An Exploration of Beliefs and Attitudes towards childbirth experiences among Ghanaian-Born Women in America (same topic that has been tweaked a little)

Research Proposal Regarding Exploration of Attitudes and Beliefs towards Childbirth Experiences in Ghanaian Women Born in America
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Research Proposal Regarding Exploration of Attitudes and Beliefs towards Childbirth Experiences in Ghanaian Women Born in America
Introduction
Research Problem
Cultural and religious beliefs are important considerations, on the issues of childbirth in Ghana. Cultural and religious background affects individuals’ under different demographical location (Ardafiyo & Schandorf , 1994). Therefore, it may be quite natural that such cultures and beliefs regarding childbirth experiences may also be prevalent in Ghanaian born women in the United States of America. Although, individuals migrate from one place to another across the globe, culture and beliefs are inculcated in them. There are various beliefs, regarding childbirth experiences, in the Ghanaian culture (Ardafiyo & Schandorf, 1994). It may impose certain taboos on women regarding their food habits or mobility (Gage, 2007). Such a practice might be viewed as an awkward behavior or an act of disrespect for the women (Ardafiyo & Schandorf, 1994).
Certain philosophies, like belief in witchcraft, persist in Ghanaian women and their families even when they are reared in westernized countries. Infertility is still viewed in the context of physical and spiritual ailments. It is speculated, that a womb that is too hot, would boil the baby and a womb that is very cold will hamper the growth of the baby.

Even under present conditions, women who cannot conceive resort to witchcraft. Such women panickand go a traditional priest. They believe that the priests would be instrumental in getting rid of the evil. Even the traditional priests make these women believe that infertility is caused due to God’s anger. Therefore, they ask these women and their family members to please God through various tangible and intangible assets (Ardafiyo & Schandorf, 1994).
Moreover, issues like birth control or labor pain is viewed as a curse of God. Often, nursing professionals or care providers are perturbed, to choose the appropriate care needs based on cultural and religious beliefs of either the patient or her family members (Ardafiyo & Schandorf, 1994). The situation becomes complex when such patients are admitted, to received westernized care based on evidence based practice guidelines (Ardafiyo & Schandorf, 1994).
These approaches and guidelines often contradict the traditional care philosophies, and oriental practice guidelines (Berg et al., 2010). The patients are struck between cultural background and scientific knowledge. Apart from patients, the care providers are also apprehensive, regarding the adherence of a patient to the prescribed treatment guidelines (Berg et al., 2010). Hence, providing care to such group of individuals is challenging.
Purpose of the Study
The present study would try to explore the prevalence of such cultural and religious beliefs in Ghanaian-women admitted for childbirth in different care set-ups in the United States of America. Such belief systems would be explored in their family members also. This would help in assessing the cultural and religious beliefs that are prioritized, in the background US culture. The study would next try to extrapolate the key determinants, which drive their cultural beliefs. Further, the study would try to investigate the factors that influence compliance to the prescribed treatment guidelines (Andrews & Boyle, 2002).
The experiential thoughts would be assessed based on cultural aspects, to understand, how such individuals cope with those thoughts. Moreover, the study will evaluate the health conditions and mortality rates in both women and children after they are discharged from care settings.
Scope of the Study
The study would be useful both from the perspectives of patient and from their family members. More importantly, the study would provide nurses and other allied healthcare professionals to recognize the values, practiced in different ethnic settings about childbirth experiences. This would help in inculcating a patient-centric care approach that may enhance adherence to treatment guidelines (Benbow & Maresh, 1998). Such information would be helpful in devising a care plan based on medical, cultural and religious aspects (Shambley-Ebron & Boyle, 2004). The study might provide newer avenues, to ensure health of prospective mothers and their children who are strongly driven by traditional beliefs and culture.
The study would help to identify the constraints imposed on prospective mothers by the societal and family settings. This would help the nurses and allied professionals to ensure proper counseling of the family members, about the future health of the mother and her child (Alexander & Korenbrot, 1995). Moreover, there may be issues related to cost effectiveness in adhering cultural or religious practices in preference to evidence based treatment guidelines (McAllister & Boyle, 2000). The study would provide a holistic basis, in evaluating the individual needs of the patients and their family members, about childbirth experiences of Ghanaian women born in the United States.
Research Question
The research questions will be evaluated by various dependent and independent variables. The dependent variables would be related to various endpoints, which would measure different aspects of physical and mental health of the prospective mothers and their child. The dependent variables will be mortality, morbidity, nutritional status, physical and mental constraints, both in relation to the mother and in relation to the child (Hill, 2007). Such dependent variables will be evaluated based on various cultural beliefs like traditional rituals, belief systems in food, practice of post-partum sex and family planning (Boyle & Mackey, 1999).
Further, the dependent variables will also be evaluated regarding the extent of cultural beliefs which may be dependent on the various independent variables like migrant status (1st generation migrants or second generation migrants), level of education, place of attaining education (United States or Ghana or other countries), the type of family set up (nuclear or non-nuclear), awareness on childbirth and postpartum care. The target population for the present study would involve Ghanaian women born in the United States who are admitted for giving childbirth, in two major hospitals in United States of America. The study population will also include the registered nurses who are providing care to such women, and the family members of such patients would be included in the study.
Theoretical Framework
The study would be conducted based on the philosophy of nursing care as Leininger. She recognized that a lack of knowledge regarding a patient’s cultural or religious beliefs might lead to poor health outcomes and affect treatment compliance (Andrews & Boyle, 2002). Hence, the nurses should be aware of such beliefs and cultures, on an individual-to-individual basis (Shambley-Ebron & Boyle, 2004). This would help in formulating care guidelines, which will increase the compliance of patients, to various treatment approaches. Such philosophy formed the basis of “trans-cultural nursing”. It is important that the cultural dynamics of a patient and their family members should be well understood by the care providers (Shambley-Ebron & Boyle, 2004).
Such information and apprehensions may be obtained through effective nurse-patient relationships based on person-centric care. Therefore, the study would be conducted on the perspective of trans-cultural knowledge and its implementation in care settings. The apprehensions and specific needs may help to modify and design a new treatment plan, which will ensure maximum therapeutic compliance. However, it must also be ensured that such modifications should not violate clinical guidelines of care. Upon assessment of the different cultural needs, the viable needs will be incorporated in a “Mandala Design” diagram. This would help in selecting the various cultural or religious needs, either independently or in association to one another. Upon such selection, nursing care should be oriented to protect such beliefs and implement those in the care system to improve care outcomes (Andrews, 2004).
Definition of Terms
The terms of reference for interviewing the patients and their family members and rendering of clinical care will be based on the theoretical perspective of Leininger’s trans-cultural nursing. Care would be referred to an aspect either behavioral or interventional, which will improve health outcomes in a patient (Andrews, 2004). The key focus of nurses should be to ensure quality and effective health care in human beings. Cultural concepts may vary from patient to patient and between ethnicities (Barry & Boyle, 1996).
The care providers must recognize that each culture around the world has their folk remedies. Such beliefs and remedies must be respected if those are supported by evidence based guidelines and clinical knowledge (Boyle & Mackey 1999). It should also be recognized that cultural beliefs could be influenced by worldviews, spiritual and societal interactions and technological rationality (Mackey and Boyle, 2000). If patients are satisfied that their cultural and religious beliefs would be preserved, it leads to increased wellbeing of the patients.
Assumptions
The study would be based on various assumptions (Health, 1995). The assumptions that would be tested are:
Does migration status affect the cultural beliefs of individual patients?
Do cultural beliefs affect individual wellbeing or health of a patient? (Filippi, 2006)
How the complications of pregnancy like diabetes and preeclampsia are viewed (medical or supernatural)?
Conception regarding labor pain as a natural phenomenon for vaginal delivery.
Whether moaning during labor pain warrants the need for epidural pain relief?
Perception regarding cesarean section (religious or clinical)?
Perception of cultural beliefs and attitudes associated with health compliance.
Does the prevalence of mortality and morbidity differ, in individuals with traditional and modern beliefs?
Hypothesis Testing and Statistical Tests
Various hypothesis and statistical tests would be deployed, to test for the acceptance or rejection of such assumptions (Wilkinson, 1999). The null hypothesis would contend that there is no significant difference regarding an observation between different groups (Branch, 2014). The null hypothesis is evaluated to eliminate the chances of bias in a statistical analysis (Wilkinson, 1999). Null hypothesis would be accepted if the “p” value (probability value) of a statistical test of significance is >0.05 (Hubbard, Parsa & Luthy, 2007). On the other hand, the null hypothesis would be rejected if the p values for such tests are <0.05 (Nickerson, 2000). For example, if there is no significant difference in cultural perceptions between 1st generation and 2nd generation migrants (p>0.05), it will be interpreted that migration status does not influence cultural beliefs of Ghanaian women, about childbirth (Sotos et al, 2009).
On the other hand, if the clinical perceptions regarding cesarean section are significantly higher, than cultural perceptions (p < 0.05), the individual would be motivated more easily for a cesarean delivery, in cases of exigency. Such a finding will not lead to additional stress of such individuals because she must be already aware regarding the need for a cesarean delivery (Clark et al, 2008).
The statistical tests that would be performed are t-test, and chi-square test (Moore, 2004). Regression equations will be constructed to find out the effect (direction and magnitude) of independent variables on the dependent variables (Mogull, 2003). Such equations would help to assess the most significant and correlated independent variable/s to the dependent variable (Ravishankar & Dey, 2002). All statistical tests will be performed through “Minitab” software.
Anticipated Limitations
Since the study would be based on subjective feelings and responses, there might be chances of elemental bias (Moore, 1997). Moreover, the cultural practices or religious practices prevalent in a family might not be projected, due to withdrawal of participation from the study (Junni & Egger, 2005). Often, the individual patients might become apprehensive in sharing cultural or religious beliefs, due to fear of retaliation (Berinsky, 2009). Thus, there can be concerns regarding subjective bias (Healey, 2008).
Such issues may affect the endpoints that the study aims to evaluate (Altman, 1999). Since, the study population would be restricted to two health care set ups only, the sample would not reflect the perceptions of the entire population (Myers et al., 2010). Lack of proper representation of the population may reduce the reliability and viability of the study (Cumming, 2011). Therefore, the sample size and the inclusion/exclusion criteria must be ensured (Vaughan, 2013).
Summary
Nursing is a challenging profession since it not only demands clinical expertise, but also the necessary skills to ensure a patient centric approach (Association of Women’s Health, Obstetric and Neonatal Nurses, 2009). Understanding the religious and cultural beliefs of a specific ethnic group will help in designing care strategies, which will ensure better treatment compliance and improve health care outcome in patients.
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