Folk tales, vaccines and veggies: University of Minnesota researchers try audio tips to reach immigrant moms

The audio messages sent to dozens of East African immigrant mothers evoked the protagonist from a Somali folk tale in a reminder about the challenges of parenting.

"As Igal Shidad traveled around for a good place for his family to live, he had challenges along his journey," the messages said, describing the trek of a nomadic camel and sheep herder. "He found it helpful to keep his faith in Allah, because it helped him keep faith in himself. Keep your faith and you too can deal with your challenges."

The outreach, part of a University of Minnesota study, is designed to address maternal and child wellness in the Somali-American community. Proponents of the effort think the system could be used to reach other populations that might struggle with written literature in English or adapting to different parenting norms in the U.S. — from nutrition recommendations to navigating the health care system.

Lead researcher Amy Susman-Stillman, director of applied research and training at the University of Minnesota's Center for Early Education and Development, said other immigrant groups could benefit from a similar process.

"Most parents seem to want to benefit from early childhood health and development [knowledge], it's just that we know that some parents are less likely to be receiving that information or there are more gaps in what they receive," Susman-Stillman said.

Fardowsa Bashir, 38, and a mother of six living in Minneapolis, found the advice helpful. She raised her first child — now 16 — in Kenya, where she recalled a culture of freedom for children. But in America, Bashir said through a translator, she has more concerns.

"In America you have to constantly be aware of your children," said Bashir, whose family is originally from Somalia and migrated to the U.S. in 2011. "In addition to their safety and their security, you have to worry about their homework, whether they're staying out of trouble or behaving themselves appropriately, and on top of that you're a working mother … you're busy. There's a lot going on here."

In the recently finished pilot phase of the study, researchers sent audio files in Somali to the mobile phones of 50 Somali-American mothers three times a week for six months, working with health practitioners at People's Center Clinics & Services. They decided against using standard written text messages, since not all participants read in their own language.

Deborah Olson, a pediatric nurse practitioner who was involved in the study, has seen many East African patients who may not keep up with parenting advice in English, from books to blogs. Much of that advice also doesn't consider large family sizes that are common in East African households.

"I think in American culture a lot of times we take parenting classes and we have some time to devote for parenting education, but in this population that was unrealistic to expect that they would have those opportunities," said Olson, who works at People's Center Clinics & Services.

She found that in East Africa, parents typically took kids to the doctor only when they felt very sick. Yet those raised in the American health care system understand the importance of going in for preventive checkups, getting vaccines, and which over-the-counter medications are best for common childhood illnesses, Olson said.

"If you weren't raised in the American health care system and your extended family is not necessarily available to you, then there's just a big absence of information I think that most of us take for granted," Olson said.

Somali lullabies played in the background of the messages about maternal well-being, playing and reading with children, feeding them fruits and vegetables, and how to bring down a fever and call a nurse line phone number for sick children. Messages encouraged well-child visits at age-appropriate intervals to check development, keep up to date on vaccines and talk about car seats, bike helmets and other safety measures.

One message, referring to a figure from a Somali folk tale, urged mothers to see a doctor if they feel sad, unmotivated and tired for more than a few weeks after having a baby. Another message focused on how to feed babies: "Do you want to introduce a new food to your baby? Give new foods in the morning, just in case your baby has any reaction to a new food. Then you can handle a problem during the day rather than at night and losing sleep."

Bashir said the research team's messages helped her serve more fruits and vegetables — oranges, apples, grapes, cabbage, spinach — instead of serving traditional high-carb foods. She began more closely monitoring the children's fat and protein intake.

"Now that I've started bringing these new foods, the children really like them — especially the apples," Bashir said. "If I bring it tonight, it'll be gone by tomorrow."

One mother interviewed by researchers said that back in Somalia, she would have let her child cry and finish what she was doing. After the study, she realized it was important to soothe the baby first and clean later.

"It just gave another way to think about what it means to have a young child and how to support them and be the best parent you can be," Susman-Stillman said. "That can look different in different places, especially if you're coming from a war-torn country where you've had a different kind of life experience."

Olson said she wants to continue signing up families to receive the message. She sees possibilities to apply the program more broadly — to people who are pregnant or have diabetes, blood pressure or other chronic diseases — in other languages, too, such as Spanish and Oromo.

She is used to sending several pages of recommendations home with patients, but, she added, "I'm sure a lot of that is just tossed, because you don't read English or it's a lot of information to sit down and look at when you're trying to get dinner for six or eight kids."