to the Korean culture, and it can affect an entire family's health care. There has been little research of Korean women as health-care clients despite the continuing immigration. Several sociological reports about Korean immigrant women were found in a study by Yu and Philips (1987). Urn (1987) conducted a study with Korean women of all ages in Chicago to identify perceptions of health problems and barriers to health care. In our study, 20 volunteer Korean women were recruited through notices posted at the Korean Self-Help Center. All potential participants were assured the interview could be terminated if they wished, and written consent of participants was obtained. A descriptive method was used with specific objectives and structured questions in interview questionnaire format (Parse, Coyne, & Smith, 1985). A structured interview guide, adapted from Al-Darazi's (1984) guide used with women in Bahrain, provided the framework. Probe items were introduced as needed after structured items were used. All interviews were conducted in Korean and audiotaped. Transcripts were typed and translated into English. Eleven women were interviewed in a private room at the center, and 9 were interviewed in their homes. All responses to a given item were listed and analyzed before moving to the next item. Each response was examined for content and meaning. Naturally occurring categories were formed as responses to an item were compared. After all categories had been formed for an item by Park, all responses were reviewed by Peterson for their fit in the category. Recurrent themes emerged as analysis progressed through the interview items. Demographic data for the 20 participants are summarized in Table 1. Interviewees' ages ranged from 26 to 32 years, with a mean age of 30 years. The number of people living in a household ranged from 3 to 6, with a mean of 3.8. All the women had had their last childbirth at a U.S. hospital. The mean number of months since the last childbirth was 27.8, with a range of 3 to 50 months. The women had been in the United States from 13 to 121 months (1 to 10 years), with a mean of 40.8 months (3.3 years). Caution must be used in generalizing the findings from this study to the entire population of Korean immigrants because of the small sample size and the nonrandom sampling procedure. However, there is no rea-
Korean Women's Childbirth Needs
263
Table 1. Demographic Data (N «= 20)
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Characteristic Highest education 9th grade High school 2 to 4 years college Graduate school Employment Full time or part time Unemployed Religion Protestant Catholic None Annual household income . < $ 10,000 $10,000-519,999 $20,000-$29,999 $30,000-539,999
n
1 8 9 2
5 40 45 10
9 11
45 55
15 3 2
75 15 10
5 7 4 4
25 35 20 20
.
son to believe our subjects' childbirth experiences were any different from those of other newly immigrated young Korean women living in a large metropolitan area. FINDINGS Health Beliefs All the interviews perceived health as positive, necessary, and pertinent to both body and mind. This view is close to the origin of the word health, or wholeness (Keller, 1981). It contrasts with a biological orientation and indicates that these women held a holistic view of individuals. Only half of the women rated their level of health as average or good. The other half described various problems, including emotional problems, bad colds, fatigue, rheumatoid arthritis, uteral disease, and oldage-related tuberculosis and poliomyelitis. There was a consensus that women's health worsens as they grow older. The causality of health was attributed to physical, psychological, and spiritual factors. The physical factors listed by the women included regular life-style, nourishment, good environment, and good health practices; the psychological factors included sound thinking, lack of stress,
264
K.-J. Y. Park and L. M. Peterson
successful stress management, and family harmony. Faith in God played a role in 45 percent of the women's beliefs about cause of health. An illness was perceived as something impeding ability to socialize or attend to activities of daily living. Most often (80%), the women referred to an impaired emotional state. Illness was perceived to be caused by factors such as worry and stress, eating an unbalanced diet, and overwork. Their beliefs about the cause of illness were comprehensive, with no folk causes of illness held by the women.
Downloaded by [] at 03:31 02 February 2015
Health Practices The interview guide elicited practices regarding Pap tests and breast self-examination. Only 1 woman regularly had a Pap test and did regular breast self-examination. All of the women attended prenatal care clinics. Eighteen took prescribed vitamin, iron, and calcium pills and reported eating well. Six of the 20 stated they could not drink milk. All of the women reported reading about child care and about educating children. They adopted some practices for the benefit of the fetus: listening to music, praying, refraining from watching terror films, keeping "peace of mind," talking to the fetus, and eating nicely decorated or perfectly shaped foods. All of the women did at least one of these. Sixteen of the women rested for 30 days after giving birth. The other 4 were unable to rest because of the unavailability of help. Rest and restriction of activity were reported to be encouraged in the culture and provided reason to hire household help. All of the women reported eating brown seaweed soup for about 20 days after childbirth. This food was highly valued by the women. They said their relatives encouraged their eating this because of the belief that it cleanses the blood and increases milk production. Families bringing this food into the hospital had created several disconcerting situations for the women and their families. They were not encouraged in this nor assisted in warming the soup by health-care providers. Seven had no bath or shower until 7 to 14 days after childbirth. Some women did not even touch cold water. The practice of avoiding cold also meant not eating refrigerated foods. Chicken or eggs were not considered desirable food. Five of the women took tonic herbs during the puerperium. Their purposes were to promote healing and health, relieve aching arms and legs, and stop dizziness. The cost of the herbal medicine from an herbal center was about $60 to $80 for a 10-day supply; some women spent $300 to $400. The rate of breast-feeding was 60%, slightly higher than the 51%
Korean Women's Childbirth Needs
265
reported as the U.S. in-hospital breast-feeding rate (Martinez & Nalenzienski, 1979). However, the women were unable to sustain breastfeeding (M = 38 days). They stated pumping breast milk was not feasible at work. Eight fed room-temperature or cold formula to their infants. Thirteen gave a sponge bath to the baby. Four gave a tub bath while the umbilical stump was still present because of misunderstanding classes held in English.
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Health-Care Experiences The women compared their health-care experiences in the United States and in Korea and questioned discrepancies. They expressed dissatisfaction because of a lack of English fluency and perceived a need to uphold a Confucian moral code that directed them to be nonassertive. Thus, they reported not asking for assistance when they needed it. Eighteen stated they had a language problem at the hospital. They were unable to describe their symptoms well, ask for what they wanted, or understand what was said to them. Nowhere was this more evident than in choosing the daily menu. The women reported they circled only the foods they recognized on the menu. One woman's husband, who could have given support and served as translator, was barred from the delivery room. DISCUSSION Beliefs The finding that only half of these women rated their health as average or good is related to their beliefs that health includes emotional health, not physical health alone. Life stresses were high in this population. Immigration is known as a stressful sociopsychological process of uprooting from the familiar, adjustment to the unfamiliar, and either accommodation of the two for creating a new synthesis or perpetual marginalization from the two (Turner, 1977). Living in an ethnic neighborhood did not alleviate stress in this sample. In addition to the stresses of immigration, this population was subject to the stresses of pregnancy and attainment of the maternal role (Lederman, Lederman, Work, & McCann, 1978). Stresses reported by this Korean population are similar in content to those of the Filipino women studied by Stern, Tilden, and Maxwell (1986). A system of neighborhood centers is needed as part of the greater health-care system. Korean health-care providers can introduce relaxa-
266
K.-J. Y. Park and L. M. Peterson
tion methods and enable group discussions about problems of living as immigrants and as pregnant women. These discussions can ease stresses through increasing practical knowledge about their neighborhood and health-care services.
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Practices Only 1 person reported regular preventive health practices in this study. These findings indicate a need to increase teaching about preventive health-care practices among the younger age group of women and to make preventive therapies available. Health-care providers need to work with the natural leaders of the community to set forth a program of education. Practices during pregnancy indicated a high need for teaching about the use of dairy products other than milk, such as cheese and yogurt. The practices adopted for the benefit of the fetus follow Taekyo, traditional prenatal health care. Cho (1987), in her extensive study, also identified these practices among Korean women. She found that the traditional customs of Taekyo had been modernized in both diet and behavior. Rest during puerperium is a common practice in other cultures such as Chinese, Filipino, and Mexican cultures (Affonso, 1981; Kay, 1978; Rose, 1978). Self-care actions can be an affront to health professionals; however, Woolery (1983) stated the need for health professionals to recognize that the pregnant woman has a responsibility for decision making about self-care actions. Conflict between the self-care agent and the health professional was labeled "self-care paradox" by Stern and Harris (1986). Stern and Harris described four paradigms by which to test self-care in practice. They suggested that both cultural elasticity and showing respect are needed to overcome such conflict. Left without appropriate intervention, these conflicts can result in the client's withdrawal from the health-care situation. The practice of eating brown seaweed soup is recorded in the literature (Chung, 1977). Health-care providers' understanding of the importance of this food to entire families and provision of means by which to heat the soup would remove one of the most negative experiences of hospitalization shared by Korean women. Providing small cups for warming in a microwave oven would obviate this problem. Nurses who understand the practice of avoiding cold can ask a woman's preference because differences exist among individuals within the same culture. A warm sponge bath can be suggested in place of a shower if a woman believes showers are too cold. The water pitcher can be filled with lukewarm water instead of ice water.
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Anticipatory guidance sessions in which the women practice asking for help with their diet orders, asking for lukewarm water in their pitchers, asking that the soup be heated, and asking that they be allowed to take warm sponge baths would prepare them for hospitalization with confidence. The practice of using tonic herbs may be potentially harmful. Dual use of Western medicine and folk medicine is found in the Korean culture as it is in the Bahamian, Haitian, Puerto Rican, Cuban, and southern U.S. black cultures (Scott, 1974). Because herbal prescriptions may contain the same chemical ingredients as used in Western medicine, use of both herbal prescriptions and Western medicine may result in overdose or adverse reactions. Health-care providers should ask specifically about herbal medicines, separately from questioning about Western prescriptions, in order to have full information. Because all the women desired to prolong the duration of breastfeeding, this is a group of women who need education about pumping and freezing milk for storage. Working mothers must be identified during pregnancy so they can be taught techniques before delivery for safely storing their, milk. The absence of question-asking behavior and the lack of stating what is wanted in the hospital, whether a result of low assertiveness or poor English fluency, require that health-care professionals inquire explicitly regarding needs and do so frequently enough that the women recognize an accepting environment for questions and needs. These women can easily spend an entire hospitalization without the normal conversational teaching that fluent English speakers receive. Experiences The possibility of not having a husband for support during delivery can create even more anxiety for these women, because a husband also can assist with interpretation, thereby decreasing language problems. The profound language problem among Koreans has been well documented in the literature for many years (Hurh & Kim, 1984, 1987; Hurh, Kim, & Kim, 1976; Kim, 1975; Um, 1986). This problem is related to an emphasis in Korea on written, not oral, use of English. Despite the documentation many years ago, health-care services did not provide adaptations to help alleviate the problem for this sample of women. Limited language ability results in limited information and limited access to health care for Korean women. In conclusion, variations exist among individual Korean women as among persons of any culture. Therefore, health-care providers need to assess each client individually before deciding on a given plan of care. The following specific educationally related recommendations seem im-
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portant in view of the numbers of problems reported: (a) Korean healthcare providers can develop pamphlets in Korean about the U.S. healthcare delivery system and community health programs, (b) A bilingual pamphlet of medical terms is needed, (c) Health-care professionals should speak slowly in clear, simple sentences and show patience in listening, (d) Health-care professionals should visit patients often to give an increased opportunity to ask for assistance and ensure understanding of instructions, (e) An interpreter's help is needed, and the women's families can help in this, (f) Finally, health-care providers must explain about the foods on a menu, and short food dictionaries could be distributed. Women interviewed were appreciative of any time taken with them by professionals. Their own desire to do exactly as health-care providers ask can result in excellent health practices for them and their families, providing they have sufficient help in surmounting the language barrier. Health-care professionals must work with community leaders to facilitate group meetings about the health-care system. Finally, immigration is an important process in the United States, and the health-care system itself must be fashioned for access, with simpler, understandable guidelines. REFERENCES Affonso, D. D. (1981). The Philipino American. In A. L. Clark (Ed.), Culture: Childbearing health professional (pp. 129-153). Philadelphia: Davis. AI-Darazi, F. A. (1984). Health and illness cognition among Bahraini women. Unpublished master's thesis, University of Illinois at Chicago. Cho, D. S. (1987). A study on the Taekyo behavior of women who had given birth and the health professional's perception of Taekyo. Unpublished doctoral dissertation. Yonsei University, Seoul, Korea. Chung, H. L. (1977). Understanding the Oriental maternity patient. Nursing Clinics of North America, 12(1), 67-75. Hurh, W. M., & Kim, K. C. (1984). Korean immigrants in America: A structural analysis of ethnic confinement and adhesive adaptation. Cranbury, NJ: Fairleigh Dickinson University Press. Hurh, W. M., & Kim, K. C. (1987). Korean immigrants in the Chicago area: A sociological study of immigration and mental health (interim descriptive report for the National Institute of Mental Health). Hurh, W. M., Kim, H. C., & Kim, K. C. (1976). Cultural and social adjustment patterns of immigrants in the United States: A case study of Korean residents in the Chicago area. Unpublished manuscript, Illinois University, Macomb, Department of Sociology and Anthropology. Kay, M. A. (1978). The Mexican-American. In A. L. Clark (Ed.), Culture: Childbearing health professional (pp. 89-108). Philadelphia: Davis.
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Keller, M. J. (1981). Toward a definition of health. Advances in Nursing Science, 4(1), 43-52. Kim, B. L. C. (1975). Study of Asian Americans in Chicago: Their socioeconomic characteristics, problems, and service needs. Unpublished master's thesis, University of Illinois, Urbana. Lederman, R., Lederman, E., Work, B., & McCann, D. (1978). Relationship of psychological factors in pregnancy to progress in labor. Nursing Research, 28, 94-97. Martinez, G. A., & Nalenzienski, J. P. (1979). The recent trend in breastfeeding. Pediatrics, 64, 686-692. Parse, R., Coyne, A., & Smith, M. (1985). Nursing research qualitative methods (pp. 3-8). Bowie, MD: Brady. Rose, P. A. (1978). The Chinese American. In A. L. Clark (Ed.), Culture: Childbearing health professional (pp. 55-63). Philadelphia: Davis. Scott, C. (1974). Health and healing practices among five ethnic groups in Miami, Florida. Public Health Report, 89, 524-532. Stem, P., & Harris, C. C. (1986). Women's health and self-care paradox: A model to guide self-care readiness. In P. N. Stern (Ed.), Women, health, and culture (pp. 151-163). Washington, DC: Hemisphere. Stern, P., Tilden, V., & Maxwell, E. (1986). Culturally induced stress during childbearing: The Philipino-American experience. In P. N. Stern (Ed.), Women, health, culture (pp. 105-121). Washington, DC: Hemisphere. Turner, V. (1977). Dramas, fields, and metaphors. Ithaca, NY: Cornell University Press. Um, C. C. (1986). Perception of health problems and barriers of a selected Korean population. Unpublished master's thesis, University of Illinois at Chicago. Um, C. C. (1987). Perception of health problems and barriers for Korean married women in Albany Park. Unpublished manuscript. U.S. Department of Commerce. (1981). 7950 Census of population (Supplementary Rep. No. PC 80-S1-3). Washington, DC: U.S. Government Printing Office. Woolery, L. (1983). Self-care for the obstetrical patients—A nursing framework. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 12, 33-37. Yu, E. Y., & Philips, E. H. (Eds.). (1987). Korean women in transition: At home and abroad. Los Angeles: California State University, Center for Korean-American and Korean Studies.
