First year with the Somali Deep Engagement Partner

The Somali Deep Engagement Partner (DEP) have completed the first year of their 3-year programme.

Focus group 1 topic: nutrition and diverse healthy eating guidance

Objectives

• Explore nutrition and healthy eating practices among Somali‑speaking communities from Somaliland, Somalia, Djibouti, Kenya Somali Region, and Ethiopia Somali State living in Birmingham
• Understand cultural beliefs, trusted messengers, communication styles, and barriers that shape how communities engage with healthy eating messages
• Identify how culturally aligned and region‑specific approaches can improve the delivery of nutrition and wellbeing programmes

Findings

Shared cultural themes

• Strong appreciation for traditional foods such as canjeero, lahoh, maraq, camel and goat milk, grilled meats, and fruits, which are seen as healthy
• Concern about sweet tea, fried snacks, heavy oil and ghee, and processed foods, which are seen as harmful
• Food is tied to faith, family, identity, and hospitality, and it influences trust in health messages

Regional Differences

Somaliland

• Prefer visual, practical workshops by trusted community organisations
• Trust elders, Somalilander‑led organisations, and community media

Somalia

• Best engagement when messages are rooted in faith, prevention, and family duty
• Imams and Somali‑speaking professionals are most trusted

Djibouti

• Prefer oral storytelling, lived experience, and moderation‑focused advice
• Trust elders, respected cooks, and bilingual health professionals

Kenya Somali Region

• Poverty makes people rely on sugary tea, bread, and affordable fast foods
• Value practical, affordable guidance tied to faith and daily realities
• Major barriers include high food costs (87%), expensive produce (75%), and time pressures (46%)

Ethiopia Somali State

• Strong reliance on verbal, faith‑rooted communication delivered face‑to‑face
• High sensitivity to produce cost and reliance on halal markets
• Significant barriers because of low English literacy

Recommendations

• Tailor messaging by region:
  • Somaliland – cooking workshops and visual demonstrations
  • Somalia and Kenya – faith‑framed prevention messaging
  • Djibouti and Ethiopia – oral storytelling approaches
• Work with trusted leaders such as imams, elders, women's groups and Somali‑led organisations
• Respect culture and food traditions – look at how to change traditional dishes, not replace them
• Improve access to and affordability of vegetables, fruits, and dairy, and support healthier options in local markets
• Use accessible communication formats such as WhatsApp audio, radio, cooking demos and storytelling; avoid apps and written information

Focus group 2 topic: oral health

Objectives

• Explore oral health practices, perceptions of dental care, and access barriers among Somali communities from Somaliland, Somalia, Djibouti, Kenya Somali Region (NFD), and Ethiopia Somali Region living in Birmingham
• Understand how cultural and religious values, such as cleanliness (nadaafad) and the use of "caday", impact oral health behaviours
• Identify systemic, cultural, linguistic, and financial barriers affecting engagement with dental services
• Inform the design of community‑led, culturally aligned oral health education and service pathways

Findings

Oral health behaviours at home

• Caday (traditional toothbrush) is widely used, especially among older adults, while younger people use modern toothbrushes, but often brush only once daily
• Low understanding of fluoride, and there are mixed beliefs about whether it is safe or beneficial
• High costs of toothpaste and toothbrushes, especially for large families, and familiar brands are not always available locally
• High sugar consumption from tea and snacks is culturally embedded and linked to hospitality
• Religious values reinforce hygiene as cleanliness is seen as a faith‑based obligation, making caday culturally meaningful

Access to dental services

• Strong reliance on word‑of‑mouth, with many unaware that dental registration is required before treatment
• Practical barriers include appointment costs, transport, long waits, childcare demands, language challenges, and inconvenient appointment times
• Cultural disconnect – dental staff are usually unfamiliar with caday or Somali oral health norms, some participants felt rushed or judged
• Trust improves with kindness, patience, and clear explanations

Community preferences

• Strong desire for community‑based dental services, including mobile or pop‑up clinics in trusted Somali community spaces
• Preference for learning through Somali‑language education, videos, and workshops by trusted community organisations
• Interest in Somali oral health champions to guide families and show positive habits

Recommendations

Community‑led oral health education

• Expand Somali‑language resources across video, social media, WhatsApp, and community workshops
• Train Somali oral health champions to provide one‑to‑one guidance
• Promote the use of caday and fluoride toothpaste and provide information on fluoride benefits and safety

Improve access

• Provide free or subsidised oral‑care packs (fluoride toothpaste, toothbrushes and caday) through schools, community organisations, and refugee welcome kits
• Increase mobile dental clinics and family‑friendly appointment models such as group bookings and appointments on weekendsand evenings
• Organise regular screening and prevention days linked to wider wellbeing events
• Expand awareness of NHS dental exemptions, registration processes, and entitlements using simple Somali‑language guides
• Prioritise fluoride varnish and supervised toothbrushing in schools with high enrolment of Somali students

Strengthen cultural accessibility

• Use Somali interpreters (in person, phone, or video) to ensure dialectal sensitivity
• Integrate Somali cultural awareness, such as caday, hospitality norms and caregiving roles, into dental staff training

Partnership and integration

• Create a Somali oral health working group with trusted community organisations to coordinate actions and monitor progress
• Embed oral health within antenatal services, early years programmes, English for speakers of other languages (ESOL) classes, refugee and migrant services, and linked health pathways such as nutrition, diabetes, and family wellbeing

Focus group 3 topic: mental health

Objectives

• Explore mental health perceptions, challenges, stigma, and lived experiences within Somali communities in Birmingham, particularly among women, young women, and female genital mutilation (FGM) survivors
• Understand how culture, religion, gender roles, migration, trauma, and structural inequalities impact mental wellbeing
• Identify what makes it hard to access mental health services, including language, trust, racism, cultural misunderstandings, and a lack of Somali‑speaking professionals
• Inform the creation of culturally sensitive, gender‑responsive, and faith‑aligned mental health services

Findings

Gender roles, resilience, and pressure

• Stress, fear, depression, anxiety, and trauma, especially among FGM survivors and migrant women, were common
• Mental health is often stigmatised, reduced to "madness" or weakness, which limits open discussion
• Somali women are culturally expected to be strong, silent, and self-sacrificing, which discourages them from getting help
• FGM survivors report fear of judgment and struggle to access culturally appropriate care

Stigma and isolation

• Many interpret mental health struggles through a religious or spiritual lens, such as jinn (spirits) and spiritual weakness
• Relying on prayer alone often delays access to professional mental health support
• Common coping methods include prayer, silence, staying busy, or confiding in trusted peers
• Creative outlets such as poetry, music, art, and storytelling are viewed as safe, non‑threatening ways to express emotions

Systemic barriers to access

• Experiences of misdiagnosis, dismissal, prejudice, and racism by health professionals
• Lack of Somali‑speaking interpreters, counsellors, and therapists reduces trust and understanding
• Long waits and communication barriers affect engagement with services

Recommendations

Build culturally safe mental health pathways

• Make sure support is faith‑inclusive, culturally appropriate, and gender‑sensitive
• Use respected elders, Somali social media influencers, and faith‑aligned messaging to reduce stigma

Strengthen cultural competence

• Recruit Somali‑speaking counsellors, interpreters, peer mentors, and community mental health workers
• Provide trauma‑informed and culturally competent training for frontline staff, including an understanding of FGM‑related trauma
• Increase visibility and availability of Somali‑speaking professionals and interpreters
• Provide culturally appropriate food and request options for non‑invasive treatments in healthcare settings

Expand community‑led services

• Commission trusted Somali organisations to deliver community-based mental health education, advocacy, and safe disclosure pathways (including complaint pathways for medical misconduct)
• Support creative, culturally familiar wellness events such as poetry, music, art, and storytelling

Focus group 4 topic: exploring female genital mutilation (FGM), collaboration with Umbrella Sexual Health

Objectives

• Understand awareness and perceptions of FGM‑related sexual health services among diverse Somali women, young women, elders, and survivors
• Identify what makes it hard and easy to access support
• Co‑create a shared vision for culturally sensitive, respectful, and effective FGM care
• Explore the physical and emotional impacts of FGM and the gaps in current service provision

Findings

Perceptions of health services

• Participants were unaware of Umbrella services and did not know what they offer
• Most women did not know where to seek help for physical complications or trauma
• Participants rarely discuss FGM with GPs (General Practitioners, usually your family doctor) due to fear, shame, and language barriers
• Concerns about confidentiality, especially when interpreters are from the community
• No positive word‑of‑mouth about Umbrella clinics

Barriers to accessing support

• Stigma around being seen entering a sexual health clinic
• Uncomfortable with FGM support being located in mixed sexual health clinics, as they also provide contraception and STI testing
• Low trust in mainstream providers and a lack of diverse Somali‑speaking staff
• The impact of not accessing support includes persistent physical pain, emotional distress, trauma, fear and a lack of information during childbirth, particularly for FGM survivors

Preferences for support

• Strong preference for diverse Somali women‑only spaces that are safe, discreet, and private
• Services should be staffed by Somali‑speaking practitioners and peer advocates
• Community‑based settings (trusted centres) are preferred over hospitals or generic clinics
• Desire for holistic wellbeing services, such as vitamin deficiency clinics, within trusted community settings

Communication and trust

• Health messaging is not reaching diverse Somali women – reliance is on word‑of‑mouth, WhatsApp, social media, and community organisations, as written English information is usually inaccessible
• Trust is built through representation and shared lived experience
• Highest engagement occurs with trusted Somali‑led organisations

Recommendations

Improve cultural and trauma‑informed practice

• Provide culturally sensitive, trauma‑informed, non‑judgemental training for professionals, including GPs, with a focus on FGM‑related health
• Use neutral, non‑stigmatising language in communications
• Recruit female, diverse Somali‑speaking clinicians, peer navigators, and cultural mediators
• Train Somali women as community champions for FGM support

Service design and accessibility

• Establish dedicated FGM‑specific clinics within trusted community settings (not sexual health clinics) and make sure confidentiality is clearly communicated
• Provide non‑invasive examination options where appropriate
• Provide culturally sensitive pre‑pregnancy and maternity education for women affected by FGM
• Include FGM support within maternity and reproductive health services, using trauma‑informed and culturally aligned approaches
• Have trusted organisations deliver additional wellbeing support, such as vitamin deficiency clinics

Community outreach and engagement

• Use Somali social media influencers, storytelling, videos, and peer testimonies to normalise getting support
• Deliver outreach through trusted community organisations rather than websites
• Strengthen partnerships with trusted Somali‑led organisations
• Maintain a consistent community presence rather than one‑off campaigns

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Page last updated: 12 February 2026