Understanding the Meaning of the Medication Experience among Limited English Proficient

232 Pages·2013·1.53 MB·English

Understanding the Meaning of the Medication Experience among Limited English
Proficient (LEP) Oromo Patients in Minnesota

A DISSERTATION
SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL
OF THE UNIVERSITY OF MINNESOTA

BY

Moustapha Omar

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

Adviser: Dr. Jon Schommer

May 2013
COPYRIGHT

© Moustapha Omar, 2013
Acknowledgements

I would like to thank Dr. Jon Schommer for his continued advice and unwavering support
throughout my time in the program. Without his support and encouragement, I would not
have completed my education. I would also like to thank Dr. Raquel Rodriguez who
spent countless number of hours helping me and encouraging me to work harder, and
finally served as the chair for my committee, in order to make sure I do not remain a
professional student forever. Together, Dr. Schommer and Dr. Rodriguez have become
my role models, and showed me what it means to be great educators. I am also grateful to
Dr. Cynthia Peden-McAlpine for serving on my committee, and for giving me expert
guidance in the methodology I used in this research. I am also grateful to Dr. Marcia
Worley for serving on my committee and for giving me constructive feedback at each
critical stage in my educational career. I truly appreciate her contribution to my education
as a professor, and for remaining committed to serve on my committee even after she left
the University of Minnesota. Finally, I would like to thank my wife, Zoubeida Ahmed
Youssouf, my two daughters, Hangatu and Darani Omar, as well as my younger brother,
Youssouf Omar, for their continued support.
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Dedication

This dissertation is dedicated to the memory of my father, Abdulahi Omar Roba, and my
mother Mardia Ahmed Mussa.
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Abstract
Based on Title VI of the 1964 Civil Rights Act, immigrants who speak English “less than
very well” are entitled to professional language access services (LAS) and all health care
providers, including pharmacies, are required to provide such services. However, many
pharmacies are not currently complying with these laws. The main purpose of this study
is to understand the meaning of the medication experiences among Limited English
Proficient (LEP) Oromo patients in Minnesota. Major objectives of this study are: 1) to
have a deeper understanding of the lived medication experiences of the research
participants, 2) to describe the meaning of these experiences from the perspectives of the
participants, and 3) to develop the data into themes and interpret them to uncover the
deep, pre-reflexive meaning they attach to their medication experiences.

This research follows Max van Mennen’s hermeneutic phenomenological methodology
to describe and interpret the meaning of the medication experiences of the research
participants based on their subjective lived experiences. Interviews were conducted in the
Oromo language, taped and transcribed in the Oromo language, and translated into
English. In addition to applying hermeneutic phenomenological reflection, the text was
analyzed using the holistic, selective, and detailed or line-by-line approaches to explicate
essential themes. The data were transformed into text by separating essential themes from
incidental themes, and developing the essential themes into text following van Manen’s
guidelines.

The results of the data analysis were organized into six major themes under the heading
of research findings in chapter nine (9) as follows: 1) beliefs regarding causes of
diseases, 2) beliefs regarding the use of medicine, 3) beliefs regarding diseases that
cannot be cured by western medicine, 4) love and hate relationship with prescription
medications, 5) mistrust of American health care system, and, 6) lack of communication
with their pharmacists. Based on the above six themes, some common characteristics that
are unique to the Oromo culture and other characteristics that may be universal to all
immigrants were drawn as conclusions and described in chapter nine (9). Finally,
discussion of these findings and specific recommendations were given in chapters 10 and
11 respectively.

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Table of Contents
List of tables v

List of figures vi

Chapter 1 Introduction and personal reflection 1
Chapter 2 Health disparities and medication experience in America 23
Chapter 3 Pharmacy services and LEP Patients in the United States 35
Chapter 4 American laws regarding Access to Language Services 49
Chapter 5 The Oromo people and their origin in East Africa 59
Chapter 6 Ethiopian healthcare system and the Oromo experience 78
Chapter 7 Research Paradigm and methodological orientation 98
Chapter 8 Research method 120
Chapter 9 Research findings 139
Chapter 10 Discussions 179
Chapter 11 Recommendations 191
Bibliography 210
Appendices 219
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List of Tables
Table 1. Participants’ demographic data 141
Table 2. Causes of illnesses as described by participants 148
Table 3. Summary of findings 175
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List of Figures
Figure 1. Researcher’s picture taken on a family farm in Kombolcha 12
Figure 2. Population figures of Ethiopia 16
Figure 3. Current map of Ethiopia 60
Figure 4. A picture of Odaa (sycamore) tree 62
Figure 5. Map of Oromia 65
Figure 6. Oromo spectators at a soccer game in the Twin Cities 71
Figure 7. Ali Birra entertaining Oromos in Minneapolis 73
Figure 8. Oromo soccer game in St. Paul 76
Figure 9. Graph showing the use of herbal medicine in some African countries 82
Figure 10. A worker in herbal garden in Ethiopia 83
Figure 11. A picture of a hospital built by the Russian Red Cross 90
Figure 12. A picture of historical Jogol hospital in the city of Harar 91
Figure 13. A picture of herbs on the shelf in a store (Addis Ababa) 95
Figure 14. Black Lion Hospital in Addis Ababa 96
Figure 15. A clinic in a small town in Oromia 97

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Chapter 1
Introduction and personal reflection
Background
Minnesota is becoming a hub for new immigrants and refugees from all around the
world. This brings challenges for Minnesota’s healthcare system because of the language
and cultural barriers between healthcare providers and patients (Institute of Medicine,
2004, Westberg, 2003, Mathematica Policy Research, 2009). The healthcare system in
Minnesota needs to provide services similar or equal to the services it provides to English
speaking patients. In order to do that, it has to provide culturally and linguistically
appropriate healthcare services. This might not be an easy task, because it requires the
healthcare system to be innovative and be ready to make necessary changes in order to
accommodate the needs of these new Americans. This is a huge challenge, although a
necessary one.

It is critically important to know about the language and the culture of these new
Americans in order to understand these patients’ attitudes, beliefs, and behavior towards
medication use. Knowledge of this kind will help healthcare professionals in providing
healthcare that will have a positive impact on the health of immigrants, reduce health
disparities in the population, and reduce the overall cost of healthcare. When the
challenges of language barriers are combined with biases formed by differences in culture
and belief systems, the issue is even more critical for patients who are not fluent in
English. Cultural differences, especially differences in communication styles, can make
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matters more complicated because the prior medication experiences of LEP patients may
hugely influence their decision-making today. Their health belief system, their opinions
regarding the American healthcare system, and their decision-making process regarding
medication use, all need to be studied and understood. This research is intended to
contribute to our understanding of the medication experiences of Oromo patients from
their own perspectives, and the findings here are based on both the participants’ shared
experiences and the interpretations of the researcher.

No research has been conducted in the Oromo community regarding the language barriers
in pharmacy service. In fact, there is very limited documentation of research of any kind
done in the Oromo community in America, since many Oromos have arrived in America
only over the last three decades. For example, peer-reviewed articles in several archived
volumes of The Journal of Oromo Studies, published twice a year, have focused mostly
on studies of Oromo history, politics, and language. No article focusing on the healthcare
experience of Oromos in America was found there. This study was designed to
understand the experiences of Oromo participants, as related to language barriers and
medication use, from the perspectives of the participants themselves using hermeneutic
phenomenological methodology. It is the first qualitative research that focuses on the
medication experiences of limited English proficient Oromo patients in Minnesota, and
the significance of those experiences. Therefore, regarding this topic, this research is the
first of its kind among Oromos living in the United States.

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