No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Do Dutch Doctors Communicate Differently with Immigrant Patients than with Dutch Patients?
Abstract
The aim of this study was to gain deeper insight into relational aspects of the medical communication pattern in intercultural consultations at GP practices in the Netherlands. We ask whether there are differences in the verbal interaction of Dutch GPs with immigrant and Dutch patients. Data were drawn from 144 adult patient interviews and video observations of consultations between the patients and 31 Dutch GPs. The patient group consisted of 61 non-Western immigrants (Turkish, Moroccan, Surinamese, Antillean, Cape Verdian) and 83 Dutch participants. Affective and instrumental aspects of verbal communication were assessed using Roter's Interaction Analysis System (RIAS). Patients' cultural background was assessed by ethnicity, language proficiency, level of education, religiosity and cultural views (in terms of being more traditional or more modern). Consultations with the non-Western immigrant patients (especially those from Turkey and Morocco) were well over 2 min shorter, and the power distance between GPs and these patients was greater when compared to the Dutch patients. Major differences in verbal interaction were observed on the affective behavior dimensions, but not on the instrumental dimensions. Doctors invested more in trying to understand the immigrant patients, while in the case of Dutch patients they showed more involvement and empathy. Dutch patients seemed to be more assertive in the medical conversation. The differences are discussed in terms of patients' ethnic background, cultural views (e.g. practicing a religion) and linguistic barriers. It is concluded that attention to cultural diversity does matter, as this leads to different medical communication patterns. A two-way strategy is recommended for improving medical communication, with implications for both doctor and patient behavior.
... 9 In many countries with a culturally and linguistically diverse (CALD) demography, a significant level of health disparities have indeed been observed. 5,[10][11][12][13][14][15] Close examination of the reasons why such disparities occur suggests, that amongst other potential factors, health professionals often https://doi.org/10.1016/j.sapharm.2020.04.009 Received 18 December 2019; Received in revised form 6 April 2020; Accepted 6 April 2020 subconsciously provide varying levels of care when they encounter patients who are culturally and linguistically different to themselves. ...
... Received 18 December 2019; Received in revised form 6 April 2020; Accepted 6 April 2020 subconsciously provide varying levels of care when they encounter patients who are culturally and linguistically different to themselves. 5,7,10,11,13,16,17 Language barriers, in particular, are a key reason for differences in care provision. For example, in the US, patients with Chinese or Vietnamese background who had low English proficiency (LEP), received less health education compared to people with adequate English proficiency. ...
... 13 This situation is not limited to English speaking nations alone, similar patterns are also evident in European countries. 5,10,16,17 In a Dutch study about medical communication patterns, for example, consults with immigrant patients were shorter and more paternalistic in style compared to those provided by doctors to local Dutch patients, which were far more consultative. 11 Along with language, cultural aspects also may affect healthcare provision. ...
Background
In Australia, one of the world's significantly multicultural nations, asthma is one of the most common chronic conditions. A significant level of health disparities have been observed in many countries with a culturally and linguistically diverse demography. Previous studies have identified that language and culture affect health care provision, this is why culturally competent care is crucial when managing chronic conditions in diverse populations.
Objective
The purpose of this study was to explore Australian community pharmacists’ experience and perspective about providing care for CALD people with asthma.
Methods
Qualitative semi-structured interviews were used as the method of choice to fulfil the study objective. Participants were recruited purposively from suburbs of relative diversity in two Australian cities: Melbourne and Sydney. Interviews with consenting pharmacist were conducted using an interview guide. Verbatim transcripts of interviews were then thematically analysed.
Results
Thirty-two interviews resulted in five emergent themes 1) Pharmacists’ attitudes towards CALD patients and Cultural Competence; 2) Barriers and facilitators; 3) Clinical issues; 4) Cultural barriers; 5) Workarounds. It was evident that language and to a smaller extent, cultural barriers were experienced regularly by pharmacists managing CALD patients; pharmacists had mostly adapted with a range of methods to work around these barriers. Although pharmacists had a positive attitude, there seemed to be a need for enhanced cultural competence skills; reflections from pharmacists supported the need for further training and pharmacy specific resources.
Conclusions
There is a significant gap in cultural awareness among Australian pharmacists. Future direction suggests obligatory training in cultural competence for health professionals in order to be able to provide cultural proficient care.
... It has been suggested that modifiable factors that can facilitate better outcomes for CALD populations may include the healthcare provision setting, where there is currently much room for improvement globally (3). Research has found that language and culture CONTACT Reem Alzaye ralz@uni.sydney.edu.au ...
... unconsciously drive health professional attitudes toward CALD patients (3). A Dutch study, for example, reported patients from CALD backgrounds received less information about their conditions from doctors due to language barriers and poor communication with consultation times involving non-Dutch-speaking patients taking far longer than those with Dutch-speaking patients (3). ...
... unconsciously drive health professional attitudes toward CALD patients (3). A Dutch study, for example, reported patients from CALD backgrounds received less information about their conditions from doctors due to language barriers and poor communication with consultation times involving non-Dutch-speaking patients taking far longer than those with Dutch-speaking patients (3). In another study conducted with African Americans in the US, participants perceived their doctors cared more about prescribing medications than talking to patients (4). ...
Objective:
The purpose of this study was to explore General Practitioners' experiences and perspectives about asthma management of culturally and linguistically diverse (CALD) people with asthma, particularly with reference to Arabic speaking patients with low English proficiency (LEP).
Methods:
Semi-structured interviews guided by an interview protocol were conducted with general practitioners who deal with CALD patients with asthma. Participants were recruited from medical practices in Melbourne, Australia. Interviews were recorded and transcribed verbatim, followed by an inductive thematic analysis.
Results:
Data saturation was achieved after 21 interviews. Interviews lasted on average 30 minutes. Thematic analyses of the interview transcripts highlighted five key emergent themes: self-autonomy, language issues, accessibility and engagement, health literacy and cultural/beliefs issues. Many participants highlighted that CALD patients do not self-manage their asthma. Miscommunication was mentioned by some participants as stemming from language barriers. Patients' difficulty in engagement with the health system, lower accessibility to health care, social isolation and non-acclimatisation were other issues participants highlighted as problems in providing effective asthma care to CALD patients. Participants reported finding it more difficult to treat CALD patients with asthma compared to local patients. Conclusion: General practitioners perceived that treating culturally and linguistically diverse patients with asthma is difficult and many key barriers were observed to affect treatment. Cultural competence training for health professionals, as well as improving asthma and health system awareness in CALD patients with asthma and their carers, are key interventions that may address asthma management gaps in CALD patients.
... Studies in primary care have shown that affective communication is often a challenge for physicians, in particular in encounters with ethnic minority patients [9][10][11]. Previous studies have revealed that, compared to encounters where physician and patient share the same culture, in encounters with ethnic minority patients both physician and patient behave differently toward each other. ...
... Previous studies have revealed that, compared to encounters where physician and patient share the same culture, in encounters with ethnic minority patients both physician and patient behave differently toward each other. In the latter, there is less affective behavior, such as less social talk and empathy, and they are less emotionally engaged with each other [9][10][11][12]. Furthermore, both patient and physician communicate differently about unpleasant emotions [12][13][14][15]. ...
... Previous studies already examined cues and concerns expressed by ethnic minority patients [9 -11, 15, 18]. While some of these studies mainly focus on the comparison between native patients and specific ethnic minority patient groups [9][10][11], others focus on specialist care [18]. ...
Objective:
The diversity in our society makes patient-centered care more difficult. In this study, we aim to describe how family physicians respond to unpleasant emotions of ethnic minority patients.
Methods:
One hundred ninety one consultations of family physicians with ethnic minority patients were video-recorded and analyzed using the Verona Codes for Provider Responses (VR-CoDES-P) to describe physicians' responses to patients' expressed unpleasant emotions or cues (implicit) and concerns (explicit).
Results:
42.4% (n=81) of all the consultations contained no cues or concerns, and thus no physician responses. Of the consultations containing at least one cue or concern, a mean of 3.45 cues and a mean of 1.82 concerns per consultation were found. Physicians are significantly (p≤0.001) more frequently stimulating further disclosure of patients' cues and concerns (providing space: n=339/494 or 68.6% versus reducing space: n=155/494 or 31.4%). However, these explorations are more often about the factual, medical content of the cue than about the emotion itself (n=110/494 or 22.3% versus n=79/494 or 16%). The inter-physician variation in response to patients' cues is larger than the variation in response to the patient's concerns.
Conclusions:
Although family physicians are quite often providing room for patients' emotions, there is much room for improvement when it comes to explicitly talking about emotional issues with patients.
Practice implications:
Further research should focus on a more qualitative in-depth analysis of the complex interplay between culture and language of ethnic minority patients in primary care and, consequently, create awareness among these healthcare providers about the importance of ethnic minority patients' emotions and how to respond accordingly.
... Only 16 studies (9%) used mixed or multiple methods of analysis. Some studies used an existing quantitative coding scheme, such as the Roter Interaction Analysis System (RIAS, n = 18) for coding medical dialogue [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]; the Verona Coding Definitions of Emotional Sequences (VR-CoDES, n = 8) for analyzing emotional communication [37][38][39][40][41][42][43][44]; and the observing patient involvement (OPTION) scale to measure shared decision making (n = 5) [45][46][47][48][49]. ...
... ti,ab. 27 3 or 12 or 25 or 26 28 remove duplicates from 27 SCOPUS 1 TITLE-ABS-KEY ( ( video OR "video-based" OR "video record*" OR videorecord* OR "video tap*" OR videotap* OR videograph* OR audiovisual OR "audio-visual" OR "audio visual" OR pictograph*) W/5 ( encounter* OR consult* OR interact* OR conversation OR discuss* OR communicat* OR research) W/5 ( healthcare OR patient* OR "primary care" OR doctor* OR physician* OR nurse* OR clinician* OR provider* OR "health professional*")) 2 ...
Objective
To examine the use of video-based observational research in outpatient clinical health care encounter research.
Methods
We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to collect data to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics.
Results
Overall, 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies.
Conclusion
Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. Reporting of study design, methodological characteristics, and ethical considerations needs improvement.
Practice Implications
Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
... Another finding of the trial was that the duration of consultations with non-Western patients was shorter than consultations with Western patients. Analyzing the videotaped consultations (with the Roter Interactional Analyzing System or RIAS) (Roter, 1991), we found that the average speaking time of the physician was the same in consultations with Western and non-Western patients (Meeuwesen et al., 2006), but that the speaking time of patients differed a lot, as non-Western patients took less time to express themselves than Western patients. Also, they did not argue or converse as much as Western patients (Meeuwesen et al., 2006). ...
... Analyzing the videotaped consultations (with the Roter Interactional Analyzing System or RIAS) (Roter, 1991), we found that the average speaking time of the physician was the same in consultations with Western and non-Western patients (Meeuwesen et al., 2006), but that the speaking time of patients differed a lot, as non-Western patients took less time to express themselves than Western patients. Also, they did not argue or converse as much as Western patients (Meeuwesen et al., 2006). This finding points to a further factor to be aware of on the part of the physician, who should ask and stimulate non-Western patients to put their questions, express their anxieties, and to speak up when they don't understand or disagree. ...
DUE TO WORLDWIDE MIGRATION, physicians in Europe and North America commonly encounter more patients from different ethnic origins and cultural backgrounds than did their predecessors; and this has had important implications for healthcare, not only in presenting physicians with a variety of formerly ‘exotic’ medical symptoms and diseases, but also presenting them with differences in the way patients view their needs and the expectations they bring to the clinical encounter (Kleinman et al., 1978). While the prevailing attitude of Western medicine has shifted over the last thirty years to a mostly patient-centred model, focused on shared decision-making (Cegala et al., 2000; Cecil & Killeen, 1997; Edwards et al., 2003), one may wonder how this model fits with the attitudes of patients coming from culturally different backgrounds (Kleinman, 1980; Pachter, 1994; Harmsen, 2003).
... Top five patient and family factors with positive and negative associations to ECRC are presented in Figure 4 C. Cooperative or thankful patients 93,121,138,159,167 were seen as more likely to receive compassionate care, while uncooperative patients with behaviors seen as problematic (e.g., anger, aggression, entitlement) 38,87,102,138,147,149,159 and patients who crossed moral boundaries (i.e., drug dealers, sexual abusers) 87,149 , or patients who lack understanding or struggle to communicate 38,121,149,173 were seen as less likely. In contrast, a personal "click" and easy and open c o m m u n i c a t i o n a p p e a r e d t o f a c i l i t a t e ECRC 38,87,121,131,146,149,159,167,174 . Limited studies regarding patients' preferences 61 , self-efficacy 61 , level of sadness 175 , and level of distress 176 showed no effect on ECRC. ...
... Demographically, evidence suggested both the possibility that ECRC might be greater toward patients with greater income/education 101,138,178 or, conversely, to more vulnerable populations (impoverished, elderly, children) 38,61,138,179 . ECRC toward minorities (i.e., immigrants, people with a language barrier, "enemy" patients during military conflicts) tended to be lower 38,40,112,159,174,180 . Blacks/African Americans were less likely recipients of ECRC as compared to W h i t e s 1 1 2 , 1 2 1 , 1 8 1 . ...
Background:
Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC).
Methods:
A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach.
Results:
One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC.
Discussion:
The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.
... 21 Some studies also described differences in interpersonal quality, with less empathetic treatment, insensitivity to cultural differences or worse communication. 19,[22][23][24] At national level, available evidence revealed less diagnostic testing in foreign patients. 25 In summary, the evidence available on changes in quality of health care during the crisis is very limited; it does not focus on immigrant population, and incorporates only partially the actors' viewpoint. ...
... These problems appear to affect immigrant users more acutely. Some are consistent with problems described in immigrant care prior to the crisis, in this 30 and other contexts, 19 but seem to have become more acute. Allowing enough time is particularly relevant for immigrant patients when making a diagnosis, because of the communication difficulties that often arise due to linguistic/cultural barriers and which may be further complicated by the reduction in mediation staff. ...
Objective:
To analyse changes in health professionals' and immigrant users' perceptions of the quality of care provided to the immigrant population during the crisis.
Methods:
A qualitative descriptive-interpretative and exploratory study was conducted in two areas of Catalonia. Semi-structured individual interviews were used with a theoretical sample of medical (n=24) and administrative (n=10) professionals in primary care (PC) and secondary care (SC), and immigrant users (n=20). Thematic analysis was conducted and the results were triangulated.
Results:
Problems related to technical and interpersonal quality emerged from the discourse of both professionals and immigrants. These problems were attributed to cutbacks during the economic crisis. Regarding technical quality, respondents reported an increase in erroneous or non-specific diagnoses, inappropriate use of diagnostic tests and non-specific treatments, due to reduction in consultation times as a result of cuts in human resources. With regard to interpersonal quality, professionals reported less empathy, and users also reported worse communication, due to changes in professionals' working conditions and users' attitudes. Finally, a reduction in the resolution capacity of the health services emerged: professionals described unnecessary repeated PC visits and limited responses in SC, while young immigrants reported an insufficient response to their health problems.
Conclusion:
The results indicate a deterioration in perceived technical and interpersonal quality during the economic crisis, due to cutbacks mainly in human resources. These changes affect the whole population, but especially immigrants.
... Op vlak van gezondheid brengt 'superdiversiteit' een waaier aan sociaal-cultureel bepaalde opvattingen over ziekte, gezondheid en genezingsprocessen met zich mee (Helman, 2007;Heylen, 2015;Lovering, 2006;Roy, Torrez, & Dale, 2004). Culturele attitudes, denkwijzen en geloofssystemen bepalen mee het gezondheidsgedrag en de levensstijl van de verschillende bevolkingsgroepen (Harmsen, 2003;Kleinman, 1980;Levecque et al., 2006;Meeuwesen, Harmsen, Bernsen, & Bruijnzeels, 2006 (Anson, 2001;Levecque et al., 2006;Roy et al., 2004). De Westerse visie over ziekte en gezondheid is voornamelijk gebaseerd op een wetenschappelijk biomedisch model waarbij de oorzaak van een ziekte niet gezocht wordt in het bovennatuurlijke. ...
... Personen met een buitenlandse herkomst zijn mogelijk niet in staat om hun gezondheidstoestand correct en/of volledig te beschrijven waardoor het risico op een foute diagnose toeneemt (Luijten & Tjadens, 1995;Meeuwesen et al., 2006;Schinkel, Schouten, & van Weert, 2013;Street, Gordon, & Haidet, 2007). Het gebrek aan taalvaardigheid belemmert hen ook in het actief deelnemen aan de consultatie waardoor ze vaak na de consultatie met vele vragen naar huis keren . ...
In een samenleving die gekenmerkt wordt door superdiversiteit dringt zich een cultureel competente vorm van preventie op. Onderzoek leert immers dat gezondheidspromotie en ziektepreventie individuen met een buitenlandse herkomst minder goed bereiken. Verschillende redenen worden naar voren geschoven om deze ‘mismatch’ te verklaren. Deze redenen houden verband met de doelgroep zelf, de gezondheidsverstrekkers en de structuur van het gezondheidssysteem. Concreet wordt onder meer verwezen naar de invloed van taal, socio-culturele waarden en normen, sociale verwachtingen en omkadering, leefgewoonten, de specificiteit van de ziektebeelden, werk- en woonomstandigheden, etc.
Met dit onderzoek wil het Steunpunt Inburgering & Integratie nadenken over hoe een cultureel competente vorm van preventie er kan uitzien. Aan de hand van interviews met huisartsen in Antwerpen (de districten) wordt nagegaan wat hun ervaring is met preventie bij patiënten met een buitenlandse herkomst.
... This finding is supported by earlier studies reporting on ethnic Dutch patients receiving better care than Dutch patients with a migration background. 32 33 39 Some papers report that healthcare workers confessed to ignoring patients with a migration background when they complained about pain because they believed it was part of their culture. 35 36 39 This phenomenon is also known as 'the Mediterranean Syndrome'. ...
Objective
To explore and characterise the discrimination and racism experienced in healthcare from the perspective of Dutch patients with a migration background.
Design
This was a qualitative phenomenological study incorporating an inductive thematic analysis of the answers provided to a free form online survey. Descriptive and differential analyses were conducted for the closed-ended questions.
Setting
This study used an online survey distributed in Dutch about experiences of discrimination and racism in healthcare to the general population in the Netherlands.
Participants
The survey was completed by 188 participants (M age =39.89, SD age =10.2). Of whom 80 (M age =37.92, SD age =10.87) met the eligibility criteria for thematic analysis (ie, has a migration background or a relative with a migration background and experienced discrimination in healthcare based on their background) and were thus included in the analysis.
Results
From the total sample, women, relative to men, were 2.31 times more likely to report experiencing healthcare discrimination (OR=2.31; 95% CI 1.23 to 4.37). The majority of the participants (60.1%) had a Moroccan or Turkish background. Six themes were identified relating to experienced discrimination in healthcare based on one’s migration background: (1) explicit discrimination, (2) prejudice, (3) not being taken seriously, (4) discriminatory behaviour, (5) language barriers and (6) pain attribution to cultural background. Some participants reported that their attire or religion was linked to their migration background, thus contributing to their experiences of discrimination.
Conclusion
Dutch patients with a migration background may experience discrimination based on their ethnic identity or other factors related to their backgrounds, such as their faith, culture and skin colour. Discrimination manifests as intersectional and may take different forms (eg, discrimination based on the intersection between race and gender). Therefore, healthcare discrimination may increase health inequities and lead to unequal access to healthcare services. Implicitly or explicitly discriminating against patients is immoral, unethical, illegal and hazardous for individual and public health. Further research on the magnitude of discrimination in healthcare and its relation to health is needed.
... Although many studies of cross-cultural communication in healthcare, mainly in Europe and the United States, have discussed the importance of cross-cultural sensitivity, there is still no clear evidence on results such as patient outcomes [22,[24][25][26][27]. However, in Japan, studies of nurses have reported that nurses avoid engaging with foreign patients by not listening sufficiently to their complaints, walking away from them, and providing only minimal care [28][29][30][31]. ...
Background: To identify factors necessary for the proper inclusion of foreigners in Japanese healthcare, we conducted a survey to determine whether foreign residents, even those with high socioeconomic status, referred to as “Highly Skilled Foreign Professionals”, experience difficulties when visiting medical institutions in Japan, using satisfaction level as an indicator. Method: A five-point Likert-scale, anonymous, online questionnaire was administered to faculty and doctoral students enrolled at the Okinawa Institute of Science and Technology Graduate University (OIST). The respondents’ demographics and their opinions on what they found difficult or important during medical examinations, their impression of Japanese medical personnel, their requirements for language support and interpretation, and their opinions about local healthcare delivery systems were collected. The questionnaires were distributed and collected using Microsoft Forms. Results: Responses were obtained from 90 respondents (response rate: 20.7%). The percentage of respondents who were dissatisfied (bottom two of five Likert scales) with medical care in Japan was 23.4%. In univariate logistic regression analysis, 11 of 35 questions were significantly correlated with dissatisfaction with medical care (p < 0.1). Duration of stay, presence of family members living with the patient, satisfaction with life, and perceived usefulness of language support were negatively correlated with dissatisfaction with medical care, while communication problems with medical personnel, need for medical personnel to respect patients’ culture, religion, and privacy, and difficulty in getting to medical facilities were positively correlated with dissatisfaction with medical care. No significant correlations were found with age, gender, or Japanese language level. Multiple logistic regression analysis showed that the presence of family members living with the subject (AOR = 0.092, p = 0.010), the desire for multilingual documentation (AOR = 0.177, p = 0.046), the physician’s concern for the patient’s culture and religion (AOR = 8.347, p = 0.029), and difficulty in communication with healthcare providers (AOR = 6.54, p = 0.036) were significantly correlated with overall dissatisfaction with medical care. Discussion: On average, the targeted Highly Skilled Foreign Professionals did not have strong levels of dissatisfaction with Japanese healthcare, but when they did have dissatisfaction, it was related to language barriers, lack of cultural and religious considerations, and difficulty in communication with healthcare providers. We believe that the results indicate the focus points of support necessary for the inclusion of foreigners. We also believe that the finding that family cohabitation is associated with satisfaction with medical care is a useful insight into effective reciprocal support on the part of patients.
... According to the WHO, the right to health implies equal and timely access to health-care services for equal health needs, the provision of health-related education and information, and the participation of the population in health-related decisions at the national and community levels. Health-care services should be physically and financially accessible to all subgroups of the population, including vulnerable groups, and should be delivered without any discrimination (16,17). ...
Introduction
The health status and health care needs of immigrant populations must be assessed. The aim of this study was to evaluate barriers to accessing primary care and the appropriateness of health care among resident immigrants in Italy, using indicators regarding maternal health, avoidable hospitalization, and emergency care.
Methods
Cross-sectional study using some indicators of the National Monitoring System of Health Status and Healthcare of the Immigrant Population (MSHIP), coordinated by the National Institute for Health, Migration and Poverty (INMP), calculated on perinatal care, hospital discharge, and emergency department databases for the years 2016–2017 in nine Italian regions (Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Latium, Basilicata, Sicily). The analyses were conducted comparing immigrant and Italian residents.
Results
Compared to Italian women, immigrant women had fewer than five gynecological examinations (8.5 vs. 16.3%), fewer first examinations after the 12th week of gestational age (3.8 vs. 12.5%), and fewer than two ultrasounds (1.0 vs. 3.8%). Compared to Italians, immigrants had higher standardized rates (× 1,000 residents) of avoidable hospitalizations (males: 2.1 vs. 1.4; females: 0.9 vs. 0.7) and of access to emergency departments for non-urgent conditions (males: 62.0 vs. 32.7; females: 52.9 vs. 31.4).
Conclusions
In Italy, there appear to be major issues regarding accessing services and care for the immigrant population. Policies aimed at improving socioeconomic conditions and promoting integration can promote healthy lifestyles and appropriate access to health care, counteracting the emergence of health inequities in the immigrant population.
... However, the doctor-patient interaction is key in identifying patients needing a referral [28]. Previous research has shown that not speaking the same language is associated with decreased symptom reporting, fewer referrals to specialist care [29] and shorter consultation time [30], which also could explain our results. An inverse socioeconomic gradient in terms of utilization of outpatient/ specialist care has also been documented in Norway [31] that confirms privileged groups are those that avail most of services [32]. ...
Background
Understanding the differential utilization of healthcare services is essential to address the public health challenges. Through the migration process, refugees move from one set of health risk factors to another and can face multiple healthcare challenges along their journey. Yet how these changing risk factors influence refugees’ use of health care services is poorly understood.
Methods
A longitudinal survey assessing health care utilization of 353 adult Syrian refugees was conducted; first in a transit setting in Lebanon and after one year of resettlement in Norway. The main outcomes are the utilization of general practitioner services, emergency care, outpatient and/or specialist care and hospitalization during the previous 12 months. Associations between use of healthcare services and several sociodemographic, migration-related and health status variables at both time points were found using regression analysis. We also analyzed longitudinal changes in utilization rates using generalized estimating equations.
Results
The use of general practitioner and emergency care increased after resettlement while outpatient/specialist care markedly dropped, and hospitalization rates remained the same. Undocumented status and poor self-rated health (SRH) prior to resettlement were identified as predictors for use of health care after arrival. After resettlement, higher health literacy, higher education, higher social support and poor SRH and quality of life were significantly associated with use of healthcare services.
Conclusions
Utilization of health services changes post migration to the destination country and are associated with migration-related and socio-demographic factors. Poor SRH is associated with use of services, both pre-arrival and post-resettlement. Our findings have implications for future resettlements, health care policies and service provision to newly arrived refugees with regard to both health needs as well as delivery of services.
... Studies amongst general practitioners and oncologists show that physicians often communicate differently with non-western patients with an immigrant background: consultations are shorter and less focused on involvement and empathy, [52] patients are involved less in decision-making, [53] and more medical jargon is used. [54] However, it is not at all evident that patient needs for prognostic discussion differ between western and non-western patients. ...
Background: Personalized ENCALS survival prediction model reliably estimates the personalized prognosis of patients with amyotrophic lateral sclerosis. Concerns were raised on discussing personalized prognosis without causing anxiety and destroying hope. Tailoring communication to patient readiness and patient needs mediates the impact of prognostic disclosure. We developed a communication guide to support physicians in discussing personalized prognosis tailored to individual needs and preferences of people with ALS and their families.
Methods: A multidisciplinary working group of neurologists, rehabilitation physicians, and healthcare researchers A) identified relevant topics for guidance, B) conducted a systematic review on needs of patients regarding prognostic discussion in life-limiting disease, C) drafted recommendations based on evidence and expert opinion, and refined and finalized these recommendations in consensus rounds, based on feedback of an expert advisory panel (patients, family member, ethicist and spiritual counsellor).
Results: A) Topics identified for guidance were 1) filling in the ENCALS survival model, and interpreting outcomes and uncertainty, and 2) tailoring discussion to individual needs and preferences of patients (information needs, role and needs of family, severe cognitive impairment or frontotemporal dementia, and non-western patients). B) 17 studies were included in the systematic review. C) Consensus procedures on drafted recommendations focused on selection of outcomes, uncertainty about estimated survival, culturally sensitive communication, and lack of decisional capacity.
Recommendations for discussing the prognosis include the following: discuss prognosis based on the prognostic groups and their median survival, or, if more precise information is desired, on the interquartile range of the survival probability. Investigate needs and preferences of the patients and their families for prognostic disclosure, regardless of cultural background. If the patient does not want to know their prognosis, with patient permission discuss the prognosis with their family. If the patient is judged to lack decisional capacity, ask the family if they want to discuss the prognosis. Tailor prognostic disclosure step by step, discuss it in terms of time range, and emphasize uncertainty of individual survival time.
Conclusion: This communication guide supports physicians in tailoring discussion of personalized prognosis to the individual needs and preferences of people with ALS and their families.
... Studies amongst general practitioners and oncologists show that physicians often communicate differently with non-western patients with an immigrant background: consultations are shorter and less focused on involvement and empathy, [52] patients are involved less in decision-making, [53] and more medical jargon is used [54]. However, it is not at all evident that patient needs for prognostic discussion differ between western and non-western patients. ...
Background
Personalized ENCALS survival prediction model reliably estimates the personalized prognosis of patients with amyotrophic lateral sclerosis. Concerns were raised on discussing personalized prognosis without causing anxiety and destroying hope. Tailoring communication to patient readiness and patient needs mediates the impact of prognostic disclosure. We developed a communication guide to support physicians in discussing personalized prognosis tailored to individual needs and preferences of people with ALS and their families.
Methods
A multidisciplinary working group of neurologists, rehabilitation physicians, and healthcare researchers A) identified relevant topics for guidance, B) conducted a systematic review on needs of patients regarding prognostic discussion in life-limiting disease, C) drafted recommendations based on evidence and expert opinion, and refined and finalized these recommendations in consensus rounds, based on feedback of an expert advisory panel (patients, family member, ethicist, and spiritual counsellor).
Results
A) Topics identified for guidance were 1) filling in the ENCALS survival model, and interpreting outcomes and uncertainty, and 2) tailoring discussion to individual needs and preferences of patients (information needs, role and needs of family, severe cognitive impairment or frontotemporal dementia, and non-western patients). B) 17 studies were included in the systematic review. C) Consensus procedures on drafted recommendations focused on selection of outcomes, uncertainty about estimated survival, culturally sensitive communication, and lack of decisional capacity.
Recommendations for discussing the prognosis include the following: discuss prognosis based on the prognostic groups and their median survival, or, if more precise information is desired, on the interquartile range of the survival probability. Investigate needs and preferences of the patients and their families for prognostic disclosure, regardless of cultural background. If the patient does not want to know their prognosis, with patient permission discuss the prognosis with their family. If the patient is judged to lack decisional capacity, ask the family if they want to discuss the prognosis. Tailor prognostic disclosure step by step, discuss it in terms of time range, and emphasize uncertainty of individual survival time.
Conclusion
This communication guide supports physicians in tailoring discussion of personalized prognosis to the individual needs and preferences of people with ALS and their families.
... Studies amongst general practitioners and oncologists show that physicians often communicate differently with non-western patients with an immigrant background: consultations are shorter and less focused on involvement and empathy, [52] patients are involved less in decision-making, [53] and more medical jargon is used. [54] However, it is not at all evident that patient needs for prognostic discussion differ between western and non-western patients. ...
Background: Personalized ENCALS survival prediction model reliably estimates the personalized prognosis of patients with amyotrophic lateral sclerosis. Concerns were raised on discussing personalized prognosis without causing anxiety and destroying hope. Tailoring communication to patient readiness and patient needs mediates the impact of prognostic disclosure. We developed a communication guide to support physicians in discussing personalized prognosis tailored to individual needs and preferences of people with ALS and their families.
Methods: A multidisciplinary working group of neurologists, rehabilitation physicians, and healthcare researchers A) identified relevant topics for guidance, B) conducted a systematic review on needs of patients regarding prognostic discussion in life-limiting disease, C) drafted recommendations based on evidence and expert opinion, and refined and finalized these recommendations in consensus rounds, based on feedback of an expert advisory panel (patients, family member, ethicist and spiritual counsellor).
Results: A) Topics identified for guidance were 1) filling in the ENCALS survival model, and interpreting outcomes and uncertainty, and 2) tailoring discussion to individual needs and preferences of patients (information needs, role and needs of family, severe cognitive impairment or frontotemporal dementia, and non-western patients). B) 17 studies were included in the systematic review. C) Consensus procedures on drafted recommendations focused on selection of outcomes, uncertainty about estimated survival, culturally sensitive communication, and lack of decisional capacity.
Communication guide: We recommend discussing prognosis based on the prognostic groups and their median survival, or, if more precise information is desired, on the interquartile range of the survival probability. Regardless of cultural background, investigate needs and preferences of the patients and their families regarding prognostic disclosure. If the patient does not want to know their prognosis, with patient permission this can be discussed with their family. If the patient is judged to lack decisional capacity, ask the family if they want to discuss the prognosis. Tailor prognostic disclosure step by step, discuss it in terms of time range, and emphasize uncertainty of individual survival time.
Conclusion: This communication guide supports physicians in tailoring discussion of personalized prognosis to the individual needs and preferences of people with ALS and their families.
... One study found that patients disclosed more information to female physicians, 10 while another study found that Dutch doctors had longer and more involved conversations with Dutch patients compared Open access with immigrant patients. 11 These findings revealed that patients and clinicians may alter communication styles based on audience. ...
Patient-centered organisations
Healthcare organisations now integrate patient feedback into value-based compensation formulas. This research considered Stanford Healthcare’s same-day feedback, a programme designed to evaluate the patient experience. Specifically, how did patients with cancer interviewed in the programme assess their physicians? Furthermore, how did assessments differ across emotional, physical, practical and informational needs when interviewed by volunteer patient and family partners (PAFPs) versus hospital staff?
Patient–physician communication barriers
Integral to this research was Communication Accommodation Theory (CAT), which suggests individuals adjust interactions based on conversational roles, needs and understanding. Previous influential research was conducted by Frosch et al (2012) and Di Bartolo et al (2017), who revealed barriers to patient–physician communication, and Baker et al (2011) who associated CAT with these interactions. However, we still did not know if patients alter physician assessments between interviewers.
Volunteers collect patient needs
This mixed methods study worked with 190 oncology unit patient interviews from 2009 to 2017. Open-ended interview responses underwent thematic analysis. When compared with hospital staff, PAFPs collected more practical and informational needs from patients. PAFPs also collected more verbose responses that resembled detailed narratives of the patients’ hospital experiences. This study contributed insightful patient perspectives of physician care in a novel hospital programme.
... General practitioners invested more time in understanding patients' concerns with immigrant patients, while with Dutch patients they showed more involvement and more empathy for suffering. 20 Two studies conducted among immigrants in The Netherlands suggested that in consultations with immigrant patients with poor Dutch language proficiency, there was poorer communication, and poorer understanding by physicians. This population was the least satisfied with the care they received, and hence least compliant with their healthcare. ...
Good communication is essential in neurological consultations, yet this is obviously compromised by the absence of a common language. Interpreters can make valuable contributions to improving consultations, but translation has its shortcomings. The consultation dialogue is not always interpreted correctly or accurately, even (or especially) when friends or family are translating. Clinicians should therefore try to ensure that key information has been communicated and understood, perhaps by repetition or asking the patient to say what they have understood. Cultural factors are also important in the patient–physician interaction. Physicians should try to adopt a culturally sensitive approach during consultations, familiarising themselves with cultural norms within the prevalent ethnic minority groups in their area. They should resist directive approaches to save time and try to involve the patient in decision-making. This requires allocating extra time to consultations with patients for whom English is not their first language.
... Social and ethnic disparities are documented in pregnancy and childbirth outcomes in Europe, North America, and Australia [1,2]. Social, cultural, and language differences between health care providers and immigrants have been shown to affect the interaction, trust, and communication [3], which leads to reduced quality of care [4][5][6]. In Norway and Sweden, communication issues have been linked directly to suboptimal health care for immigrant women and increased perinatal death rates [7,8]. ...
Inequity in immigrants’ health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system.
... In one study, Dutch GP consultations with non-Western immigrant patients were on average two minutes shorter than consultations with Dutch patients. With immigrant patients, GPs invested more time in understanding patients' concerns while for Dutch patients they showed more involvement and empathy for suffering 18 . ...
Frequent immigration of peoples from outside often challenges various systems of any country; healthcare sector is the most confronted one. One of the most prominent reasons for this confrontation is communication gap between physicians and immigrant patients. In this systematic narrative review, we studied existing literature on physician-immigrant patient communication. We systematically searched the repositories of literature and followed some criteria to select literature. We selected 32 literatures for information extraction. Three themes emerged from the synthesis: Physicians’ viewpoint about communication barrier with their immigrant patients, Immigrant patients’ viewpoint about the communication barrier with their physicians, and Interpreter as a mitigation process of communication barrier and associated challenges. Physicians are mostly concerned about the fidelity of their conversation with immigrant patients while the Immigrant patients are mostly concerned about their culture and sometimes fearful that the physicians will misunderstand them due to lack of language proficiency. This review provides an updated summary of communication barriers that may arise between physicians and immigrant patients, and their effects on quality of care.
... Mehrere Studien fokussieren die kommunikative Interaktion zwischen Ärz-tInnen und PatientInnen. In den Niederlanden untersuchten Meeuwesen et al. (2006; die Kommunikationsmuster zwischen AllgemeinpraktikerInnen und nicht-westlichen sowie niederländischen PatientInnen. Sie stellten zunächst fest, dass die Konsultationen mit den MigrantInnen, insbesondere tür-kischer und marokkanischer Herkunft, im Durschnitt über zwei Minuten kür-zer waren und der Machtunterschied zwischen den ÄrztInnen und diesen PatientInnen grösser war als bei den NiederländerInnen. ...
Migration & Gesundheit: Übersicht über ausgewählte Fachliteratur 2006-2008
... It is believed that communication barriers, including language barriers, play a role, as well as cultural barriers and bias of health care providers. Health care providers generally communicate less effectively with migrants and ethnic minorities (Paternotte, 2015;Meeuwesen, 2006) and show less affective behaviours. While it is generally agreed that cultural competence training can result in better access to and increased quality of care for migrants and ethnic minorities (Horvat, 2014;Tuong, 2014;Beach 2005;Chiarenza 2018), cultural and ethnic diversity is not an integrated part of medical education and cultural diversity training is an under-represented topic in the medical curriculum (Sorensen, 2017a, Paternotte et al., 2014Smedley et al., 2003;Van Wieringen, 2003). ...
Background
Health inequalities related to culture and ethnicity may be reduced by training future health care providers.
Medical teachers therefore also need to be culturally competent. The aim of this study was to assess medical teachers' preparedness and their training needs to teach cultural competence topics and to teach a diverse class.
Methods
A link to an online survey was sent to medical teachers of eleven European institutions. Results were analysed through descriptive analysis and answers to open-ended questions were analysed using qualitative analysis.
Results
968 respondents were included. The majority of respondents felt it was important that cultural competence topics should be incorporated into the medical curriculum. Assessment of skills in cultural competence was found important as well.
Over 60% of all respondents reported to be somewhat or very prepared to teach cultural competence topics like migrant health and disparities. Most respondents felt somewhat or very prepared to teach a diverse class. A high interest in training was expressed on teaching cultural competence topics, specifically on communication-related topics.
Conclusion
This study emphasizes the importance of incorporating cultural issues into the medical curriculum and to train medical teachers according to their needs.
... Social determinants are worthy of specific consideration: not only low socio-economic status but also separation from family, xenophobic feelings in the larger community, traditional beliefs influencing healthseeking behaviour, the lack of policies to protect migrants' labour rights and welfare, etc. Even if problems may be stronger within insurance-type healthcare systems, several reports show that migrants are undertreated also in systems based on a principle of equality of access (such as many European healthcare systems), due both to personal barriers and to sociocultural conditions: for instance, worse clinical relationships, with regard both to verbal interaction and to personal empathy (Schouten and Meeuwesen 2006;Meeuwesen et al. 2006). ...
The right to health implies, among other things, that individuals and communities must be allowed to have a voice in decisions concerning the definition of their well-being. The article argues for a more active participation of ethnocultural minorities in healthcare decisions and highlights the relevance of strategies aimed at creating a bottom-up engagement of people and groups, as well as of measures aimed at a broader organizational flexibility, in order to meet migrants’ and minorities’ needs. Finally, the article clarifies that these strategies are not simply the outcome of a welcoming attitude of the Western healthcare system but may be interpreted as a specific duty resulting from the notion of “particularly vulnerable groups,” as formulated by the ECtHR in its case law: when vulnerable groups are at stake, every decision about state actions and rules regarding healthcare should start from an aprioristic favour towards the needs of vulnerable minority groups
... [15,16] Our findings for the Turkish women were consistent with previous research that demonstrated a negative association with having a first generation Turkish immigrant background and having to communicate about medical topics with the caregiver. [55] Literature provided no confirmation for the findings of the Surinamese group concerning the inadequate communication in obstetric care. Possibly their negative opinions were influenced by the caregivers' directive and culturally unadjusted communication skills and the fact that the content of given information did not meet their cultural and religious views on health and healthcare. ...
Background
Low-educated native Dutch and non-western minority women have inadequate access to obstetric care. Moreover, the care they receive lacks responsiveness to their needs and cultural competences. Gaining a deeper understanding of their experiences and satisfaction with antenatal, birthing and maternity care will help to adjust healthcare responsiveness to meet their needs during pregnancy, childbirth and the postpartum period.
Methods
We combined the World Health Organization conceptual framework of healthcare responsiveness with focus group research to measure satisfaction with antenatal, birthing and maternity care of women with a low-educated native Dutch and non-western ethnic background.
Results
From September 2011 until December 2013, 106 women were recruited for 20 focus group sessions. Eighty-five percent of the women had a non-western immigrant background and 89% a low or intermediate educational attainment. The study population was mostly positive about the provided care during the antenatal phase. They were less positive about the other two phases of care. Moreover, the obstetric healthcare systems’ responsiveness in all phases of care (antenatal, birthing and maternity) did not meet these women’s needs. The ‘respect for persons’ domains ‘autonomy’, ‘communication’ and ‘dignity’ and the ‘client orientation’ domain ‘prompt attention’ were judged most negatively.
Conclusions
The study findings give contextual meaning and starting points for improvement of responsiveness in the provision of obstetric care within a multi-ethnic women’s population.
... For instance, patients will be more enabled to discuss medical issues when they share sufficient common ground regarding preferred and enacted communication styles and a common language with their physician. Previous research has indeed indicated that ethnic minority patients who are less proficient in the physicians' language had lower participation levels compared to ethnic minority patients who are more proficient (e.g., Meeuwesen, Harmsen, Bernsen, & Bruijnzeels, 2006). As Turkish-Dutch patients are the least proficient in the Dutch language of all main migrant groups in the Netherlands (Huijnk & Dagevos, 2012), their low Dutch language proficiency might be an important barrier to their participation during medical encounters. ...
Previous research has shown that ethnic minority patients participate less during medical encounters than patients from majority populations. Given the positive outcomes of active patient participation, such as higher understanding of information and better treatment adherence, interventions are required to enhance ethnic minority patients’ participation levels. However, little is known about what patients perceive as barriers hindering their participation. This study therefore aimed to explore differences in perceptions of barriers to patient participation among ethnic minority and ethnic majority patients in general practice. Eight focus-groups with Turkish-Dutch and indigenous Dutch participants were performed. A semi-structured topic-list concerning patients’ enabling and predisposing factors to participate, and physicians’ responses guided the interviews. Interviews were recorded, transcribed verbatim, and transcripts were analyzed using the constant comparison method described in Grounded Theory. Regarding Turkish-Dutch patients’ enabling factors to participate, two perceptions of barriers were identified: (i) low Dutch language proficiency; (ii) a preference for an indirect communication style. Three perceptions of barriers to Turkish-Dutch patients’ predisposition to participate were identified: (i) collectivistic values; (ii) power distance; (iii) uncertainty avoidance. Regarding doctors’ responses, discrimination was identified among Turkish-Dutch patients as a perception of barrier to their patients’ participation. None of these perceptions of barriers emerged among indigenous Dutch patients. This study contributes to our understanding of which perceptions of barriers might impede ethnic minority patients’ level of patient participation. To enhance their participation, a combined intervention is needed, tackling the language barrier, raising awareness about cultural differences in values, and increasing doctors’ cultural competencies to communicate adequately with ethnic minority patients.
... , Luengo, Izquierdo, Juando-Prats,Sáenz de Ormijana & Robledo, 2015;Briones Vozmediano, Agudelo Suárez, López Jacob, Vives Cases, Ballester Laguna & Ronda Pérez, 2014;Canga, Vivar & Naval, 2011;Casado Marín, 2006;Casado-Mejía et al., 2009;Galiana-Gómez de Cádiz et al., 2008;Gallart, Cruz & Zabalegui, 2013;Garcés, Carretero, Ródenas & Vivancos, 2010;Zabalegui et al., 2008), Italia(ANS, 2015; INPS, 2015;Lazzarini, Santagati & Bollani, 2007;Melchiori, 2008;Starovici, 2015), Reino Unido(Bunting & Jenkins, 2016;Davis & Smith, 2013;Downs & Collins, 2015;Gu, Rosenberg & Zeng, 2017;Hawkes et al., 2015;Henderson, Baker &Mak, 2016;Likupe, 2014;Meeuwesen, Harmsen, Bernsen & Bruiknzeels, 2006;Mold, Fitzpatrick & Roberts, 2005;Sienko, 2002;Slewa-Younana, Santalucia, McDonald & Salem, 2016;Victor, Martin & Zubair, 2011), Rumanía (Ministry of Labour, 2017; National Council of Elderly People, 2015; The Government ofRomania, 2015). ...
Introducción: El proyecto europeo IENE7 aglutina cinco socios (dos en Italia, Reino Unido, Rumanía y el grupo de investigación HUM-498 Intervención Psicológica en Desarrollo, Educación y Orientación de la Universidad de Almería) con el objetivo común de desarrollar un modelo adecuado de educación dirigido a cuidadores informales de personas mayores que reciben atención en el hogar. Este colectivo de cuidadores procede en un alto porcentaje de grupos desfavorecidos (inmigrantes, personas sin formación o en riesgo de exclusión social, etc.). El objetivo principal de esta fase del proyecto es conocer las necesidades de cuidado de las personas mayores en el hogar, así como las necesidades formativas de sus cuidadores, en este contexto europeo en el que se desarrolla el proyecto. Metodología:Se realizó una revisión de la literatura científica tanto a nivel nacional (España, Italia, Reino Unido y Rumanía) como internacional. Resultados: El análisis de necesidades, desde nuestra doble perspectiva de partida (necesidades de cuidado para las personas mayores y necesidades formativas para sus cuidadores informales) puede sintetizarse en seis aspectos clave: 1) Soledad, 2) Problemas de comunicación, 3) Necesidad de un cuidado centrado en la persona y culturalmente apropiado, 4) Limitación de la Movilidad, 5) Seguridad y Protección (aspectos éticos y legales del cuidado), 6) Recursos sociosanitarios. Conclusiones: El conocimiento de estas necesidades de cuidado para las personas mayores y formativas de sus cuidadores informales constituye un punto de partida imprescindible para la propuesta y desarrollo de un modelo adecuado de educación dirigido a este colectivo de cuidadores, capaz de dar respuesta a las mismas, objetivo general de nuestro proyecto europeo IENE7, para atender esta importante y urgente demanda social
... Research has demonstrated that communication patterns differ when Dutch medical doctors interact with cultural minority or majority patients. Communication with cultural minorities was characterised by less empathy and involvement, and more emphasis on the patients' symptoms (Meeuwesen, Harmsen, Bernsen, & Bruijnzeels, 2006). In clinical psychology practice, such patterns may interfere with forming a therapeutic alliance. ...
This is the first research into preparation for multicultural clinical psychology practice in Europe. It applies the theory of multicultural counselling competency (MCC) to a case study in the Netherlands. It was hypothesized that cross-cultural practice experience, identification as a cultural minority, and satisfaction with cultural training was associated with MCC. The Multicultural Awareness Knowledge and Skills Survey was completed by 106 participants (22 students, 10 academics, 74 alumni) from clinical psychology masters' programs. MANOVA detected a main effect of cross-cultural experience on MCC for all groups and universities. The data were enriched with exploratory qualitative data from 14 interviews (5 students, 5 academics, 4 alumni). Interpretative Phenomenological Analysis revealed three themes: limitations of clinical psychology, strategies for culturally competent practice, and strategies for cultural competency development. These outcomes suggest that cultural competency continues to require attention in master's programs. The paper makes recommendations for further research enquiry related to training clinical psychologists to practice in Europe's multicultural societies.
... Language and communications barriers include not only the lack of comprehensible information about services available or entitlements but also communication with doctors that goes beyond language. GPs may communicate differently with immigrants and non-immigrants: consultation with immigrants was shorter with GPs talking more and immigrants less demanding [14]. Less effective communication with migrants may lead to non-adherence to treatments (due to misunderstanding) and inadequate referral to secondary care. ...
Aims:
To describe the prevalence and management of diabetes among immigrants according to ethnic group and duration of stay, compared to Italian citizens.
Methods:
Diabetic immigrant and Italian residents aged 20-69 years in the administrative database of the Lombardy Region. Immigrants were classified by region of origin and as long-term residents (LTR) and short-term residents (STR). Age- and sex-adjusted prevalence and indicators of diabetes management were calculated for immigrants by region of origin and by length of stay using Cox proportional models.
Results:
In 2010 19,992 immigrants (mean age 49.1 ± 10.8, 53.7% males) and 195,049 Italians (mean age 58.7 ± 9.3, 61.1 males) with diabetes were identified. Immigrants had a higher adjusted diabetes prevalence than Italians (OR 1.48; 95% CI 1.45-1.50). STR received significantly fewer recommended cardiovascular drugs (antiplatelets, statins and ACE-inhibitors/ARBs) than Italians, although prescription was higher among LTR from some ethnic groups. Immigrants were less likely to be seen by a diabetologist and to do at least one HbA1c test per year. Although the recommended tests/visits were more often done for the LTR than the STR, in the majority of ethnic groups these indicators were still far from optimal.
Conclusion:
The prevalence and management of diabetes differ between immigrants and Italians, although some improvement can be seen among LTR.
... However, both Norwegian GPs and pharmacists have in former studies reported linguistic barriers as the main obstacle when they are in contact with non-Western immigrants and that they give a minimum of medical information to the patients when such barriers are present [14,16]. Similar results are found in other European countries where healthcare personnel have reported that much of the consultation time with non-Western immigrants is often spent on interpretation [28,29]. It is important to note that despite the participants' long residence time in Norway (mean 29 years) in the present study, almost two-thirds had to or were more comfortable to be interviewed in Urdu. ...
The prevalence of Type 2 diabetes (T2D) among Pakistani women in Norway is remarkably high. This study aims to assess how they live with the disease and their response to lifestyle and medical information. 120 Pakistani women living in Norway (mean age: 55.7 years) were personally interviewed about their T2D using a structured questionnaire (response rate: 95%). The participants were first-generation immigrants (mean residence time: 28.7 years) of whom 27% were illiterates. Poor health was reported by one-third, and 71% had developed macrovascular comorbidities. A majority reported physical inactivity and an unhealthy diet included religious fasting. One-third was not able to self-measure their blood glucose. There was a great variation in antidiabetic drug regimens and one-fourth had to use insulin in addition to tablets. Pakistani women in Norway showed suboptimal control of their T2D in terms of lifestyle habits, comorbidities and drug use. Low literacy and cultural factors seem to challenge adherence to lifestyle and medical information.
... Different types of signals may be conveyed through smiling, e.g., support, optimism, sadness or encouragement. Possibly, immigrant women in general attach more value to the types of smiles that radiate optimism and support, thus instilling a sense of hope [28,51,52]. Moreover, a 'sympathetic smile' may for these women have reduced their perception of oncologist's authority and, consequently, have come at the expense of their trust. ...
Previous findings suggest immigrant patients have lower trust in their physicians, and perceive nonverbal communication differently compared to non-immigrant patients. We tested discrepancies in trust and the impact of non-verbal behavior between immigrants and non-immigrants in The Netherlands. Nonverbal communication of an oncologist was systematically varied in an experimental video vignettes design. Breast cancer patients (n = 34) and healthy women (n = 34) viewed one of eight video versions and evaluated trust and perceived friendliness of the oncologist. In a matched control design, women with immigrant and non-immigrant backgrounds were paired. Immigrant women reported stronger trust. Nonverbal communication by the oncologist did not influence trust differently for immigrants compared to for non-immigrants. However, smiling strongly enhanced perceived friendliness for non-immigrants, but not for immigrants. Immigrant patients’ strong trust levels may be formed a priori, instead of based on physicians’ communication. Physicians may need to make extra efforts to optimize their communication.
Electronic supplementary material
The online version of this article (doi:10.1007/s10903-017-0580-x) contains supplementary material, which is available to authorized users.
... Ancora, forme di partecipazione ai costi delle prestazioni sanitarie incidono sulle possibilità di spesa dei soggetti più vulnerabili, tra i quali si annoverano gli immigrati, che complessivamente hanno uno status socioeconomico inferiore rispetto agli autoctoni. D'altra parte molto è stato scritto sulle barriere di tipo informale che possono ostacolate l'uso dei servizi sanitari degli immigrati (Bischoff e Hudelson, 2010;Meeuwesen et al., 2006;Patel, 1995;Newbold, 2005). Linguaggio, comunicazione, fattori socioculturali e "novità" del sistema sanitario (e la loro interazione) sono tutti aspetti che pongono al migrante ostacoli di non facile superamento e che rendono i servizi sanitari non sempre "amichevoli". ...
... According to Swedish law, all residents of Sweden have the right to good health and healthcare on equal terms [2]. However, previous studies have shown that access to and use of healthcare services are associated with numerous variables, such as socioeconomic factors and occupation level [3][4][5], ethnicity [6][7][8] and the behaviour of the healthcare providers [9][10][11][12]. A lack of knowledge about health and the healthcare system among immigrants can limit access to healthcare or explain why they use healthcare inappropriately [13][14][15]. ...
Background:
Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden.
Methods:
This is a cross-sectional study using a postal questionnaire to all Thai women (18-64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used.
Results:
The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR = 2.02, CI: 1.16-3.54), having low trust in others (OR = 1.61, CI: 1.10-2.35), having predominantly bonding social capital (OR = 1.50, CI: 1.02-2.23) and belonging to the oldest age group (OR = 2.65, CI: 1.32-5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR = 6.07, CI: 3.94-9.34) and living without a partner (OR = 2.53, CI: 1.30-4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %).
Conclusions:
The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services. However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions.
... Our results add to the literature that the importance of these intercultural communication challenges is confirmed by doctors in clinical practice, which underscores the need to pay attention to these challenges in training programmes for doctors. Although this need has been established before [10,33], there still seems to be a gap between intercultural communication experienced by doctors and ICC theory, which mainly focusses on the challenges and specific aspects of intercultural communication [31,34,35]. ...
Background
Intercultural communication behaviour of doctors with patients requires specific intercultural communication skills, which do not seem structurally implemented in medical education. It is unclear what motivates doctors to apply intercultural communication skills. We investigated how purposefully medical specialists think they practise intercultural communication and how they reflect on their own communication behaviour. Methods
Using reflective practice, 17 medical specialists independently watched two fragments of videotapes of their own outpatient consultations: one with a native patient and one with a non-native patient. They were asked to reflect on their own communication and on challenges they experience in intercultural communication. The interviews were open coded and analysed using thematic network analysis. ResultsThe participants experienced only little differences in their communication with native and non-native patients. They mainly mentioned generic communication skills, such as listening and checking if the patient understood. Many participants experienced their communication with non-native patients positively. The participants mentioned critical incidences of intercultural communication: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. Conclusion
Despite extensive experience in intercultural communication, the participants of this study noticed hardly any differences between their own communication behaviour with native and non-native patients. This could mean that they are unaware that consultations with non-native patients might cause them to communicate differently than with native patients. The reason for this could be that medical specialists lack the skills to reflect on the process of the communication. The participants focused on their generic communication skills rather than on specific intercultural communication skills, which could either indicate their lack of awareness, or demonstrate that practicing generic communication is more important than applying specific intercultural communication. They mentioned well-known critical incidences of ICC: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. Nevertheless, they showed a remarkably enthusiastic attitude overall was noteworthy.A strategy to make doctors more aware of their intercultural communication behaviour could be a combination of experiential learning and ICC training, for example a module with reflective practice.
... Secondly, patients' unfamiliarity with the Dutch care system may underlie differences in intervention rates. Dutch patients are assertive in voicing their wishes to their physician and the same is probably expected from non-Western women [31]. If care providers are unaware of this difference in attitude, Table 5. Multilevel logistic regression models of individual level maternal characteristics, neighbourhood SES and hospital density and location of birth° in low risk women. ...
Background:
All women in the Netherlands should have equal access to obstetric care. However, utilization of care is shaped by demand and supply factors. Demand is increased in high risk groups (non-Western women, low socio-economic status (SES)), and supply is influenced by availability of hospital facilities (hospital density). To explore the dynamics of obstetric care utilization we investigated the joint association of hospital density and individual characteristics with prototype obstetric interventions.
Methods:
A logistic multi-level model was fitted on retrospective data from the Netherlands Perinatal Registry (years 2000-2008, 1.532.441 singleton pregnancies). In this analysis, the first level comprised individual maternal characteristics, the second of neighbourhood SES and hospital density. The four outcome variables were: referral during pregnancy, elective caesarean section (term and post-term breech pregnancies), induction of labour (term and post-term pregnancies), and birth setting in assumed low-risk pregnancies.
Results:
Higher hospital density is not associated with more obstetric interventions. Adjusted for maternal characteristics and hospital density, living in low SES neighbourhoods, and non-Western ethnicity were generally associated with a lower probability of interventions. For example, non-Western women had considerably lower odds for induction of labour in all geographical areas, with strongest effects in the more rural areas (non-Western women: OR 0.78, 95% CI 0.77-0.80, p<0.001).
Conclusion:
Our results suggest inequalities in obstetric care utilization in the Netherlands, and more specifically a relative underservice to the deprived, independent of level of supply.
This volume addresses the issue of pragmatic meaning and interpretation in communication contexts regarding health and does so by combining a series of diverse and complementary approaches, which together highlight the relevance of successfully shared understanding to achieve more accessible, inclusive, and sustainable healthcare systems. The volume is divided into five thematic sections: 1) Analytical approaches to health communication, 2) Intercultural and mediated communication, 3) Negotiation and meaning construction, 4) Expertise and common ground, 5) Uncertainty and evasive answers, bringing together a group of top scholars on the much-debated issue of shared understanding both at the micro-level of dialogues between professionals and patients, and the macro-level of institutional communication. In the variety of its contributions, it represents an ambitious attempt at setting pragmatics at the core of healthcare communication research and practice, by combining conceptual reflections on core topics in the field of pragmatics (among which are speech acts, common ground, ambiguity, implicitness), with discourse and linguistic analysis of real-world examples exploring various problems in health communication.
-Objective: The purpose of the study was to explore Primary care physicians’ experiences and perspectives of obesity counseling and management of culturally and linguistically diverse populations (CALD). Particularly in reference to Spanish speaking patients with low English proficiency (LEP).
-Methods: Semi-structured interviews were employed to achieve the aim of this study. 27 interviews were conducted. Participants were recruited from medical practices in Bernalillo county, New Mexico and Monmouth county, New Jersey. All participants provided primary care in clinics with a large proportion of LEP individuals. Of the 27 physicians, 17 were males and 10 were females. 23 physicians were trained in Internal Medicine and 4 were trained in Family medicine. All providers were either American board certified or board eligible. All interviews were conducted in English while encounters were audio taped. All transcripts were de-identified, followed by inductive thematic analysis.
-Results: On average, interviews lasted 14 minutes. Thematic analysis of the interview transcripts identified 5 key themes: time constraints, chief complaint prioritization, lack of knowledge on access pathways, limited health literacy, and physician bias.
-Conclusion: Physicians perceived obesity counseling and management in culturally and linguistically diverse patients to be more challenging. Barriers identified included time constraints, chief complaint prioritization and physician bias.
Cultural competence training for healthcare professionals, setting up follow-up appointments specifically to initiate obesity counseling, or considering referrals to a dedicated obesity clinic to primarily manage obesity may address the management gaps of for obesity in CALD patients. In addition, physicians’ education on billing and insurance reimbursement related to obesity can help providers better navigate counseling and management of this population.
Although Muslims are a growing population within many non-Muslim countries, there are insufficient Muslim clinicians to care for them. Studies have shown that non-Muslim clinicians have limited knowledge and understanding of Islamic practices affecting health, which may lead to disparities in the quality of healthcare delivery and outcomes when caring for Muslim patients. Muslims come from many different cultures and ethnicities and have variations in their beliefs and practices. This literature review provides some insights which may strengthen therapeutic bonds between non-Muslim clinicians and their Muslim patients resulting in improved holistic, patient-centered care in the areas of cancer screening, mental health, nutrition, and pharmacotherapy. Additionally, this review informs clinicians about the Islamic perspective on childbirth, end of life issues, travel for Islamic pilgrimage, and fasting during the month of Ramadan. Literature was sourced by a comprehensive search in PubMed, Scopus, and CINAHL along with hand screening of citations. Title and abstract screening followed by full-text screening excluded studies including less than 30% Muslim participants, protocols, or reporting results deemed irrelevant to primary care. 115 papers were selected for inclusion in the literature review. These were grouped into the themes of general spirituality, which were discussed in the Introduction, and Islam and health, Social etiquette, Cancer screening, Diet, Medications and their alternatives, Ramadan, Hajj, Mental health, Organ donation and transplants, and End of life. Summarizing the findings of the review, we conclude that health inequities affecting Muslim patients can be addressed at least in part by improved cultural competency in non-Muslim clinicians, as well as further research into this area.
Background
Due to various socio-cultural and language related factors, healthcare providers experience barriers when communicating with older culturally and linguistically diverse (CALD) patients with cancer, which can lower the quality of care received by patients and negatively impact healthcare providers. Studies focusing on communication barriers of older CALD patients with cancer and a systematic comparison of those barriers between different healthcare providers have been largely missing.
Objectives
In order to lay out the healthcare providers' perceived barriers to communication, the present study identified and compared communication barriers among different healthcare providers when caring for older CALD patients with cancer.
Methods
An online survey was conducted among healthcare providers in the Netherlands who identified as being involved in the care of CALD patients with cancer (N = 191), specifically; GPs (NGPs = 54), specialists (Nspecialists = 29), oncology nurses (Nnurses = 77), and pharmacists (Npharmacists = 31). Providers assessed twelve pre-specified factors on (i) importance and (ii) frequency of these factors as barriers to communication. A composite score by employing the QUOTE (Quality Of care Through the patients' Eyes) methodology was used to rank, and classify factors as either potential or influential barriers.
Results and conclusion
Overall, low Dutch language proficiency of older CALD patients with cancer, family interpreters providing inadequate translations, not knowing the extent of patients' informational needs, cultural differences in views about healthcare (i.e., illnesses and treatments) and family members blocking communication were found to be influential communication barriers. Healthcare providers showed several differences in what they perceived to be a potential or an influential barrier: Cultural differences in views about healthcare and patients getting treatment in their home countries were important barriers for GPs, while not knowing the patient's contact person was for pharmacists. Nurses perceived the highest number of influential barriers, while specialists perceived the least. We conclude that specific interventions that address differences in perceived barriers among providers are needed, and we highlight potential interventions that involve digital communication tools, such as the Conversation Starter.
This paper analyses interactions collected in Italian healthcare services with migrant patients and with or without interpreting help. The analysis focuses on noncompliant patients’ actions, such as claims of medical knowledge, personal narratives, rejections of medical advices and reactions to medical disapproval. Our analysis concerns the ways in which compliance is achieved in the interaction, i.e. how migrant patients’ noncompliant actions are responded to by both interpreters and clinicians. We look at those participants’ actions which upgrade/downgrade their authority and the consequences of such actions for participants’ positioning and for the management of migrant patients’ noncompliance.
Objectives
Prevalence rate of diabetes is high among migrants. Whether migrants are correctly addressed to a standard quality of care for diabetes and are properly followed up are the questions addressed by this retrospective cohort study.
Methods
Compliance to one or repeated Guideline Composite Indicator (GCI), a standard process indicator of care quality, was tested in migrants compared to non-migrant Italian residents with diabetes, living in Tuscany Region, Italy, in years 2011–2015. For those with no GCI, the analysis was repeated for the chance of being tested by at least one or more HbA1c measurements.
Results
GCI compliance, in a single or repeated manner over time, was significantly less likely by about 15–20% among migrants (n = 3992) compared to non-migrants (n = 130,874), even after fully matching both cohorts. For those with no GCI, being tested by HbA1c was still significantly less likely among migrants.
Conclusions
Being addressed to a standard quality of care is impaired among migrant patients with diabetes living in Tuscany compared to non-migrants. Migrants, moreover, have a significantly lower probability of adhering to guidelines or to be tested by HbA1c measurement over time.
Le pharmacien peut se retrouver quotidiennement confronté à un patient non-francophone. Cette thèse tentera d'évaluer la probabilité d'une telle confrontation, en s'appuyant sur l'analyse de données chiffrées concernant le tourisme et l'émigration. Cette probabilité n'étant pas négligeable, on peut se demander si le pharmacien, muni des connaissances acquises durant ses études et des outils actuellement à sa disposition, peut exercer son métier de façon optimale avec ce type de patients. A cette fin, les enseignements en langues étrangères des étudiants en pharmacie français seront passés en revue. Les outils d'aide linguistique existants seront ensuite détaillés. Plusieurs études évaluant la prise en charge des patients ne parlant pas la langue de leurs soignants seront également analysées. Ce travail ayant recensé les besoins existants, un nouvel outil sera créé pour faciliter la dispensation du pharmacien à ses patients non-francophones : le site internet « Pharmophone ». Ce site proposera des traductions spécifiques au métier de pharmacien. Plusieurs langues seront disponibles, mais seule la version en anglais fera l'objet d'une description complète dans cette thèse.
Use of health care services can differ among migrants and natives, especially in preventive care, because of different health status perceptions. In many European Union (EU) countries the worldwide financial crisis had an impact on the provision of essential medical services. This could have particularly affected more vulnerable people, such as migrants. We aimed to evaluate the access to medical examinations in the absence of disorders or symptoms by migrants, taking into account cultural and religious backgrounds, socioeconomic status, length of stay in the destination country, difficulties in learning the new language, and gender.
Background: Communication is a central part of providing family centred care in neonatal nurseries and is associated with a range of positive outcomes for families. However, previous research has indicated that communication is more problematic between health professionals and minority groups of patients and families, although much of this research is atheoretical. The current study used communication accommodation theory to examine nurses’ perceptions of effective and ineffective interactions with typical parents, culturally and linguistically diverse parents (CALD), and adolescent parents in neonatal nurseries.
Method: We conducted semi-structured interviews with nurses from 2 tertiary hospitals in Australia. Twelve nurses from one hospital were asked about interactions with typical parents, and twenty-nine nurses from the other hospital were asked about interactions with CALD and adolescent parents. Interviews were coded for communication strategy and accommodative stance, using a coding system based on communication accommodation theory.
Results: Descriptions of interactions with typical parents (who were perceived as Anglo-Australian) differed from those with CALD and adolescent parents. Interactions with CALD parents focused mostly on comprehension and cultural differences, with limited mention of other strategies. Interactions with adolescent parents were regarded as particularly problematic, and involved greater focus on face management than for other groups of parents. Generally, interactions with minority groups were based on a narrower range of strategies, and were more intergroup than interpersonal in focus.
Conclusions: Our findings show the importance of studying health professionals’ perceptions of interactions with people from different minority groups. We discuss the implications for our understanding of communicating with diverse patients and families, and educating health professionals, including the utility of communication accommodation theory as a guiding framework for training.
En France, le nombre de sujets diabétiques passera de 1,8 million en 1998 à 2,8 millions à l'horizon 2016. Devant cette pandémie annoncée, les populations migrantes sont plus susceptibles d'être touchées par le diabète de type 2. Or, il existe des difficultés de prise en charge et des inégalités de santé dans les populations migrantes en médecine générale. Notre étude porte sur la mise en évidence des difficultés dans la prise en charge des populations diabétiques de type 2 d'origine maghrébine liées à la barrière linguistique et culturelle en médecine générale. Une analyse qualitative est ainsi menée auprès de médecins généralistes d'une part, et de patients maghrébins diabétiques de type 2 ayant des niveaux de compréhension variables en langue française, et accompagnés ou non d'un interprète dans leur langue maternelle d'autre part. Notre étude souligne l'importance de la prise en compte des représentations en santé. Elle analyse les avantages et difficultés liés à l'intervention d'un interprète non professionnel dans la relation médicale, et pose des bases essentielles pour une réflexion sur un interprétariat individuel en médecine générale. Les bases d'une réflexion sur l'intérêt à développer un interprétariat collectif dans la prise en charge diététique des patients diabétiques de type 2 d'origine étrangère est également développé. Enfin, notre étude montre la complexité de la relation soignant-soigné en contexte interculturel et pose les jalons d'une réflexion pour la formation des professionnels de santé aux représentations culturelles en santé
The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys. The deceased donor kidney program has yet to achieve its full potential; hence, living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however, raises a number of social, ethical, and legal concerns surrounding informed consent, voluntarism, psychosocial evaluation, perioperative care, and long-term follow-up of living kidney donors. Many of these concerns become heightened in a multicultural, multilingual society within a Gulf country such as Qatar. This article provides an insight into the challenges that living kidney donation poses in a multiethnic society with significant socioeconomic divides. It also discusses the remedial measures that the Qatari government, healthcare authorities, and transplant community have adopted to address these issues.
The clinical interaction I: a psychological perspectiveThe clinical interaction II: a sociolinguistic perspectiveThe clinical interaction III: a psychodynamic perspectiveThe clinical interaction IV: a literary perspectiveThe interpreted consultationReferences
Communication is defined as the exchange information, or the use of common system of symbols, signs, behavior for this; a verbal or written message; a system of routes; techniques for the effective transmission of information, ideas, etc. Communication also transfers information from one person to another. The ability to communicate with each other is of vital importance for the existence of the people. Communication pattern has a wide range of implications for our everyday life, dealing with communication the family, friends, in society at work, and with patients.
The present research deals with the communication pattern of the great leader Moses. Biblical texts were examined and verses related to Moses' communication with the Jewish people, and Pharaoh, King of Egypt were studied closely from a contemporary perspective.
Health communication, which is a multi-attribute concept, is a generic title describing clinical practice. The literature shows that the relation between health communication and healthcare service satisfaction (HSS) has been found to be significant. The main objective of pursuing better health communication is to achieve the best outcome and patient satisfaction where healthcare systems are supposed to deliver. However, the health communication is a complex process. Also, measuring patients’ satisfaction is not an easy task since satisfaction is a complex notion with several factors. In this study, questions in the questionnaire directed to patients are factor-analyzed in order to obtain components which are used as independent attributes that will be modeled by fuzzy rule-based systems (FRBS) in order to explain HSS. Utilizing FRBS brings two different advantages, one of which is to use mathematical functions called membership functions for linguistically expressed responses. The second one is to observe the transition among the linguistic values expressed by patients. The four independent variables, namely, doctor–patient communication (DPC), information seeking behavior (ISB), equal behavior and tolerance to cultural differences (TCD) and the dependent variable HSS are employed in the modeling. Although both DPC and ISB have positive effects on HSS, TCD has none. One interesting finding about DPC is that if DPC scores below the average value tend to lower, it does not have a decreasing effect on HSS, which means that if a patient does expect to have average DPC, his or her evaluation on HSS does not lower, which says that if a patient knows that the doctor has a poor communication skill, the patient does not pay attention to this attribute.
Linguistic, cultural, and geographical differences might challenge the management of diabetes patients travelling in a culturally and linguistically homogeneous country. This article presents an instructive case and identifies various factors that can help in effective diabetes management of such cases. A Russian female patient aged 23 came to Japan and visited our hospital for a second opinion regarding glycemic control. She was diagnosed with type 1 diabetes at age three and started insulin injections and diet therapy with carbohydrate counting methods. Her HbA1c level was 11.0% with multiple daily insulin injections. She showed neuropathy, nephropathy, and blindness due to her progressed retinopathy. Because of the language barrier, suggestions for lifestyle modification were not effectively conveyed to the patient. We analyzed possible barriers to effective diabetes management in such foreign patients. In addition to language barriers and difficulties in diet therapy, dissimilar diabetes treatment guidelines, inadequate healthcare insurance, and stress-inducing conditions can be barriers to effective diabetes management. Foreign diabetes patients might face several barriers in effective management while travelling in Japan. Use of medical interpreters, adequate medical insurance, and trained medical staff will help in overcoming these barriers. J. Med. Invest. 63: 15-18, February, 2016
Over the past four decades, the United States has attracted immigrants from all around the world, with the majority emigrating from Latin America, Asia and Europe. The resulting increase in ethnic, cultural
and linguistic diversity has been accompanied by a great – and growing – need for language access services
in health care settings. According to the 2000 Census, nearly 47 million U.S. residents aged 5 or older
speak a language other than English at home, and more than 21 million have English proficiency self-rated
less than “very well.” California is arguably the most ethnically and linguistically diverse state in the
country: 39.5 percent of Californians speak a language other than English at home, and one in five
Californians has a level of English proficiency that suggests s/he would benefit from language assistance
when accessing the health care system.
The issue of language barriers in health care settings has received significant attention in recent years, in
large part due to a series of federal policies, including Executive Order 13166 which mandated that all
federal agencies review their own policies and procedures to ensure equal access for Limited English
Proficient (LEP) clients; the ensuing Department of Health and Human Service’s (DHHS) Office of Civil
Rights Policy Guidance on Title VI and Language Access; and the DHHS Office of Minority Health’s
release of the National Standards on Culturally and Linguistically Appropriate Services in Health Care.
These and other developments, such as the Institute of Medicine’s report, “Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care,” have generated substantial debate on the
extent and effects of language barriers in health care and the role of health care providers, institutions and
government in providing language access for LEP patients.
To better inform this discussion, The California Endowment commissioned an annotated bibliography of the
research on the prevalence, role and effects of language barriers in health care. The goal of this publication
is to provide a comprehensive – but given the extent and pace of research, not exhaustive – review of the
research literature in this area. Our hope is that this bibliography will provide an empirical basis for future
discussions about the need for and impact of language access services in the provision of health care.
Background: Little is known about the causes of problems in communication between health care professionals and ethnic‐minority patients. Not only language difficulties, but also cultural differences may result in these problems. This study explores the influence of communication and patient beliefs about health (care) and disease on understanding and compliance of native‐born and ethnic‐minority patients. Methods: In this descriptive study seven general practices located in a multi‐ethnic neighbourhood in Rotterdam participated. Eighty‐seven parents who visited their GP with a child for a new health problem took part: more than 50% of them belonged to ethnic‐minorities. The consultation between GP and patient was recorded on video and a few days after the consultation patients were interviewed at home. GPs filled out a short questionnaire immediately after the consultation. Patient beliefs and previous experiences with health care were measured by different questionnaires in the home interview. Communication was analysed using the Roter Interaction Analysis System based on the videos. Mutual understanding between GP and patient and therapy compliance was assessed by comparing GP's questionnaires with the home interview with the parents. Results: In 33% of the consultations with ethnic‐minority patients (versus 13% with native‐born patients) mutual understanding was poor. Different aspects of communication had no influence on mutual understanding. Problems in the relationship with the GP, as experienced by patients, showed a significant relation with mutual understanding. Consultations without mutual understanding more often ended in non‐compliance with the prescribed therapy. Conclusion: Ethnic‐minority parents more often report problems in their relationship with the GP and they have different beliefs about health and health care from native‐born parents. Good relationships between GP and patients are necessary for mutual understanding. Mutual understanding has a strong correlation with compliance. Mutual understanding and consequently compliance is more often poor in consultations with ethnic‐minority parents than with native‐born parents.
Received 14 January 2000. Accepted 21 March 2001.
American ethnic groups are often thought of as discrete categories to which people belong and that explain some aspects of psychological functioning. However, ethnicity is a complex multidimensional construct that, by itself, explains little. To understand its psychological implications, it is necessary to identify and assess those aspects of ethnicity that may have an impact on outcomes of interest. In this article, the author examines 3 key aspects of ethnicity: cultural norms and values; the strength, salience, and meaning of ethnic identity; and the experiences and attitudes associated with minority status. These aspects are best understood in terms of dimensions along which individuals and samples vary, rather than as categories into which individuals can be classified. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
CAMERA is a system for collecting and editing ethological data. The hardware and software enable easy coding of complex behavioral
interactions from video recordings. It is especially designed to improve accuracy, reliability, and training standards in
coding behavior. The system also supports several basic analyses of collected data. CAMERA operates with both North American
and European video signals.
Many studies have documented race and gender differences in health care received by patients. However, few studies have related differences in the quality of interpersonal care to patient and physician race and gender.
To describe how the race/ethnicity and gender of patients and physicians are associated with physicians' participatory decision-making (PDM) styles.
Telephone survey conducted between November 1996 and June 1998 of 1816 adults aged 18 to 65 years (mean age, 41 years) who had recently attended 1 of 32 primary care practices associated with a large mixed-model managed care organization in an urban setting. Sixty-six percent of patients surveyed were female, 43% were white, and 45% were African American. The physician sample (n = 64) was 63% male, with 56% white, and 25% African American.
Patients' ratings of their physicians' PDM style on a 100-point scale.
African American patients rated their visits as significantly less participatory than whites in models adjusting for patient age, gender, education, marital status, health status, and length of the patient-physician relationship (mean [SE] PDM score, 58.0 [1.2] vs 60.6 [3.3]; P = .03). Ratings of minority and white physicians did not differ with respect to PDM style (adjusted mean [SE] PDM score for African Americans, 59.2 [1.7] vs whites, 61.7 [3.1]; P = .13). Patients in race-concordant relationships with their physicians rated their visits as significantly more participatory than patients in race-discordant relationships (difference [SE], 2.6 [1.1]; P = .02). Patients of female physicians had more participatory visits (adjusted mean [SE] PDM score for female, 62.4 [1.3] vs male, 59.5 [3.1]; P = .03), but gender concordance between physicians and patients was not significantly related to PDM score (unadjusted mean [SE] PDM score, 76.0 [1.0] for concordant vs 74.5 [0.9] for discordant; P = .12). Patient satisfaction was highly associated with PDM score within all race/ethnicity groups.
Our data suggest that African American patients rate their visits with physicians as less participatory than whites. However, patients seeing physicians of their own race rate their physicians' decision-making styles as more participatory. Improving cross-cultural communication between primary care physicians and patients and providing patients with access to a diverse group of physicians may lead to more patient involvement in care, higher levels of patient satisfaction, and better health outcomes.
While pervasive racial and ethnic inequalities in access to care and health status have been documented, potential underlying causes, such as patients' perceptions of their physicians, have not been explored as thoroughly.
To assess whether a person's race or ethnicity is associated with low trust in the physician.
Data were obtained from the 1996 through 1997 Community Tracking Survey, a nationally representative sample. Adults who identified a physician as their regular provider and had at least 1 physician visit in the preceding 12 months were included (N = 32,929).
Patients' ratings of their satisfaction with the style of their physician and their trust in physicians. The Satisfaction With Physician Style Scale measured respondents' perceptions of their physicians' listening skills, explanations, and thoroughness. The Trust in Physician Scale measured respondents' perceptions that their physicians placed the patients' needs above other considerations, referred the patient when needed, performed unnecessary tests or procedures, and were influenced by insurance rules.
After adjustment for socioeconomic and other factors, minority group members reported less positive perceptions of physicians than whites on these 2 conceptually distinct scales. Minority group members who lacked physician continuity on repeat clinic visits reported even less positive perceptions of their physicians on these 2 scales than whites.
Patients from racial and ethnic minority groups have less positive perceptions of their physicians on at least 2 important dimensions. The reasons for these differences should be explored and addressed. Arch Fam Med. 2000;9:1156-1163
Little is known about the causes of problems in communication between health care professionals and ethnic-minority patients. Not only language difficulties, but also cultural differences may result in these problems. This study explores the influence of communication and patient beliefs about health (care) and disease on understanding and compliance of native-born and ethnic-minority patients.
In this descriptive study seven general practices located in a multi-ethnic neighbourhood in Rotterdam participated. Eighty-seven parents who visited their GP with a child for a new health problem took part: more than 50% of them belonged to ethnic-minorities. The consultation between GP and patient was recorded on video and a few days after the consultation patients were interviewed at home. GPs filled out a short questionnaire immediately after the consultation. Patient beliefs and previous experiences with health care were measured by different questionnaires in the home interview. Communication was analysed using the Roter Interaction Analysis System based on the videos. Mutual understanding between GP and patient and therapy compliance was assessed by comparing GP's questionnaires with the home interview with the parents.
In 33% of the consultations with ethnic-minority patients (versus 13% with native-born patients) mutual understanding was poor. Different aspects of communication had no influence on mutual understanding. Problems in the relationship with the GP, as experienced by patients, showed a significant relation with mutual understanding. Consultations without mutual understanding more often ended in non-compliance with the prescribed therapy.
Ethnic-minority parents more often report problems in their relationship with the GP and they have different beliefs about health and health care from native-born parents. Good relationships between GP and patients are necessary for mutual understanding. Mutual understanding has a strong correlation with compliance. Mutual understanding and consequently compliance is more often poor in consultations with ethnic-minority parents than with native-born parents.
This review's goal was to determine how differences between physicians and patients in race, ethnicity and language influence the quality of the physician-patient relationship.
We performed a literature review to assess existing evidence for ethnic and racial disparities in the quality of doctor-patient communication and the doctor-patient relationship.
We found consistent evidence that race, ethnicity; and language have substantial influence on the quality of the doctor-patient relationship. Minority patients, especially those not proficient in English, are less likely to engender empathic response from physicians, establish rapport with physicians, receive sufficient information, and be encouraged to participate in medical decision making.
The literature calls for a more diverse physician work force since minority patients are more likely to choose minority physicians, to be more satisfied by language-concordant relationships, and to feel more connected and involved in decision making with racially concordant physicians. The literature upholds the recommendation for professional interpreters to bridge the gaps in access experienced by non-English speaking physicians. Further evidence supports the admonition that "majority" physicians need to be more effective in developing relationships and in their communication with ethnic and racial minority patients.
To identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication.
Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication.
A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001.
Aboriginal patients from the Yolngu language group of north-east Arnhem Land and their medical, nursing and allied professional carers.
Factors influencing the quality of communication.
A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters.
Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.
There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur?
The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers’ contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers’ behaviors may contribute to these disparities.
This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers.
We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance.
Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up.
The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.
This study explored whether racial differences in patient-physician relationships contribute to disparities in the quality of health care.
We analyzed data from The Commonwealth Fund's 2001 Health Care Quality Survey to determine whether racial differences in patients' satisfaction with health care and use of basic health services were explained by differences in quality of patient-physician interactions, physicians' cultural sensitivity, or patient-physician racial concordance.
Both satisfaction with and use of health services were lower for Hispanics and Asians than for Blacks and Whites. Racial differences in the quality of patient-physician interactions helped explain the observed disparities in satisfaction, but not in the use of health services.
Barriers in the patient-physician relationship contribute to racial disparities in the experience of health care.
African-American patients who visit physicians of the same race rate their medical visits as more satisfying and participatory than do those who see physicians of other races. Little research has investigated the communication process in race-concordant and race-discordant medical visits.
To compare patient-physician communication in race-concordant and race-discordant visits and examine whether communication behaviors explain differences in patient ratings of satisfaction and participatory decision making.
Cohort study with follow-up using previsit and postvisit surveys and audiotape analysis.
16 urban primary care practices.
252 adults (142 African-American patients and 110 white patients) receiving care from 31 physicians (of whom 18 were African-American and 13 were white).
Audiotape measures of patient-centeredness, patient ratings of physicians' participatory decision-making styles, and overall satisfaction.
Race-concordant visits were longer (2.15 minutes [95% CI, 0.60 to 3.71]) and had higher ratings of patient positive affect (0.55 point, [95% CI, 0.04 to 1.05]) compared with race-discordant visits. Patients in race-concordant visits were more satisfied and rated their physicians as more participatory (8.42 points [95% CI, 3.23 to 13.60]). Audiotape measures of patient-centered communication behaviors did not explain differences in participatory decision making or satisfaction between race-concordant and race-discordant visits.
Race-concordant visits are longer and characterized by more patient positive affect. Previous studies link similar communication findings to continuity of care. The association between race concordance and higher patient ratings of care is independent of patient-centered communication, suggesting that other factors, such as patient and physician attitudes, may mediate the relationship. Until more evidence is available regarding the mechanisms of this relationship and the effectiveness of intercultural communication skills programs, increasing ethnic diversity among physicians may be the most direct strategy to improve health care experiences for members of ethnic minority groups.
We examined the association between patient race/ethnicity and patient-physician communication during medical visits.
We used audiotape and questionnaire data collected in 1998 and 2002 to determine whether the quality of medical-visit communication differs among African American versus White patients. We analyzed data from 458 African American and White patients who visited 61 physicians in the Baltimore, Md-Washington, DC-Northern Virginia metropolitan area. Outcome measures that assessed the communication process, patient-centeredness, and emotional tone (affect) of the medical visit were derived from audiotapes coded by independent raters.
Physicians were 23% more verbally dominant and engaged in 33% less patient-centered communication with African American patients than with White patients. Furthermore, both African American patients and their physicians exhibited lower levels of positive affect than White patients and their physicians did.
Patient-physician communication during medical visits differs among African American versus White patients. Interventions that increase physicians' patient-centeredness and awareness of affective cues with African Americans patients and that activate African American patients to participate in their health care are important strategies for addressing racial/ethnic disparities in health care.
Twenty-one million Americans are limited in English proficiency (LEP), but little is known about the effect of medical interpreter services on health care quality. Asystematic literature review was conducted on the impact of interpreter services on quality of care. Five database searches yielded 2,640 citations and a final database of 36 articles, after applying exclusion criteria. Multiple studies document that quality of care is compromised when LEP patients need but do not get interpreters. LEP patients' quality of care is inferior, and more interpreter errors occur with untrained ad hoc interpreters. Inadequate interpreter services can have serious consequences for patients with mental disorders. Trained professional interpreters and bilingual health care providers positively affect LEP patients' satisfaction, quality of care, and outcomes. Evidence suggests that optimal communication, patient satisfaction, and outcomes and the fewest interpreter errors occur when LEP patients have access to trained professional interpreters or bilingual providers.
Objectives
This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers.
Methods
We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance.
Results
Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up.
Conclusion
The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.
Background: African-American patients who visit physicians of the same race rate their medical visits as more satisfying and participatory than do those who see physicians of other races. Little research has investigated the communication process in race-concordant and race-discordant medical visits. Objectives: To compare patient-physician communication in race-concordant and race-discordant visits and examine whether communication behaviors explain differences in patient ratings of satisfaction and participatory decision making. Design: Cohort study with follow-up using previsit and postvisit surveys and audiotape analysis. Setting: 16 urban primary care practices. Patients: 252 adults (142 African-American patients and 110 white patients) receiving care from 31 physicians (of whom 18 were African-American and 13 were white). Measurements: Audiotape measures of patient-centeredness, patient ratings of physicians' participatory decision-making styles, and overall satisfaction. Results: Race-concordant visits were longer (2.15 minutes [95% Cl, 0.60 to 3.71]) and had higher ratings of patient positive affect (0.55 point, [95% Cl, 0.04 to 1.05]) compared with race-discordant visits. Patients in race-concordant visits were more satisfied and rated their physicians as more participatory (8.42 points [95% Cl, 3.23 to 13.60]). Audiotape measures of patient-centered communication behaviors did not explain differences in participatory decision making or satisfaction between race-concordant and race-discordant visits. Conclusions: Race-concordant visits are longer and characterized by more patient positive affect. Previous studies link similar communication findings to continuity of care. The association between race concordance and higher patient ratings of care is independent of patient-centered communication, suggesting that other factors, such as patient and physician attitudes, may mediate the relationship. Until more evidence is available regarding the mechanisms of this relationship and the effectiveness of intercultural communication skills programs, increasing ethnic diversity among physicians may be the most direct strategy to improve health care experiences for members of ethnic minority groups.
Bridging Differences: Effective Intergroup Communication is based on the assumption that the processes operating when we communicate with people from other groups are the same processes operating when we communicate with people from our own groups. Author William B. Gudykunst has written this book from the perspective of "communicating with strangers" and addresses how factors related to our group memberships (e.g., inaccurate and unfavorable stereotypes of members of other cultures and ethnic groups) can cause us to misinterpret the messages we receive from members of those groups. Designed for students taking courses in Intercultural Communication or Intergroup Communication, Bridging Differences is also useful for many courses in Cultural Studies, Anthropology, Sociology, and Management.
The Second Edition of this classic work, first published in 1981 and an international bestseller, explores the differences in thinking and social action that exist among members of more than 50 modern nations. Geert Hofstede argues that people carry "mental programs" which are developed in the family in early childhood and reinforced in schools and organizations, and that these programs contain components of national culture. They are expressed most clearly in the different values that predominate among people from different countries. Geert Hofstede has completely rewritten, revised and updated Cultures Consequences for the twenty-first century, he has broadened the book's cross-disciplinary appeal, expanded the coverage of countries examined from 40 to more than 50, reformulated his arguments and a large amount of new literature has been included. The book is structured around five major dimensions: power distance; uncertainty avoidance; individualism versus collectivism; masculinity versus femininity; and long term versus short-term orientation. --Publisher.
Our study assessed the value of personality variables over and above demographic variables for predicting the type of relationships patients prefer with their doctors––from giving all the decision-making power to the doctors to a more egalitarian, information-seeking relationship. We investigated several personality variables (health locus of control, assertiveness, conservatism, and self-efficacy) in a mailed survey. Hierarchical regression analyses indicated that personality variables explained additional variance in desire for shared decision-making after controlling for demographic variables. Specifically, adults with a greater belief that powerful others (e.g., doctors) controlled their health were less likely to want to seek information or make decisions about their health. Assertive adults were more likely to want comprehensive information. Our findings indicate that personality variables are important in predicting patient preferences regarding their relationships with their doctors. These findings also have important implications for improving patient satisfaction and compliance with medical treatment.
Due to increased migration physicians encounter more communication difficulties due to poor language proficiency and different culturally defined views about illness. This study aimed to develop and validate a 'patient's cultural background scale' in order to classify patients based on culturally conditioned norms instead of on ethnicity. A total of 986 patients from 38 multi-ethnic general practices were included. From a list of 36 questions, non-contributing and non-consistent questions were deleted and from the remaining questions the scale was constructed by principal component analysis. Comparing the scale with two other methods of construction assessed internal validity. Comparing the found dimensions with known dimensions from literature assessed the construct validity. Criterion validity was determined by comparing the patient's score with criteria assumed or known to have relationship with cultural background. Criterion validity was reasonably good but poor for income. A valid patient's cultural background scale was developed, for use in large-scale quantitative studies.
Estudio acerca de los procesos que dan origen a las diferencias de pensamiento y acción social entre las culturas nacionales. El autor sostiene que los seres humanos llevan consigo "programas mentales" que son desarrollados tempranamente en el medio familiar y reforzados en las instituciones educativas y las organizaciones. Para Geert Hofstede, las diferencias culturales tienen su expresión más clara en las escalas de valores de miembros de distintas naciones y se extienden a los comportamientos, instituciones y organizaciones.
A microscopic analysis of doctor-patient communication in the general practitioner's surgery is presented. Verbatim transcripts of 85 medical interviews, audiotaped in a natural situation were analysed. The effects of type of complaint, patient gender and physician gender on the process of verbal communication were assessed. This study focused upon the relational aspects of communication, using Stiles' Verbal Response Mode coding system (VRM), and, to a limited extent, upon the content of patient's complaints--whether they were primarily somatic or of a psychosocial nature. The hypothesis of an asymmetrical relation between physician and patient was confirmed. Results partially confirmed the hypothesis that interviews of psychosocial patients take more time than those of somatic patients. There was also some evidence that psychosocial patients try to exert more control over the conversation as compared to somatic patients. Male and female patients differed in the way they elaborated their complaints. When telling their complaints, women referred more to persons (family, friends, colleagues) than did men. In case of male GP's, the interviews of female patients took more time than those of male patients. The largest differences were between male and female physicians. In agreement with the hypothesis males were more imposing and presumptuous (giving more advisements and interpretations). Female GP's were more attentive and non-directive (giving more subjective and objective information and acknowledgements). The medical interviews of female GP's took more time than the interviews of their male colleagues. The results are discussed in the light of theoretical concepts of harmony and discrepancy with respect to doctor-patient communication and theories about gender differences.
International and national research has documented the relations between socio-economic conditions and health. Nonetheless, racial/ethnic group comparisons of health indices frequently are presented in the United States without stratifying or adjusting for socio-economic conditions that could affect interpretation of the data. This paper examines how racial/ethnic group identifiers have been used in past research. While some studies assume biologic differences; others presume that race/ethnicity is a proxy for socio-economic race factors. One consequence of these presumptions has been an underdevelopment of knowledge about racial/ethnic minority populations that could help shape public policies and preventive interventions to reduce disparities in health. Findings from studies that examine the influence of both race and social class on health are reviewed in an effort to clarify the state-of-knowledge. Although the findings vary for particular health indices, the studies provide considerable evidence that socio-economic conditions are a powerful, although not necessarily exclusive, explanatory variable for racial disparities in health. The findings are used as the basis for encouraging more theoretically grounded and methodologically rigorous research rather than avoiding an assessment of the influence of race/ethnicity on health.
To determine the extent of communication problems that arose from patients whose primary language was non-English presenting to an inner city accident and emergency (A&E) department.
A prospective survey over seven consecutive days during September 1995. All adult patients other than those directly referred by their general practitioner to an inpatient team had a questionnaire completed by the A&E doctor first seeing the patient. The doctor recorded language ability and form of interpreter used, and estimated any prolongation of the consultation and ability to improve communication by the use of additional services.
103 patients (17%) did not speak English as their primary language; 55 patients (9.1% of the study population) had an English language ability rated as other than good, and 16 (29%) of these consultations could have been improved by the use of additional interpreter services; 28 patients overall (4.6% of the study population) required the use of an interpreter, who was usually a relative.
A significant number of patients presenting to A&E have difficulty in communicating in English. These consultations could often have been improved by the use of additional interpreter services. Telephone interpreter services may provide the answer for use in A&E departments because of their instant and 24 hour availability.
Patients from racial and ethnic minority groups use fewer health care services and are less satisfied with their care than patients from the majority white population. These disparities may be attributable in part to racial or cultural differences between patients and their physicians.
To determine whether racial concordance between patients and physicians affects patients' satisfaction with and use of health care.
We analyzed data from the 1994 Commonwealth Fund's Minority Health Survey, a nationwide, telephone survey of noninstitutionalized adults. For the 2201 white, black, and Hispanic respondents who reported having a regular physician, we examined the association between patient-physician racial concordance and patients' ratings of their physicians, satisfaction with health care, reported receipt of preventive care, and reported receipt of needed medical care.
Black respondents with black physicians were more likely than those with nonblack physicians to rate their physicians as excellent (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.55-3.72) and to report receiving preventive care (adjusted OR, 1.74; 95% CI, 1.01-2.98) and all needed medical care (adjusted OR, 2.94; 95% CI, 1.10-7.87) during the previous year. Hispanics with Hispanic physicians were more likely than those with non-Hispanic physicians to be very satisfied with their health care overall (adjusted OR, 1.74; 95% CI, 1.01-2.99).
Our findings confirm the importance of racial and cultural factors in the patient-physician relationship and reaffirm the role of black and Hispanic physicians in caring for black and Hispanic patients. Improving cultural competence among physicians may enhance the quality of health care for minority populations. In the meantime, by reducing the number of underrepresented minorities entering the US physician workforce, the reversal of affirmative action policies may adversely affect the delivery of health care to black and Hispanic Americans.
Despite its potential influence on quality of care, there has been little research on the way physicians perceptions of and beliefs about patients are affected by patient race or socio-economic status. The lack of research in this area creates a critical gap in our understanding of how patients' demographic characteristics influence encounter characteristics, diagnoses, treatment recommendations, and outcomes. This study uses survey data to examine the degree to which patient race and socio-economic status affected physicians' perceptions of patients during a post-angiogram encounter. A total of 842 patient encounters were sampled, out of which 193 physicians provided data on 618 (73%) of the encounters sampled. The results of analyses of the effect of patient race and SES on physician perceptions of and attitude towards patients, controlling for patient age, sex, race, frailty/sickness, depression, mastery, social assertiveness and physician characteristics, are presented. These results supported the hypothesis that physicians' perceptions of patients were influenced by patients' socio-demographic characteristics. Physicians tended to perceive African-Americans and members of low and middle SES groups more negatively on a number of dimensions than they did Whites and upper SES patients. Patient race was associated with physicians' assessment of patient intelligence, feelings of affiliation toward the patient, and beliefs about patient's likelihood of risk behavior and adherence with medical advice; patient SES was associated with physicians' perceptions of patients' personality, abilities, behavioral tendencies and role demands. Implications are discussed in terms of further studies and potential interventions.
Patient-centered interviewing is associated with greater patient satisfaction and better medical outcomes than traditional encounters, but actively seeking patients' views of their illnesses and encouraging patients to express expectations, thoughts, and feelings is difficult in encounters that require an interpreter. We sought to examine physicians' use of the patient-centered approach with patients who required the assistance of an interpreter. SUBJECTS and
A cross-sectional sample of patients was videorecorded during visits with physicians at a multi-ethnic, university-affiliated, primary care clinic. Nineteen medical encounters of Spanish-speaking patients who required an interpreter and 19 matched English-speaking encounters were coded for frequency that patients mentioned symptoms, feelings, expectations, and thoughts (collectively called "offers"). Physicians' responses were coded as ignoring, closed, open, or facilitative of further discussion.
English-speaking patients made a mean (+/- SD) of 20 +/- 11 offers, compared with 7 +/- 4 for Spanish-speaking patients (P = 0.001). Spanish-speaking patients also were less likely to receive facilitation from their physicians and were more likely to have their comments ignored (P <0.005). English-speaking patients usually received an answer or acknowledgment to their questions even if the physicians did not encourage further discussion on the topic.
Spanish-speaking patients are at a double disadvantage in encounters with English-speaking physicians: these patients make fewer comments, and the ones they do make are more likely to be ignored. The communication difficulties may result in lower adherence rates and poorer medical outcomes among Spanish-speaking patients.
Although patient participation is acclaimed to be a much healthier model of the doctor-patient encounter than the traditional paternalistic paradigm, there has been a dearth of research that has empirically assessed the effects of patient involvement or addressed barriers that must be overcome before patients can actively participate in the medical encounter. The purpose of this investigation was twofold: to assess the effects of patient participation on patient commit- ment to medical decisions and patient satisfaction and to examine cultural barriers related to patient participation. The investigation supported the claim that patient participation increases patient commitment to medical decisions and patient satisfaction. The investigation also supported the claim that patient participation is higher for Mainland American patients than Asian American patients. The justification for cultural differences, however, was not supported. Specifically, it was predicted that cultural norms influence patients' assertive- ness and their self- and response-efficacy regarding patient participation that, in turn, influences patient participation. The study supported the claim that Asians are less assertive and participate less than Mainlanders. Assertiveness, however, was not related to patient participation. Cultural differences for response- and self-efficacy were not found. Yet both response- and self-efficacy were significant predictors of patient participation. The findings of this study highlight the importance of working toward collaborative relationships and have important implications for developing future patient participation tools. Limitations and directions for future research are discussed.
This paper provides a review of the main findings concerning the relationship between the cultural syndromes of individualism and collectivism and personality. People in collectivist cultures, compared to people in individualist cultures, are likely to define themselves as aspects of groups, to give priority to in-group goals, to focus on context more than the content in making attributions and in communicating, to pay less attention to internal than to external processes as determinants of social behavior, to define most relationships with ingroup members as communal, to make more situational attributions, and tend to be self-effacing.
Intercultural mediation was developed to solve problems between western (Belgian) health professionals and Turkish, Moroccan and Italian clients. The need for intercultural mediation in Belgium Health Care was measured by asking intercultural mediators to complete a questionnaire about situations in which language, culture, social-economic and personal circumstances cause difficulties. Results show that the profession 'intercultural mediator' continues to be important in improving the quality and accessibility of the Belgian health care for ethnic minorities. Even if clients speak Flemish fluently, there are still difficulties between health professional and client caused by culture, social-economic and personal circumstances.
As the US population becomes increasingly diverse, understanding consumer-provider communication among special populations becomes of paramount importance. Cultural competence is a key element in improving communication between non-minority providers and minority patients. This includes overcoming sociocultural and linguistic barriers that hinder access to care and diminish quality consumer-provider communication. Of special concern is the lack of cancer prevention communication between providers and their special population patients. More research is needed to understand cancer communication needs and barriers among special populations, and to direct effective interventions to improve consumer-provider communication for special populations. To this end, interactive training to improve communication skills among oncologists and medical students, increasing the availability of trained medical translators, increasing the number of health professionals from special populations, and increasing the number of special population participants in communication research are recommended. Furthermore, research should focus on identifying and overcoming cultural factors that negatively impact consumer-provider interactions.
Significant conceptual work on shared decision making has taken place but there are still significant challenges in achieving it in routine clinical practice. This paper outlines what research has identified to date that may promote shared decision making, and the further research that is required to enable continuing progress. Greater understanding of the models of decision making and instruments to identify them in practice are still required. Specifying consumer competences, developing instruments to assess these and interventions to enhance them may also be important. Clarifying all these aspects may enable those charged with training professionals to improve the content of professional development programmes. This may be particularly important in the field of cancer treatments where the stakes are high-patients usually desire much information but their desire for involvement in decision making is more variable. The consequences of getting this balance right or wrong are significant with much to be gained or lost. Continued development and evaluation of decision aids and decision explorers that use interactive technology will also be important in identifying how to progress with consumer involvement. If we can learn these lessons, then wider implementation of shared decision making or consumer involvement may become a nearer prospect.
Following a brief overview and commentary on the physician-patient communication literature, this article summarizes and evaluates research on the relationship between physician-patient control (dominant-submissive) and affiliation (friendly hostile) behaviors as they relate to medical outcomes. Findings for both verbal and nonverbal control and affiliation measures are included. The interpersonal circumplex (together with the important interactional principles that it incorporates) is then introduced as an heuristic guide for future medical interaction research. The circumplex was constructed as a conceptual and empirical model to integrate the numerous studies that have established control and affiliation as universal dimensions of human interpersonal behavior and relationships. Next, the small group of studies that have applied circumplex inventories to analyses of practitioner-patient transactions are reviewed with emphasis on their strengths and unique aspects of their findings. The concluding section enumerates advantages and innovations that the interpersonal circumplex and its measures can provide to facilitate more heuristic studies of physician-patient interactions.
Mutual understanding between physician and patient is essential for good quality of care; however, both parties have different views on health complaints and treatment. This study aimed to develop and validate a measure of mutual understanding (MU) in a multicultural setting. The study included 986 patients from 38 general practices. GPs completed a questionnaire and patients were interviewed after the consultation. To assess mutual understanding the answers from GP and patient to questions about different consultation aspects were compared. An expert panel, using nominal group technique, developed criteria for mutual understanding on consultation aspects and secondly, established a ranking to combine all aspects into an overall consultation judgement. Regarding construct validity, patients' ethnicity, age and language proficiency were the most important predictors for MU. Regarding criterion validity, all GP-related criteria (the GPs perception of his ability to explain to the patient, the patient's ability to explain to the GP, and the patient's understanding of consultation aspects), were well-related to MU. The same can be said of patient's consultation satisfaction and feeling that the GP was considerate. We conclude that the Mutual Understanding Scale is regarded a reliable and valid measure to be used in large-scale quantitative studies.
Culture and ethnicity have often been cited as barriers in establishing an effective and satisfying doctor-patient relationship. The aim of this paper is to gain more insight in intercultural medical communication difficulties by reviewing observational studies on intercultural doctor-patient communication. In addition, a research model for studying this topic in future research is proposed.
A literature review using online databases (Pubmed, Psychlit) was performed.
Findings reveal major differences in doctor-patient communication as a consequence of patients' ethnic backgrounds. Doctors behave less affectively when interacting with ethnic minority patients compared to White patients. Ethnic minority patients themselves are also less verbally expressive; they seem to be less assertive and affective during the medical encounter than White patients.
Most reviewed studies did not relate communication behaviour to possible antecedent culture-related variables, nor did they assess the effect of cultural variations in doctor-patient communication on outcomes, leaving us in the dark about reasons for and consequences of differences in intercultural medical communication. Five key predictors of culture-related communication problems are identified in the literature: (1) cultural differences in explanatory models of health and illness; (2) differences in cultural values; (3) cultural differences in patients' preferences for doctor-patient relationships; (4) racism/perceptual biases; (5) linguistic barriers. It is concluded that by incorporating these variables into a research model future research on this topic can be enhanced, both from a theoretical and a methodological perspective.
Using a cultural sensitive approach in medical communication is recommended.
Although Hispanics constitute the most rapidly growing ethnic group in the United States, few studies have examined the relationship between Hispanic ethnicity and patients' experiences with the use of antidepressant medications.
The purpose of this study was to examine the influence of Hispanic ethnicity on patients' expression of complaints about and problems of adherence with antidepressant medications and physicians' reactions to these complaints and adherence problems.
Data were collected as part of a larger cross-sectional study of physician-patient communication conducted during 1995 in the general medicine and family practice clinics of the University of New Mexico. Between March and December 1995, patients' medical visits were recorded on audiotape, patients were interviewed after each visit, and patients' medical records were reviewed. The present analysis focused on patients who received a prescription for an antidepressant on the day of the audiotaped visit. Because this was a cross-sectional study, only 1 visit was recorded for each patient.
Ninety-eight patients were identified who received a new or refill prescription for an antidepressant on the day of the audiotaped visit. Twenty-eight (28.6%) patients expressed a complaint about their antidepressant therapy. Younger patients and non-Hispanic white patients were more likely to express such a complaint than were older patients and Hispanic patients. Ten (10.2%) patients reported an adherence problem. Patients who rated their physical health as better were more likely to express adherence problems with antidepressant therapy than were patients who rated their physical health was worse. Physicians were generally responsive to patients' expression of complaints and adherence problems.
Patients' ethnicity was related to their expression of complaints about antidepressant therapy but not to their expression of adherence problems or to physicians' reactions on patients' expression of either. Because many patients express complaints about and adherence problems with antidepressant therapy, providers should be prepared to educate patients about their prescribed therapy or change the antidepressant regimen.