Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study

International Journal for Equity in Health

Research

W. Spiegel¹  C. Lionis²  A. Saridaki²  M. Papadakaki³  E. Teunissen⁴  E. Van Weel-Baumgarten⁴  F. Van den Driessen Mareeuw⁴  C. Van Weel⁵  M. Van den Muijsenbergh⁶  C. Dowrick⁷  K. Gravenhorst⁷  M. O’Reilly-de Brún⁸  T. de Brún⁸  N. Burns⁹  C. O’Donnell^1,10  F. S. Mair^1,10  A. MacFarlane^1,11 

[1] Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, A-1090, Vienna, Austria;Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece;Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece;Department of Social Work, School of Health and Social Welfare Technological Educational Institute of Crete Heraklion, Crete, Greece;Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, the Netherlands;Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands;Australian Primary Health Care Research Institute, Nijmegen, the Netherlands;Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands;Pharos, Centre of Expertise for Health Disparities, Utrecht, the Netherlands;Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, United Kingdom;Discipline of General Practice, School of Medicine, National University ofIreland, Galway, Ireland;Faculty of Health and Medicine, Lancaster University, Lancaster, UK and General Practice & Primary Care, Institute of Health & Wellbeing, College of MVLS, University of Glasgow, Glasgow, UK;General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK;Graduate Entry Medical School, University of Limerick, Limerick, Ireland;

关键词: Primary Health Care;    Transients and Migrants;    General Practice;    Community-Based Participatory Research;    Cross-cultural communication;    Equity;   

DOI  :  10.1186/s12939-017-0525-y

 received in 2016-08-15, accepted in 2017-01-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice.MethodsWe undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers’ fieldwork reports, were coded and thematically analysed by each team using NPT.ResultsIn all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants’ needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP’s diagnoses and GPs reported a clearer understanding of migrants’ symptoms.ConclusionsMigrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.

【 授权许可】

CC BY   
© The Author(s). 2017