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

Teunissen, E. et al. (2017) 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, 16, 32. (doi: 10.1186/s12939-017-0525-y) (PMID:8222736) (PMCID:PMC532076)

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.

• Item Type: Articles
• Additional Information: The RESTORE project was funded by the EU Seventh Framework Programme (FP7/2007–2013) under Grant Agreement No. 257258. RESTORE: REsearch into Implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: O'Donnell, Professor Kate and Burns, Dr Nicola and Mair, Professor Frances
• Authors: 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., and MacFarlane, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: International Journal for Equity in Health
• Publisher: BioMed Central
• ISSN: 1475-9276
• ISSN (Online): 1475-9276
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in International Journal for Equity in Health 16:32
• Publisher Policy: Reproduced under a Creative Commons License