BMJ Open
Volume 9, Issue 4, 2019

Understanding perceptions of global healthcare experiences on provider values and practices in the USA: A qualitative study among global health physicians and program directors (Article) (Open Access)

Matthews-Trigg N. , Citrin D. , Halliday S. , Acharya B. , Maru S. , Bezruchka S. , Maru D.*
  • a Department of Global Health, University of Washington, Seattle, WA, United States
  • b Department of Global Health, University of Washington, Seattle, WA, United States, Possible, Kathmandu, Nepal, Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, United States, Department of Anthropology, University of Washington, Seattle, WA, United States
  • c Possible, Kathmandu, Nepal, Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, United States
  • d Possible, Kathmandu, Nepal, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
  • e Possible, Kathmandu, Nepal, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, United States, Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States, Department of Obstetrics Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
  • f Department of Global Health, University of Washington, Seattle, WA, United States, Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States
  • g Possible, Kathmandu, Nepal, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, United States, Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States, Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Abstract

Objectives The study aimed to qualitatively examine the perspectives of US-based physicians and academic global health programme leaders on how global health work shapes their viewpoints, values and healthcare practices back in the USA. Design A prospective, qualitative exploratory study that employed online questionnaires and open-ended, semi-structured interviews with two participant groups: (1) global health physicians and (2) global health programme leaders affiliated with USA-based academic medical centres. Open coding procedures and thematic content analysis were used to analyse data and derive themes for discussion. Participants 159 global health physicians and global health programme leaders at 25 academic medical institutions were invited via email to take a survey and participate in a follow-up interview. Twelve participants completed online questionnaires (7.5% response rate) and eight participants (four survey participants and four additionally recruited participants) participated in in-depth, in-person or phone semi-structured interviews. Results Five themes emerged that highlight how global health physicians and academic global health programme leaders perceive global health work abroad in shaping USA-based medical practices: (1) a sense of improved patient rapport, particularly with low-income, refugee and immigrant patients, and improved and more engaged patient care; (2) reduced spending on healthcare services; (3) greater awareness of the social determinants of health; (4) deeper understanding of the USA's healthcare system compared with systems in other countries; and (5) a reinforcement of values that initially motivated physicians to pursue work in global health. Conclusions A majority of participating global health physicians and programme leaders believed that international engagements improved patient care back in the USA. Participant responses relating to the five themes were contextualised by highlighting factors that simultaneously impinge on their ability to provide improved patient care, such as the social determinants of health, and the challenges of changing USA healthcare policy. © Author(s) (or their employer(s)) 2019.

Author Keywords

domestic health learning exchange Global health health equity

Index Keywords

perception prospective study immigrant refugee lowest income group health equity health care policy e-mail follow up human controlled study social determinants of health medical practice qualitative research male semi structured interview female leadership questionnaire clinical article Article awareness adult content analysis global health reinforcement
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85063860538&doi=10.1136%2fbmjopen-2018-026020&partnerID=40&md5=423a007aaf75e16327c0f8cba1023b02
DOI: 10.1136/bmjopen-2018-026020
ISSN: 20446055
Original Language: English