Working with the Hmong

Population in a Genetics Setting:

Genetic Counselor Perspectives
By: Aleka Arredondo
Juan Lanerdos
Marwa Mohamed
Ice breaker
1. What does the term genetic counseling mean?
2. What should the role of an interpreter be?
3. What is cultural competency?
Introduction
➔ Hmong individuals face challenges accessing and utilizing the United States
healthcare system for reasons such as their cultural beliefs.
➔ Hmong beliefs may be a barrier and complicate genetic counseling (GC)
sessions if the patient is not a English speaker and a interpreter is not
involved.
➔ Study purpose: The study aims to fill the gap to describe the experiences of
genetic counselors when working with interpreters in sessions with Hmong
patients who are not native English speaker.
➔ Specific objectives to identify GC thoughts and perception:
◆ Differences and lessons learned from preparing for these sessions
◆ Unique communication challenges during these sessions
◆ GC perception of Hmong culture.
Methodology / Study Design
➔ Design: Telephone based qualitative interview without fixed response.
◆ Gives more information which includes feelings, attitudes, and
understanding of the subject.
➔ Instrumentation: Semi-structured interview questions for GC, that were
developed using results from previously unpublished pilot study at the
University of Wisconsin that interviewed Hmong medical interpreters.
➔ Demographic questions were included in the interview.
◆ These questions included: types of counseling sessions, percentage of
those sessions that had an interpreter present, and how long they have
been a practicing genetic counselor.
Population & sample
➔ Population: Genetic counselors
◆ California, Minnesota, Wisconsin
➔ Sample Size:
◆ A total of 13 respondents
◆ Only 11 respondents data was recorded
➔ Criteria:
◆ Board certified or eligible Genetic Counselors
◆ Close proximity to the cities
◆ Have experience with at least 1 Hmong patient session
➔ Limitations: Not interviewing interpreters as well
Intervention
➔ Intervention: Semi-structured interview
➔ Recruitment: National Society of Genetic Counselors
◆ contacted 177 counselors via email
◆ 13 counselors respondent and agreed to the interview
➔ Representation: Genetic Counselors
◆ Not Representation to Hmong population
◆ 9 female, 3 male, and all are caucasian
Outcome measures
➔ Qualitative data was evaluated to determine five emerging themes
◆ relevant training during graduate school
“I try to ask questions and check in
◆ session preparation frequently because we’re also often
working with an interpreter so I tried
◆ content of the counseling session to keep the amount of detail, I don’t
◆ perception of Hmong culture elaborate on details as much
because I know that information is
◆ reflections on working with Hmong interpreters. being interpreted into their language
and sometimes there isn’t the same
word that translates well. So, I’ve
learned that using the term gene is
“So I think one of the things that was easier for them to understand than
valuable for me, was to recognize that “I think still one of the big the basic activities using like chromosome or they may
you can start with a smaller amount of is just to evaluate your own perspective. have heard of genes before, but not
information and you can build on it Whether it’s religion, or family, or rural versus necessarily chromosomes.”– GC01
depending on the degree of interest of urban, or whatever, just to know where you
the patient.”– GC08 are and where you stand with your beliefs
and principles. Understand that not
everybody thinks the way you do.”– GC02
Outcome Measures
Significant Sub-Variables:

“The technical information was, I think was difficult.

Trying to explain the concept, not heredity as they
have big families, most people get the idea of
heredity, but cellular-based information was
certainly much more challenging because you had
to, you weren't building on, you didn't have the
building blocks in some cases to begin with. They
were starting at the very, very bottom.”– GC08
Results
➔ The study identified three challenges faced by genetic counselors when
working with the Hmong population
◆ Translation of medical information into the Hmong language
◆ The need for continued cultural awareness training
◆ The importance of communication regarding expectations of the interpreter.

➔ These results reflect the thematic elements discussed during their interviews
of providers.
➔ Due to the qualitative nature of the study, values reported and data tables
reflect thematic similarities between interview participants.
Study Discussion
➔ From the three challenges, two suggestions emerged
◆ The value of graduate education in the development of a toolkit to continue building cultural
awareness while in practice
◆ The importance of communicating expectations to the interpreter prior to the start of the
session
➔ These challenges brought about recommendations for genetic counseling
practice and identification of areas still in need of improvement
➔ This study points out the importance of cultural competence, but more
importantly it identifies the need for research and discussion on what role an
interpreter should play when translating medical information.
Limitations
➔ The study only had 11 participants, which limits the breadth of the research.
➔ Of the 11 participants, all had worked with more than one Hmong client.
◆ Experiences of providers with less exposure to the Hmong population may present more
challenges and suggestions for increasing competency
➔ The small sample size also limited the ability to identify trends within the
genetic counseling profession.
➔ The population sampled consisted only of genetic counselors, who were all
caucasian.
◆ Including the experiences of interpreters, as well as clients may give more information on the
challenges faced and suggestions for addressing those issues
◆ Lack of ethnic concordance
Discussion Questions
1. How could the suggestions of this article be applied in the real world?
2. Will reducing the amount of jargon used between medical providers and
patients help communication through language barriers?
3. Does increasing the cultural competency of providers have an effect on a
clients comprehension of genetic counseling?