Abstract
Patient cultural backgrounds strongly influence decision-making processes and outcomes in genetic counseling. The present study investigated influences of culture and acculturation on prenatal decision making processes of native Palestinians and Palestinian Americans. Seventeen native Palestinians and 14 first-generation, Palestinian Americans were interviewed and asked to imagine themselves as patients in hypothetical premarital and prenatal situations. Five major issues were investigated: 1) Influence of family history of an inherited condition on pre-marital decisions; 2) Perceptions of non-directive genetic counselor statements regarding options; 3) Role of gender in prenatal decisions; 4) Gender differences in emotional expression; and 5) Role of family and society in prenatal decisions. Several similarities and differences in native Palestinian and Palestinian American responses were obtained. Similarities appear to be due to common cultural roots, while differences may be due to acculturation. Practice and research recommendations are provided.
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References
Abraham, N. (1995). Arab Americans. In R. J. Vecoli, J. Galens, A. Sheets, & R. V. Young (Eds.) Gale encyclopedia of multicultural America, volume 1 (pp. 84–98). New York: Gale Research.
Abudabbeh, N. (1996). Arab families. In M. McGoldrick, J. Giordano, & J. K. Pearce (Eds.) Ethnicity and family therapy, (2nd ed., pp. 333–346). New York: Guilford.
Abudabbeh, N., & Nydell, M. K. (1993). Transcultural counseling and Arab Americans. In J. McFadden (Ed.) Transcultural counseling: Bilateral and international perspectives (pp. 261–284). Alexandria, VA: American Counseling Association.
Albar, M. A. (1999). Counseling about genetic disease: An Islamic perspective. East Mediterranean Health Journal, 5, 1129–1133.
Ali, S. R., Liu, W. M., & Humedian, M. (2004). Islam 101: Understanding the religion and therapy implications. Professional Psychology, Research and Practice, 35, 635–642.
Al-Mughni, H. (1993). Women in Kuwait: The politics of gender. London: Saqi Books.
Berry, J. W. (1994). Acculturation and psychological adaptation: An overview. In A. Bouvy, F. J. R. Van De Vijver, P. Boski, & P. Schmitz (Eds.) Journeys into cross-cultural psychology (pp. 129–141). Berwyn, PA: Swets & Zeitlinger.
Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46, 5–34.
El-Hazmi, M. A. F. (2004). Ethics of genetic counseling: Basic concepts and relevance to Islamic communities. Annals of Saudi Medicine, 24(2), 84–92.
Erickson, C. D., & Al-Timimi, N. R. (2001). Providing mental health services to Arab Americans: Recommendations and conclusions. Cultural Diversity and Ethnic Minority Psychology, 7, 308–327.
Israeli Central Bureau of Statistics (2003). The Arab population of Israel. www.cbs.gov.il.
Jaber, L. A. (2003). Barriers and strategies for research in Arab Americans. Diabetes Care, 26, 514–515.
Jaber, L., Dolfin, T., Shohat, T., Halpern, G. J., Reish, O., & Fejgin, M. (2000). Prenatal diagnosis for detecting congenital malformations: Acceptance among Israeli Arab women. IMAJ, 2, 346–349.
Jackson, M. (1997). Counseling Arab Americans. In C. Lee (Ed.) Multicultural issues in counseling: New approaches to diversity, (2nd ed., pp. 333–349). Alexandria, VA: American Counseling Association.
Kim, B. S. K., Atkinson, D. R., & Umemoto, D. (2001). Asian cultural values and the counseling process: Current knowledge and directions for future research. The Counseling Psychologist, 29, 570–603.
Landrine, H., & Klonoff, E. A. (1995). The African American acculturation scale II: Cross-validation and short form. Journal of Black Psychology, 21, 124–152.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic enquiry. Beverly Hills, CA: Sage.
National Society of Genetic Counselors. www.nsgc.org.
Nobles, A. Y., & Sciarra, D. T. (2000). Cultural determinants in the treatment of Arab Americans: a primer for mainstream therapies. American Journal of Orthopsychiatry, 70, 182–191.
Nydell, M. (1987). Understanding Arabs: A guide for westerners. Yarmouth, ME: Intercultural Press.
Palestinian Central Bureau of Statistics (2001–2006). Projected mid-year population in the Palestinian Territory by governorate. www.pcbs.gov.ps.
Parette, P. (1999). Transition planning with families across cultures. Career Development for Exceptional Individuals, 22, 213–211.
Patai, R. (1973). The Arab mind. New York: Charles Scribners.
Patton, M. Q. (1990). Qualitative evaluation and research methods. Newbury Park, CA: Sage.
Puddifoot, J. E., & Johnson, M. P. (1997). The legitimacy of grieving: The partner’s experience at miscarriage. Social Science & Medicine, 45, 837–845.
Rashad, H., Osman, M., & Roudi-Fahimi, F. (2005). Marriage in the Arab World. Population reference bureau (pp. 1–8). Washington, D.C.
Raz, A. E., & Atar, M. (2003). Nondirectiveness and its lay interpretations: The effect of counseling style, ethnicity, and culture, on attitudes towards genetic counseling among Jewish and Bedouin respondents in Israel. Journal of Genetic Counseling, 12, 313–332.
Raz, A. E., & Atar, M. (2004). Cousin marriage and premarital carrier matching in a Bedouin community in Israel: Attitudes, service development and educational intervention. Journal of Family Planning and Reproductive Health Care, 30, 49–51.
Said, E. W. (1997). Covering Islam: How the media and the experts determine how we see the rest of the world. New York: Pantheon Books.
Sayed, M. A. (2003). Psychotherapy of Arab Patients in the West. American Journal of Psychotherapy, 57, 445–459.
Shaheen, J. G. (1986). The Hollywood Arabs: 1984–86. Mideast Monitor, 3, 1–6.
Smart, D. W., & Smart, J. F. (1992). Cultural issues in the rehabilitation of Hispanics. Journal of Rehabilitation, 58, 29–37.
Suleiman, M. W. (1988). Arabs in the mind of America. Brattleboro, VT: Amana Books.
Terry, J. (1985). Mistaken Identity: Arab stereotypes in American popular writing. Washington, DC: American-Arab Affairs Council.
United Nations (2001). Report on the Palestinian economy.
U.S. Census Bureau (2003). The Arab population: 2000, 1–9, December.
U.S.Census Bureau (2004). www.census.gov.
Wertz, D. (1998). Eugenics is alive and well: A survey of genetic professionals around the world. Science Context, 11, 493–510.
Williams, J. E., & Best, D. L. (1990). Sex and psyche: Gender and self viewed cross-culturally pp. 118–133. Newbury Park, CA: Sage.
Acknowledgments
This study was completed in partial fulfillment of the requirements for the first author’s Master of Science degree from the University of Minnesota. We would like to thank the interviewees who contributed their time and thoughts to this important topic and acknowledge Dr. Yusuf Abul-Hajj who verified translation of Arabic transcripts to English.
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An erratum to this article can be found at http://dx.doi.org/10.1007/s10897-008-9165-0
Appendix
Appendix
Interview Questions
Opening Question
Have you heard of genetic counseling? [If yes, what have you heard?]
Definition of Genetic Counseling
Interviewer provides this definition to each participant: Genetic counseling is a health care profession that serves individuals and families who are either affected with, or are at risk of being affected with, a genetic condition. Genetic counselors answer patients’ questions, provide support, and communicate genetic and medical information in a clear, understandable manner.
Hypothetical Situation 1
Imagine that before you married your husband/wife [For single participants, say “Imagine you are about to marry your husband/wife, and...”] you discover that s/he has a family history of mental retardation. One of your husband/wife’s siblings is mentally retarded, as well as a few of his/her cousins. This means that there is a chance that you and your husband/wife could have children affected with mental retardation. Although there is no cure for mental retardation, there is a pregnancy test that would predict with 100% accuracy whether the baby would be affected when it is born. Let’s talk about how this might affect your decision about marriage.
[Prompts: Would you proceed with the marriage anyway and test each pregnancy? Proceed with the marriage and not chose to test each pregnancy? Or would you pick a different partner and avoid this process all together?]
Hypothetical Situation 2
This situation I will read to you is unrelated to the first. Imagine that you and your partner are expecting, and your baby has tested positive for beta-thalassemia very early in the pregnancy. Beta-thalassemia is a common blood disorder in the Middle East where normally both parents are carriers of the genes causing the condition but are not themselves affected. At the genetic counseling clinic the counselor says: “Individuals affected with beta-thalassemia have anemia and their blood cannot deliver oxygen efficiently to their body. This results in life-threatening complications early in life. Treatment is available in the form of frequent blood transfusions which allow individuals to live a normal life. Patients undergoing treatment have normal intelligence and can attend school and hold regular jobs. However, due to potential complications from iron accumulation, the life expectancy is 20–30 years.” Why do you think the counselor is telling you this information? What do think the counselor is telling you regarding your choices for this pregnancy?
[Prompts: Do you think the counselor is giving you information to help you make an informed decision that is right for you, or is s/he directly suggesting a specific option for you (pregnancy termination or continuation)?]
How will a decision be reached? Who will make the decision?
[Prompts: What do you envision your role in the decision making process would be? What if you and your partner disagree? What role, if any, would you like the counselor to play in your decision?]
Hypothetical Situation 3
You and your partner attend a genetic counseling session. The counselor is presenting you with information about your pregnancy telling you that your baby has a birth defect. You feel a range of emotions (sadness, anger, fear, etc.). How would express these emotions? What would you do?
[Prompts: Would you turn to your partner and discuss the situation? Would you turn to the counselor and discuss the situation? If yes, what would you want the counselor to say? Do? Would you wait until the session is over to discuss the situation with you partner? Would you choose not to express those emotions and deal with them on your own?]
Hypothetical Situation 4
A genetic counselor calls you up and delivers bad news about your current pregnancy. Your baby has a birth defect. With who would you chose to discuss the situation?
[Prompts: Would you choose to discuss it with the counselor? Your partner? Your family? Who in your family? A friend outside the family? Other patients in a similar situation?]
Hypothetical Situation 5
If you were to learn that your baby does have a birth defect, what would worry you the most?
[Prompts: Would you worry about the perception of others in your family? Perceptions of people outside the family? The relationship between you and your partner? The welfare of your child and his/her future life?]
Final Questions
Let’s assume that you do go for genetic counseling for an affected pregnancy. What would be the most helpful/least helpful things the counselor could say or do?
Do you have any final comments?
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Awwad, R., Veach, P.M., Bartels, D.M. et al. Culture and Acculturation Influences on Palestinian Perceptions of Prenatal Genetic Counseling. J Genet Counsel 17, 101–116 (2008). https://doi.org/10.1007/s10897-007-9131-2
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DOI: https://doi.org/10.1007/s10897-007-9131-2