International Journal for Equity in Health
Volume 16, Issue 1, 2017

Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: A qualitative participatory European study (Article) (Open Access)

Teunissen E. , Gravenhorst K. , Dowrick C. , Van Weel-Baumgarten E. , Van Den Driessen Mareeuw F. , De Brún T. , Burns N. , Lionis C. , Mair F.S. , O'Donnell C. , O'Reilly-De Brún M. , Papadakaki M. , Saridaki A. , Spiegel W. , Van Weel C. , Van Den Muijsenbergh M.* , MacFarlane A.
  • a Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, Netherlands
  • b Department of Psychological Sciences, B121 Waterhouse Buildings, University of Liverpool, Liverpool, United Kingdom
  • c Department of Psychological Sciences, B121 Waterhouse Buildings, University of Liverpool, Liverpool, United Kingdom
  • d Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, Netherlands
  • e Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, Netherlands
  • f Discipline of General Practice, School of Medicine, National University OfIreland, Galway, Ireland
  • g Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
  • h General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
  • i Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece
  • j Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece
  • k Discipline of General Practice, School of Medicine, National University OfIreland, Galway, Ireland
  • l General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom, Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete Heraklion, Crete, Greece
  • m General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
  • n Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, Vienna, A-1090, Austria
  • o Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, Netherlands, Australian Primary Health Care Research Institute, Nijmegen, Netherlands
  • p Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, Netherlands, Pharos, Centre of Expertise for Health Disparities, Utrecht, Netherlands
  • q Graduate Entry Medical School, University of Limerick, Limerick, Ireland

Abstract

Background: Cross-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. Methods: We 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. Results: In 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. Conclusions: Migrants, 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. © 2017 The Author(s).

Author Keywords

Transients and migrants Primary health care equity Cross-cultural communication Community-based participatory research General practice

Index Keywords

information processing education Health Personnel participatory approach communication barrier cultural anthropology Communication Barriers training program feasibility primary medical care methodology Communication Europe health care personnel interpersonal communication mental health human analytical framework Practice Guidelines as Topic protocol compliance stakeholder Guideline Adherence general practitioner clinical practice migrants experience Cultural Competency cultural competence qualitative research health personnel attitude public attitude Humans migrant consultation male Emigrants and Immigrants female patient referral problem based learning Referral and Consultation qualitative analysis Problem-Based Learning medical education Article research method health care palliative therapy migration equity learning aid cross cultural communication participatory research Transients and Migrants primary health care fieldwork practice guideline Focus Groups implementation process health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85014471331&doi=10.1186%2fs12939-017-0525-y&partnerID=40&md5=b685af3834f93637379e0ba7c7fe8392
DOI: 10.1186/s12939-017-0525-y
ISSN: 14759276
Cited by: 11
Original Language: English