BMJ Open
Volume 6, Issue 7, 2016

Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: A theoretically informed participatory study (Article) (Open Access)

Lionis C.* , Papadakaki M. , Saridaki A. , Dowrick C. , O'Donnell C.A. , Mair F.S. , Van Den Muijsenbergh M. , Burns N. , De Brún T. , O'Reilly De Brún M. , Van Weel-Baumgarten E. , Spiegel W. , MacFarlane A.
  • a Faculty of Medicine, University of Crete, Heraklion, Greece
  • b Faculty of Medicine, University of Crete, Heraklion, Greece, Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Heraklion, Greece
  • c Faculty of Medicine, University of Crete, Heraklion, Greece
  • d Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
  • e Department of General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom
  • f Department of General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom
  • g Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands, Pharos Centre of Expertise on Health Disparities, Utrecht, Netherlands
  • h Department of General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom, Faculty of Health and Medicine, Lancaster Medical School, Furness College, University of Lancaster, Lancaster University, Lancaster, United Kingdom
  • i Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
  • j Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
  • k Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
  • l Centre for Public Health, Medical University of Vienna, Vienna, Austria
  • m Graduate Entry Medical School, University of Limerick, Limerick, Ireland

Abstract

Objectives: Guidelines and training initiatives (G/TIs) are available to support communication in crosscultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings. Setting: As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands. Participants: A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners). Primary and secondary outcome measures: We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs. Results: The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project. Conclusions: This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants. © Published by the BMJ Publishing Group Limited.

Author Keywords

Primary care Community involvement Migrant health cross-cultural consultation

Index Keywords

information processing doctor patient relation Netherlands nurse Communication interpersonal communication human middle aged Practice Guidelines as Topic statistics and numerical data general practitioner Austria procedures qualitative research Young Adult Humans migrant Ireland Adolescent health services research male England consultation female Greece European Union theoretical model thematic analysis human experiment migration Culturally Competent Care transcultural care health care system Transients and Migrants practice guideline Focus Groups primary health care Learning
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84979871451&doi=10.1136%2fbmjopen-2015-010822&partnerID=40&md5=fa159aff93d42379d1e2f22757c88c90
DOI: 10.1136/bmjopen-2015-010822
ISSN: 20446055
Cited by: 14
Original Language: English