Barriers to sexual health care: a survey of Iranian-American physicians in California, USA
Background: Despite increasing numbers of Iranian-American physicians practicing in the United States, little is known about the barriers that may impact them as providers of sexual health care. This is an important topic as discussions of sexual topics are generally considered a taboo among Iranians. We aimed to identify barriers experienced by Iranian-American physicians that inhibit their willingness to engage in discussions of sexual health care with patients. Methods: In 2013, a self-administrated questionnaire was sent to 1,550 Iranian-American physicians in California. Questions included demographics of the physicians as well as their perception of challenges in discussing various sexual health topics with their patients. Factor analysis: Principal components approach with a Varimax rotation was used to detect latent factors within the data that may help explain possible barriers to discussion of sexual health among physicians. The analysis was performed on 11 items, specifically focused on possible barriers, to detect a possible relationship between correlated variables within the data to produce a set of uncorrelated variables (factors). Results: The overall response rate was 23 %. Data revealed specific barriers regarding sexual history taking, discussing STIs and sexual dysfunctions with patients based on their gender, and age. Three factors were identified as internally consistent (Cronbach’s alpha = 0.82 to 0.91): (i) embarrassment, (ii) cultural and religious, (iii) lack of time and financial constraint. Significant associations were found between these 3 factors and some variables such as: country of medical graduation, religious affiliation, birthplace, age, and gender. Conclusions: Our findings are the first to identify possible barriers among Iranian-American physicians in delivering effective sexual health care to patients. Additional studies from Iranian-American physicians as well as from other foreign-born/subpopulation of US physicians populations and mainstream US physicians are needed to assess the extent of such barriers, and changes over time. Effective strategies to better engage such physicians in these studies are needed. If confirmed from other studies, our findings could have implications for the training of US medical graduates.
Sexual Self-Concept through a Cross-Cultural Lens: Qualitative Case Studies of Iranian-American Women
Recently scholars have examined more closely the topic of female sexual self-concept as an aspect of sexual well-being. Few studies have focused on migrated women's life experiences cross-culturally, and how that informs a woman's view of herself as a sexual being. This is particularly true about most middle-eastern cultures, including Iranian-American women. Four case studies draw on qualitative data from interviews with first generation Iranian-American women in the USA to describe the sexual self-concepts evolving as a result of life in both cultures. Applying narrative methodology and feminist theoretical perspectives two themes were revealed. These are i) the influence of family power, and ii) patriarchal social practices. The analysis introduces a multidimensional aspect and process associated with each woman's view of her sexual self-concept, which takes into account their behaviours, cognitions, and emotions developed in each life stage, and inform her sexual subjectivity (view of herself as a sexual being). Implications of these findings for clinicians and policy makers involved in sexual health care for women are briefly discussed.