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Olszewski AE, Bogetz J, Bradford MC, Mercer A, Scott M, Fields B, Williams K, Rosenberg AR, Trowbridge A. Family Responses to Different Types of Clinician Empathy Expression in Pediatric Care Conferences. J Palliat Med 2024; 27:383-387. [PMID: 38048291 DOI: 10.1089/jpm.2023.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Background: Clinician empathy positively impacts patient outcomes. Few studies have assessed the effects of different types of empathic expression. Objective: To describe how families respond when clinicians express empathy in different ways. Design: Prospective, mixed-methods cohort. Setting/Subjects: English and interpreted pediatric inpatient care conferences at a U.S. quaternary hospital between January 1, 2018 and January 1, 2021. Measurements: Directed content analysis of clinician empathic statements and family responses. Results: Of 29 patient-family dyads, 11 (39%) used language interpretation. In response to 80 clinician empathic statements, families expressed agreement or shared more 84% (67/80) of the time. Families shared more about their perspective in response to explore statements 71.4% (10/14) of the time, in response to validate statements 61% (17/28) of the time, and in response to respect/support statements 39% (11/28) of the time. Conclusion: Certain types of empathic statements may be more effective at prompting families to share more about their perspective, a key element of shared decision-making.
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Affiliation(s)
- Aleksandra E Olszewski
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
- Division of Critical Care Medicine, Department of Pediatrics, Lurie Children's Hospital and Northwestern University, Chicago, Illinois, USA
| | - Jori Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
- Treuman Katz Center, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Amanda Mercer
- Counseling Education Department, Portland State University, Portland, Oregon, USA
| | - Maya Scott
- Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington, USA
| | - Blanca Fields
- Department of Interpreter Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kelli Williams
- Parent Advisory Council, Seattle Children's Hospital, Seattle, Washington, USA
| | - Abby R Rosenberg
- Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Trowbridge
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
- Treuman Katz Center, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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Duveau C, Wets C, Delaruelle K, Demoulin S, Dauvrin M, Lepièce B, Ceuterick M, De Maesschalck S, Bracke P, Lorant V. Individual, interpersonal, and organisational factors associated with discrimination in medical decisions affecting people with a migration background with mental health problems: the case of general practice. ETHNICITY & HEALTH 2024; 29:126-145. [PMID: 37936401 DOI: 10.1080/13557858.2023.2279476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. DESIGN An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. RESULTS Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress. CONCLUSION This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients.
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Affiliation(s)
- Camille Duveau
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Camille Wets
- Health and Demographic Research, Ghent University, Ghent, Belgium
| | | | - Stéphanie Demoulin
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie Dauvrin
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- Belgian Health Care Knowledge Centre, KCE, Brussels, Belgium
| | - Brice Lepièce
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | | | | | - Piet Bracke
- Health and Demographic Research, Ghent University, Ghent, Belgium
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Klinker L, Boeckler A, Kreibich S, Mazigo H. Cultural adaption and validation of the Explanatory Model Interview Catalogue-Community Stigma Scale in the assessment of public stigma related to schistosomiasis in lakeshore areas of Mwanza region, Tanzania. PLoS Negl Trop Dis 2023; 17:e0011534. [PMID: 37578967 PMCID: PMC10449129 DOI: 10.1371/journal.pntd.0011534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/24/2023] [Accepted: 07/15/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Previous qualitative studies on attitudes towards schistosomiasis demonstrated inconclusive results on the extent of stigma towards schistosomiasis in endemic communities around the world. The Explanatory Model Interview Catalogue-Community Stigma Scale (EMIC-CSS) has been used and validated for the assessment of public stigma across numerous countries in various health conditions. This study tested the performance of the scale in the context of stigma related to schistosomiasis in twelve communities in the three districts of Magu, Nyamagana and Ilemela in Mwanza region, Tanzania. METHODOLOGY/PRINCIPAL FINDINGS The 15-item-version of the EMC-CSS was first translated to Kiswahili language. The translation was discussed within the research team to retain the meaning of the items and implement cultural adaptations. Validation of the adapted EMIC-CSS scale was conducted following the framework of Herdman and Fox- Rushby. A pilot study with 41 participants from two communities provided the basis for testing the performance of each item and assessing the semantic and operational equivalence of the scales. In addition, eight qualitative focus group discussions (FGDs) were conducted to evaluate the conceptional equivalence of the EMIC-CSS. Finally, the performance of the adjusted scale was tested on 200 participants with a 50:50 male-female ratio from ten communities. The mean score of the EMIC-CSS M = 8.35 (SD = 6.63) shows clear indications for public stigma towards schistosomiasis. The EMIC-CSS demonstrated a good internal consistency with Cronbach's alpha α = .857 and no floor and ceiling effects. CONCLUSION/SIGNIFICANCE The results demonstrate that the EMIC-CSS is a useful instrument in assessing public stigma towards schistosomiasis and allow a clear recommendation of the EMIC-CSS for schistosomiasis in the Tanzanian culture. However, future studies are additionally recommended to address specific aspects and forms of the disease and how they contribute to the development of stigma towards schistosomiasis.
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Affiliation(s)
- Laura Klinker
- Department of Psychology, Julius-Maximilian University Wuerzburg, Wuerzburg, Germany
| | - Anne Boeckler
- Department of Psychology, Julius-Maximilian University Wuerzburg, Wuerzburg, Germany
| | - Saskia Kreibich
- Department of medical social projects, DAHW German Leprosy and Tuberculosis Relief Association, Wuerzburg, Germany
| | - Humphrey Mazigo
- Department of Parasitology and Entomology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. PATIENT EDUCATION AND COUNSELING 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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5
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Leu GR, Links AR, Park J, Beach MC, Boss EF. Parental Expression of Emotions and Surgeon Responses During Consultations for Obstructive Sleep-Disordered Breathing in Children. JAMA Otolaryngol Head Neck Surg 2021; 148:145-154. [PMID: 34882170 DOI: 10.1001/jamaoto.2021.3530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Little is known about emotional communication between parents and surgeons. Understanding the patterns and correlates of emotional communication may foster collaboration during surgical consultations. Objective To describe the emotional expressions by parents when bringing their child for evaluation of obstructive sleep-disordered breathing (SDB) as well as surgeon responses to these emotional expressions and to evaluate the association between parental demographic characteristics and surgeon response types. Design, Setting, and Participants This cross-sectional study analyzed the audio-recorded consultations between otolaryngologists and parents of children who underwent their initial otolaryngological examination for obstructive SDB at 1 of 3 outpatient clinical sites in Maryland from April 1, 2016, to May 31, 2017. Data analysis was performed from November 1 to December 31, 2019. Main Outcomes and Measures Emotional expressions by parents and surgeon responses were audio recorded, transcribed, and coded using the Verona Coding Definitions of Emotional Sequences. Results A total of 59 consultations, of which 40 (67.8%) contained at least 1 emotional expression, were included. Participants included 59 parents (53 women [89.8%]; mean [SD] age, 33.4 [6.4] years) and 7 surgeons (4 men [57.1%]; mean [SD] age, 42.8 [7.9] years). Parents made 123 distinct emotional expressions (mean [SD], 3.08 [2.29] expressions per visit), which were often expressed as subtle cues (n = 103 of 123 [83.7%]) vs explicit concerns (n = 20 [16.3%]). Most expressions (n = 98 [79.7%]) were related to medical issues experienced by the child (eg, symptoms and surgical risks). Most surgeon responses provided parents space for elaboration of emotional expressions (n = 86 [69.9%]) and were nonexplicit (n = 55 [44.7%]). Surgeons were less likely to explore the emotions of parents from racial and ethnic minority groups compared with White parents (OR, 0.47; 95% CI, 0.18-0.98). Conclusions and Relevance This cross-sectional study found that emotional communication occurs between surgeons and parents of pediatric patients with obstructive SDB. However, surgeon responses varied according to parental race and ethnicity, suggesting the existence of implicit biases in surgeon-patient communication and calling for further research to inform efforts to promote family-centered, culturally competent communication in surgery.
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Affiliation(s)
- Grace R Leu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenny Park
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Catherine Beach
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Baraldi C, Gavioli L. Effective Communication and Knowledge Distribution in Healthcare Interaction with Migrants. HEALTH COMMUNICATION 2021; 36:1059-1067. [PMID: 32192369 DOI: 10.1080/10410236.2020.1735701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Modern patient-centered approaches increasingly recognize the contribution of patients' knowledge in interactions with health-care personnel. Effective involvement is exceptionally difficult when patients are migrants with limited command of specialized language. Interactional practices that promote effective distribution of knowledge and access to it are needed: by doctors interacting directly with patients in a shared language and by mediators providing interpreting services across different languages. In this paper, we look at two types of sequence which seem to be effective in involving (migrant) patients. The first concerns clinicians' reactions to spontaneous patients' initiatives, like claims to knowledge or personal narratives. The second concerns interpreters' explanations when they render the clinicians' instructions to the patients. While both sequences are clearly designed to promote patients' participation, they need particular communicative competence on the part of staff, clinicians, and interpreters.
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Affiliation(s)
- Claudio Baraldi
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia
| | - Laura Gavioli
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia
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The Unmet Supportive Care Needs of Arab Australian and Arab Jordanian Cancer Survivors: An International Comparative Survey. Cancer Nurs 2020; 42:E51-E60. [PMID: 29757770 DOI: 10.1097/ncc.0000000000000609] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Research exploring the unmet supportive care needs of Arab cancer survivors is limited, with most conducted with immigrant groups. No study has compared the unmet supportive care needs of immigrant Arab cancer survivors with Arab cancer survivors living in their native country. OBJECTIVE To explore the unmet supportive care needs of both Arab Australian and Arab Jordanian cancer survivors. METHODS Arab people living in Sydney, Australia, and Amman, Jordan, and diagnosed with cancer within the last 5 years were invited to complete a questionnaire that measured unmet supportive care needs, depression, and language acculturation. Multiple regression analysis was performed to identify predictors of unmet supportive care needs. RESULTS Seventy-seven Arab Jordanian and 66 Arab Australian cancer survivors were recruited. Australian participants were older than their Jordanian counterparts (61.5 vs 52.3 years; P < .001) and reported higher levels of overall unmet needs (44.9 vs 36.1; P = .012). Controlling for age and stage of cancer diagnosis, higher levels of depression (β = .34) and living in Australia (β = .26) were significant predictors of unmet needs and explained almost 17% of the variance. CONCLUSIONS These findings have extended our understanding of the unmet supportive care needs of Arab cancer survivors and confirm disparities in unmet needs in immigrant populations. IMPLICATIONS FOR PRACTICE Greater attention is needed to ensure the supportive care needs are met for immigrant patients with cancer. Additional strategies to address physical and psychological needs are particularly needed in this group.
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Krystallidou D, Bylund CL, Pype P. The professional interpreter's effect on empathic communication in medical consultations: A qualitative analysis of interaction. PATIENT EDUCATION AND COUNSELING 2020; 103:521-529. [PMID: 31623946 DOI: 10.1016/j.pec.2019.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 09/03/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate how empathic communication is expressed in interpreter-mediated consultations (IMCs) and the interpreter's effect on it. METHODS We coded 20 authentic video-recorded IMCs by using the Empathic Communication Coding System (ECCS). We compared patient-initiated empathic opportunities (EOs) and doctors' responses as expressed by patients and doctors and as rendered by interpreters. RESULTS We identified 44 EOs. In 2 of the 44 EOs there was a close match in the way the EOs were expressed by the patient in the first place and in the way they were rendered by the interpreter. Twenty-four of the 44 EOs that were passed on by the interpreter to the doctor and presented the doctor with an opportunity to respond, came with a shift in meaning and/or intensity. Twenty of the 44 EOs were not passed on by the interpreter to the doctor. CONCLUSION In IMCs, EOs are subject to the interpreter's renditions and the doctor's actions during interaction. PRACTICE IMPLICATIONS Doctors and interpreters require skills to detect patient cues, assess them correctly, render them completely and in an appropriate manner (interpreters) and display communicative behaviours that take into account the intricacies of interpreter-mediated clinical communication and facilitate each other's communicative goals.
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Affiliation(s)
- Demi Krystallidou
- KU Leuven, Faculty of Arts, Antwerp Sint Jacob Campus, Antwerp, Belgium.
| | - Carma L Bylund
- University of Florida, Department of Public Relations, College of Journalism and Communications, Gainesville, USA
| | - Peter Pype
- Ghent University, Department of Public Health and Primary Care, Ghent, Belgium
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Jager M, den Boeft A, Leij-Halfwerk S, van der Sande R, van den Muijsenbergh M. Cultural competency in dietetic diabetes care-A qualitative study of the dietician's perspective. Health Expect 2020; 23:540-548. [PMID: 32045075 PMCID: PMC7321725 DOI: 10.1111/hex.13019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/04/2019] [Accepted: 12/12/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Diabetes type 2 is more prevalent in ethnic minorities in the Netherlands, and outcomes of health care in general are worse compared to other Dutch patients. The purpose of this study is to explore the experiences of dieticians and the knowledge, skills and attitudes they consider to be important for effective dietetic care in migrant patients. METHODS Semi-structured interviews were held with 12 dieticians, of various ages, ethnic backgrounds and experience. The interview guide was based on Seeleman's cultural competence model and the Dutch dietetic consultation model. Interviews were transcribed, coded and thematically analysed, revealing 7 main themes. RESULTS Dieticians were uncertain whether their care fulfilled their migrant patients' needs. They experienced language differences as a major barrier for retrieving information and tailoring advice to the patient's needs. Furthermore, dieticians feel they lack cultural knowledge. An open and respectful attitude was considered important for effective care. The communication barrier hindered building a trusting relationship; however, few dieticians mentioned a need for communication training. They expressed a need for cultural competence training, specifically to acquire cultural knowledge. CONCLUSION Dieticians struggle with providing dietetic care for migrant diabetes patients due to communication barriers and difficulty in building a trusting relationship. They are conscious of their lack of cultural knowledge, and acknowledge the need for an open and respectful attitude and essential communication skills in order to collect and convey information. They seem unaware of the impact of low (health) literacy. Cultural competence training is needed for effective dietetic care for migrants.
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Affiliation(s)
- Mirjam Jager
- Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Primary and Community Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andrea den Boeft
- Internal Medicine and Dermatology, Department of Dietetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Susanne Leij-Halfwerk
- Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Rob van der Sande
- Primary and Community Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Pharos, National Centre of Expertise on Health Disparities, Utrecht, The Netherlands
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Theys L, Krystallidou D, Salaets H, Wermuth C, Pype P. Emotion work in interpreter-mediated consultations: A systematic literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:33-43. [PMID: 31431309 DOI: 10.1016/j.pec.2019.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/10/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify the ways in which physicians, patients and interpreters express emotions, react to emotional expressions and/or coordinate the emotional interaction in interpreter-mediated consultations (IMCs). METHODS We systematically searched four databases and screened 10 307 articles. The following inclusion criteria were applied: 1) participants are patients with limited proficiency in the host language, physicians and professional interpreters, 2) analysis of patient-physician-interpreter interaction, 3) focus on emotions, 4) in vivo spoken language interpretation, and 5) authentic primary data. RESULTS The results of 7 included studies suggest that physicians, patients and interpreters work together and verbally and paraverbally contribute to the co-construction of emotional communication (EC) in IMCs. However, a decrease in EC might still compromise the patient's quality of care in IMCs. CONCLUSION There is a dearth of scientific evidence of EC as an interactional process between participants in IMCs. More research on under investigated modes of communication and emotions is needed to advance our understanding. For now, EC seems to be subject to the successful interaction between participants in IMCs. PRACTICE IMPLICATIONS Evidence-based curricula of interprofessional education between physicians and interpreters on EC in IMCs could be beneficial to the effective co-construction of EC in IMCS.
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Affiliation(s)
- Laura Theys
- KU Leuven, Faculty of Arts (Antwerp Campus), Sint-Andriesstraat 2, B-2000 Antwerp, Belgium; Ghent University, Department of Public Health and Primary Care, Corneel Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Demi Krystallidou
- KU Leuven, Faculty of Arts (Antwerp Campus), Sint-Andriesstraat 2, B-2000 Antwerp, Belgium.
| | - Heidi Salaets
- KU Leuven, Faculty of Arts (Antwerp Campus), Sint-Andriesstraat 2, B-2000 Antwerp, Belgium.
| | - Cornelia Wermuth
- KU Leuven, Faculty of Arts (Antwerp Campus), Sint-Andriesstraat 2, B-2000 Antwerp, Belgium.
| | - Peter Pype
- Ghent University, Department of Public Health and Primary Care, Corneel Heymanslaan 10, B-9000 Ghent, Belgium.
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11
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Emotional Communication in HIV Care: An Observational Study of Patients' Expressed Emotions and Clinician Response. AIDS Behav 2019; 23:2816-2828. [PMID: 30895426 DOI: 10.1007/s10461-019-02466-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emotional support is essential to good communication, yet clinicians often miss opportunities to provide empathy to patients. Our study explores the nature of emotional expressions found among patients new to HIV care, how HIV clinicians respond to these expressions, and predictors of clinician responses. Patient-provider encounters were audio-recorded, transcribed, and coded using the VR-CoDES. We categorized patient emotional expressions by intensity (subtle 'cues' vs. more explicit 'concerns'), timing (initial vs. subsequent), and content (medical vs. non-medical). Emotional communication was present in 65 of 91 encounters. Clinicians were more likely to focus specifically on patient emotion for concerns versus cues (OR 4.55; 95% CI 1.36, 15.20). Clinicians were less likely to provide space when emotional expressions were repeated (OR 0.32; 95% CI 0.14, 0.77), medically-related (OR 0.36; 95% CI 0.17, 0.77), and from African American patients (OR 0.42; 95% CI 0.21, 0.84). Potential areas for quality improvement include raising clinician awareness of subtle emotional expressions, the emotional content of medically-related issues, and racial differences in clinician response.
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12
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Brady B, Veljanova I, Chipchase L. The Intersections of Chronic Noncancer Pain: Culturally Diverse Perspectives on Disease Burden. PAIN MEDICINE 2019; 20:434-445. [PMID: 29846709 DOI: 10.1093/pm/pny088] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study highlights the burden of chronic non-cancer-related pain from the perspectives of three culturally and linguistically diverse communities, using an intersectionality analysis. Specifically, we identify how multiple social identities intersect to account for the unequal distribution of the burden of chronic pain. DESIGN AND METHODS Six focus groups of 41 culturally and linguistically diverse participants (Mandaean, Assyrian, and Vietnamese) living with chronic noncancer pain were conducted in South-West Sydney, Australia, between February and July 2015. Data were analyzed using inductive and intersectional methodology. RESULTS The interaction between a patient with chronic pain from a culturally and linguistically diverse background and the health system is influenced by four identified social identities that interact to create relative positions of disadvantage for the patient within the health system and with health care providers. The social identities identified were ethnoculture, social class, migration status, and gender. CONCLUSIONS Health care providers must consider how the intersectionality of social identities related to ethnoculture, social class, migration status, and gender can factor into the creation and maintenance of chronic pain disparities. A greater, more thoughtful incorporation of intersectionality in chronic pain research and clinical practice will ensure that pain management approaches are designed and applied in a way that reflects the social context of affected communities and individuals from those communities.
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Affiliation(s)
- Bernadette Brady
- School of Science and Health, Western Sydney University, Sydney, Australia.,Departments of Pain Medicine and Physiotherapy, Liverpool Hospital, Sydney, Australia
| | - Irena Veljanova
- School of Social Science and Psychology, Western Sydney University, Sydney, Australia
| | - Lucinda Chipchase
- School of Science and Health, Western Sydney University, Sydney, Australia
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Brady B, Veljanova I, Andary T, Southwell T, Chipchase L. Recognising ethnocultural diversity in chronic pain assessment: validation of the Pictorial Representation of Illness and Self Measure (PRISM) for use with culturally diverse communities. Health Qual Life Outcomes 2019; 17:56. [PMID: 30961623 PMCID: PMC6454629 DOI: 10.1186/s12955-019-1126-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/26/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A comprehensive and accurate assessment of pain is critical for successful pain management. However, there is a lack of reliable and valid assessment tools for exploring multidimensional aspects of the chronic pain experience in culturally and linguistically diverse communities. This study investigates the reliability and validity of the Pictorial Representation of Illness and Self Measure + (PRISM+) for evaluating pain-related suffering and the sociocultural context of chronic pain within culturally and linguistically diverse patient cohorts. METHOD Three prospective validation studies are reported for three culturally and linguistically diverse communities. Two hundred and fifty-one patients with chronic pain who self-identified as Assyrian (n = 85), Arabic (n = 83) or Vietnamese (n = 83) completed a PRISM+ assessment, alongside a battery of standardised pain assessments. To evaluate construct validity, the position of the 'pain' disk placement was correlated with the Brief Pain Inventory (BPI), Depression Anxiety and Stress Scale (DASS), and the Short-Form 36 Health Survey (SF-36). For content validity, thematic analysis of patient narratives accompanying each disk placement was conducted. Test-retest reliability of repeated 'pain' and five additional disks (PRISM+) values was analysed using intra-class correlation coefficients. RESULTS The PRISM pain assessment demonstrated moderate to good test-retest reliability for Arabic (ICC 0.76; 95% CI 0.65-0.84), Assyrian (ICC 0.65; 95% CI 0.50-0.76) and Vietnamese (ICC 0.82; 95% CI 0.73-0.88) patients. Moderate correlations between the PRISM 'pain' disk and sub-scores for the BPI, DASS and SF-36 were found (p < 0.001). Patient interpretations of the 'pain' disk aligned with accepted definitions of suffering, supporting content validity for PRISM. For the additional disks (PRISM+), moderate to good test-retest reliability (ICC 0.67-0.88) was observed and qualitative analysis highlighted each disk reflected social and cultural values. CONCLUSION The PRISM demonstrates acceptable psychometric properties for measuring pain-related suffering for participants with chronic pain across three culturally and linguistically diverse communities. The use of additional disks (PRISM+) presents a reliable and valid option for exploring social and cultural dimensions of chronic pain in clinical encounters.
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Affiliation(s)
- Bernadette Brady
- School of Science and Health, Western Sydney University, Sydney, NSW Australia
- Departments of Pain Medicine and Physiotherapy, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 1871 Australia
| | - Irena Veljanova
- School of Social Science and Psychology, Western Sydney University, Sydney, NSW Australia
| | - Toni Andary
- Physiotherapy Department, Fairfield Hospital, Fairfield, NSW Australia
| | - Troy Southwell
- School of Science and Health, Western Sydney University, Sydney, NSW Australia
| | - Lucinda Chipchase
- School of Science and Health, Western Sydney University, Sydney, NSW Australia
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Pot A, Keijzer M, de Bot K. [The language barrier for older Turkish females, further investigated]. Tijdschr Gerontol Geriatr 2018; 49:274-282. [PMID: 30478784 DOI: 10.1007/s12439-018-0270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
Abstract
A growing group of migrants age in an environment in which the dominant language (L2) differs from their mother tongue (L1). This study considers the occurrence of a language barrier in accessing (information on) health and healthcare provisions, and under which circumstances a limited proficiency in the L2 negatively influences well-being for a group of older Turkish women in the Netherlands. Data from interviews with 39 Turkish females reveal that a limited L2 proficiency does not automatically result in a lower level of well-being. When individuals are well-embedded in a social network (and feel belonging to it), a limited L2 proficiency can be alleviated by either L1 assistance from their environment or by facilitating an interpreter in L2 situations. However, when such a network is absent, L2 situations can cause anxiety, which may have repercussions for well-being. Even though there is no clear one-on-one relationship between language and well-being, language does play a role in many (social) processes that influence well-being.
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Affiliation(s)
- Anna Pot
- Rijksuniversiteit Groningen, Oude Kijk in 't Jatstraat 2, 9712 EK, Groningen, Nederland.
| | - Merel Keijzer
- Rijksuniversiteit Groningen, Oude Kijk in 't Jatstraat 2, 9712 EK, Groningen, Nederland
| | - Kees de Bot
- Rijksuniversiteit Groningen, Oude Kijk in 't Jatstraat 2, 9712 EK, Groningen, Nederland
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Piccolo LD, Finset A, Mellblom AV, Figueiredo-Braga M, Korsvold L, Zhou Y, Zimmermann C, Humphris G. Verona Coding Definitions of Emotional Sequences (VR-CoDES): Conceptual framework and future directions. PATIENT EDUCATION AND COUNSELING 2017; 100:2303-2311. [PMID: 28673489 DOI: 10.1016/j.pec.2017.06.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To discuss the theoretical and empirical framework of VR-CoDES and potential future direction in research based on the coding system. METHODS The paper is based on selective review of papers relevant to the construction and application of VR-CoDES. RESULTS VR-CoDES system is rooted in patient-centered and biopsychosocial model of healthcare consultations and on a functional approach to emotion theory. According to the VR-CoDES, emotional interaction is studied in terms of sequences consisting of an eliciting event, an emotional expression by the patient and the immediate response by the clinician. The rationale for the emphasis on sequences, on detailed classification of cues and concerns, and on the choices of explicit vs. non-explicit responses and providing vs. reducing room for further disclosure, as basic categories of the clinician responses, is described. CONCLUSIONS Results from research on VR-CoDES may help raise awareness of emotional sequences. Future directions in applying VR-CoDES in research may include studies on predicting patient and clinician behavior within the consultation, qualitative analyses of longer sequences including several VR-CoDES triads, and studies of effects of emotional communication on health outcomes. PRACTICE IMPLICATIONS VR-CoDES may be applied to develop interventions to promote good handling of patients' emotions in healthcare encounters.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Arnstein Finset
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anneli V Mellblom
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Pediatric Medicine, Women and Children's Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Margarida Figueiredo-Braga
- Faculty of Medicine, University of Porto, Portugal; I3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Live Korsvold
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yuefang Zhou
- University of St Andrews, Medical School, North Haugh, St Andrews, UK
| | - Christa Zimmermann
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gerald Humphris
- University of St Andrews, Medical School, North Haugh, St Andrews, UK
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Aelbrecht K, De Maesschalck S, Willems S, Deveugele M, Pype P. How family physicians respond to unpleasant emotions of ethnic minority patients. PATIENT EDUCATION AND COUNSELING 2017; 100:1867-1873. [PMID: 28535925 DOI: 10.1016/j.pec.2017.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 03/29/2017] [Accepted: 04/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The diversity in our society makes patient-centered care more difficult. In this study, we aim to describe how family physicians respond to unpleasant emotions of ethnic minority patients. METHODS One hundred ninety one consultations of family physicians with ethnic minority patients were video-recorded and analyzed using the Verona Codes for Provider Responses (VR-CoDES-P) to describe physicians' responses to patients' expressed unpleasant emotions or cues (implicit) and concerns (explicit). RESULTS 42.4% (n=81) of all the consultations contained no cues or concerns, and thus no physician responses. Of the consultations containing at least one cue or concern, a mean of 3.45 cues and a mean of 1.82 concerns per consultation were found. Physicians are significantly (p≤0.001) more frequently stimulating further disclosure of patients' cues and concerns (providing space: n=339/494 or 68.6% versus reducing space: n=155/494 or 31.4%). However, these explorations are more often about the factual, medical content of the cue than about the emotion itself (n=110/494 or 22.3% versus n=79/494 or 16%). The inter-physician variation in response to patients' cues is larger than the variation in response to the patient's concerns. CONCLUSIONS Although family physicians are quite often providing room for patients' emotions, there is much room for improvement when it comes to explicitly talking about emotional issues with patients. PRACTICE IMPLICATIONS Further research should focus on a more qualitative in-depth analysis of the complex interplay between culture and language of ethnic minority patients in primary care and, consequently, create awareness among these healthcare providers about the importance of ethnic minority patients' emotions and how to respond accordingly.
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Affiliation(s)
- Karolien Aelbrecht
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium.
| | | | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Myriam Deveugele
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Peter Pype
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
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Lorié Á, Reinero DA, Phillips M, Zhang L, Riess H. Culture and nonverbal expressions of empathy in clinical settings: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:411-424. [PMID: 27693082 DOI: 10.1016/j.pec.2016.09.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/22/2016] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To conduct a systematic review of studies examining how culture mediates nonverbal expressions of empathy with the aim to improve clinician cross-cultural competency. METHODS We searched three databases for studies of nonverbal expressions of empathy and communication in cross-cultural clinical settings, yielding 16,143 articles. We examined peer-reviewed, experimental or observational articles. Sixteen studies met inclusion criteria. RESULTS Nonverbal expressions of empathy varied across cultural groups and impacted the quality of communication and care. Some nonverbal behaviors appeared universally desired and others, culturally specific. Findings revealed the impact of nonverbal communication on patient satisfaction, affective tone, information exchange, visit length, and expression decoding during cross-cultural clinical encounters. Racial discordance, patients' perception of physician racism, and physician implicit bias are among factors that appear to influence information exchange in clinical encounters. CONCLUSION Culture-based norms impact expectations for specific nonverbal expressions within patient-clinician dyads. Nonverbal communication plays a significant role in fostering trusting provider-patient relationships, and is critical to high quality care. PRACTICE IMPLICATIONS Medical education should include training in interpretation of nonverbal behavior to optimize empathic cross-cultural communication and training efforts should accommodate norms of local patient populations. These efforts should reduce implicit biases in providers and perceived prejudice in patients.
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Affiliation(s)
- Áine Lorié
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA
| | - Diego A Reinero
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA; New York University, Department of Psychology, New York, NY, USA
| | - Margot Phillips
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA
| | - Linda Zhang
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA
| | - Helen Riess
- Massachusetts General Hospital/Harvard Medical School, Empathy and Relational Science Program, Department of Psychiatry, Boston, MA, USA.
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Ortwein H, Benz A, Carl P, Huwendiek S, Pander T, Kiessling C. Applying the Verona coding definitions of emotional sequences (VR-CoDES) to code medical students' written responses to written case scenarios: Some methodological and practical considerations. PATIENT EDUCATION AND COUNSELING 2017; 100:305-312. [PMID: 27597160 DOI: 10.1016/j.pec.2016.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate whether the Verona Coding Definitions of Emotional Sequences to code health providers' responses (VR-CoDES-P) can be used for assessment of medical students' responses to patients' cues and concerns provided in written case vignettes. METHODS Student responses in direct speech to patient cues and concerns were analysed in 21 different case scenarios using VR-CoDES-P. RESULTS A total of 977 student responses were available for coding, and 857 responses were codable with the VR-CoDES-P. In 74.6% of responses, the students used either a "reducing space" statement only or a "providing space" statement immediately followed by a "reducing space" statement. Overall, the most frequent response was explicit information advice (ERIa) followed by content exploring (EPCEx) and content acknowledgement (EPCAc). DISCUSSION VR-CoDES-P were applicable to written responses of medical students when they were phrased in direct speech. The application of VR-CoDES-P is reliable and feasible when using the differentiation of "providing" and "reducing space" responses. Communication strategies described by students in non-direct speech were difficult to code and produced many missings. PRACTICE IMPLICATIONS VR-CoDES-P are useful for analysis of medical students' written responses when focusing on emotional issues. Students need precise instructions for their response in the given test format.
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Affiliation(s)
- Heiderose Ortwein
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - Alexander Benz
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Goethestr. 31, 80336 Munich, Germany
| | - Petra Carl
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Goethestr. 31, 80336 Munich, Germany
| | - Sören Huwendiek
- Institute for Medical Education, Assessment und Evaluation, Konsumstrasse 13, 3010 Bern, Switzerland
| | - Tanja Pander
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Ludwig-Maximilians-Universität München, Ziemssenstrasse 1, 80336 München, Germany
| | - Claudia Kiessling
- Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816 Neuruppin, Germany
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Jakič M, Rotar Pavlič D. Patients' perception of differences in general practitioners' attitudes toward immigrants compared to the general population: Qualicopc Slovenia. Zdr Varst 2016; 55:155-165. [PMID: 27703534 PMCID: PMC5031064 DOI: 10.1515/sjph-2016-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/21/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Globally, the number of immigrants is rising every year, so that the number of immigrants worldwide is estimated at 200 million. In Slovenia, immigrants comprise 6.5% of the overall population. Immigrants bring along to a foreign country their cultural differences and these differences can affect immigrants' overall health status and lead to chronic health conditions. The aim of this study was to identify patients' perception of general practitioners' (GPs') attitudes toward immigrants in Slovenia. METHODS This study was based on the Qualicopc questionnaire. We used the questions that targeted patients' experience with the appointment at their GP on the day that the study was carried out. RESULTS There were no differences in GPs' accessibility based on groups included in our study (p>0.05). Compared to the non-immigrant population, first-generation immigrants answered that their GPs were impolite (p=0.018) and that they did not take enough time for them (p=0.038). In addition, they also experienced more difficulties understanding their GP's instructions (p<0.001). Second-generation immigrants experienced more negative behaviour from GPs, and first-generation immigrants had more difficulties understanding GPs' instructions. CONCLUSION There may be some differences in patients' perception of GPs' attitudes towards immigrants in comparison with the general Slovenian population. However, based on the perception of the immigrants that do benefit from the medical care it is not possible to judge the GPs' attitudes towards immigrants as worse compared to their attitude towards the non-immigrant population. Indeed, there may be other reasons why the patients answered the way they did.
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Affiliation(s)
- Maja Jakič
- University of Ljubljana, Faculty of Medicine, Department of Familiy Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Danica Rotar Pavlič
- University of Ljubljana, Faculty of Medicine, Department of Familiy Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
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Brodie K, Abel G, Burt J. Language spoken at home and the association between ethnicity and doctor-patient communication in primary care: analysis of survey data for South Asian and White British patients. BMJ Open 2016; 6:e010042. [PMID: 26940108 PMCID: PMC4785310 DOI: 10.1136/bmjopen-2015-010042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate if language spoken at home mediates the relationship between ethnicity and doctor-patient communication for South Asian and White British patients. METHODS We conducted secondary analysis of patient experience survey data collected from 5870 patients across 25 English general practices. Mixed effect linear regression estimated the difference in composite general practitioner-patient communication scores between White British and South Asian patients, controlling for practice, patient demographics and patient language. RESULTS There was strong evidence of an association between doctor-patient communication scores and ethnicity. South Asian patients reported scores averaging 3.0 percentage points lower (scale of 0-100) than White British patients (95% CI -4.9 to -1.1, p=0.002). This difference reduced to 1.4 points (95% CI -3.1 to 0.4) after accounting for speaking a non-English language at home; respondents who spoke a non-English language at home reported lower scores than English-speakers (adjusted difference 3.3 points, 95% CI -6.4 to -0.2). CONCLUSIONS South Asian patients rate communication lower than White British patients within the same practices and with similar demographics. Our analysis further shows that this disparity is largely mediated by language.
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Affiliation(s)
- Kara Brodie
- University of California Davis School of Medicine, Sacramento, California, USA
| | - Gary Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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21
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Griep ECM, Noordman J, van Dulmen S. Practice nurses mental health provide space to patients to discuss unpleasant emotions. J Psychiatr Ment Health Nurs 2016; 23:77-85. [PMID: 26710237 DOI: 10.1111/jpm.12279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions. Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients with mild psychosocial and psychological problems provide signs of worrying or express a clear unpleasant emotion in 94% of consultations with a practice nurse mental health. Nurses' responses to patients' signs of worrying or clear unpleasant emotions were mostly characterized by providing space for patients to talk about these emotions, by using minimal responses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Practice nurses' mental health have passive listening skills, and to a lesser extent, use active listening techniques. Accurate emotion detection and the ability to pick out emotional signs during consultations must also be considered as an important skill for health providers to improve patient-centred communication. AIM Patients with physical problems are known to express their emotional concerns in an implicit way only. Whether the same counts for patients presenting mental health problems in primary care is unknown. This study aims to examine how patients with mild psychosocial and psychological complaints express their concerns during consultations with the practice nurse mental health and how practice nurses respond to these expressions. METHOD Fifteen practice nurses mental health working in Dutch general practices participated in the study. Their consultations with 116 patients with mild psychosocial or psychological complaints were video recorded. patients' explicitly expressed emotional concerns and more implicit expressions of underlying emotional problems (cues) as well as nurses' responses to these expressions were rated using the Verona Coding Definition of Emotional Sequences. RESULTS Almost all consultations contained at least one cue or concern (94%). Nurses' responses were mostly characterized by providing space for patients to talk about their cue or concern in a non-explicit way (62%), by using minimal responses (42%). DISCUSSION Practice nurses mental health have passive listening skills, and to a lesser extent, use active listening techniques. However, there are no strict rules which way of responding is the best and patients value responses differently.
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Affiliation(s)
| | | | - S van Dulmen
- NIVEL, Utrecht, The Netherlands.,Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands.,Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
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22
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Squires A. Nursing's opportunity within the global refugee crisis. Int J Nurs Stud 2015; 55:1-3. [PMID: 26679509 DOI: 10.1016/j.ijnurstu.2015.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Allison Squires
- Assistant Professor & Director of International Education, New York University College of Nursing, United States; Research Assistant Professor of Medicine, New York University School of Medicine, United States; Fellow, Health Workforce Migration, Migration Policy Institute, United States; Consultant - Health Labor Markets, World Bank.
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Schouten BC, Schinkel S. Emotions in primary care: Are there cultural differences in the expression of cues and concerns? PATIENT EDUCATION AND COUNSELING 2015; 98:1346-1351. [PMID: 26092767 DOI: 10.1016/j.pec.2015.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Accepted: 05/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study compared native-Dutch and Turkish-Dutch patients' expressions of emotional cues/concerns and GPs' responses to these cues/concerns. Relations between patient's cues/concerns and GPs' perceptions of the patient's health complaint were examined too. METHODS 82 audiotaped encounters with native-Dutch and 38 with Turkish-Dutch GP patients were coded using the VR-CoDES and VR-CoDES-P. Patients filled out a survey before each consultation to assess their cultural identification, Dutch language proficiency and health-related variables. GPs filled out a survey after each consultation to assess their perceptions of the patient's health complaint. RESULTS Turkish-Dutch patients expressed more cues than native-Dutch patients, which was explained by higher worries about their health and worse perceived general health. GPs responded more often with space-providing responses to Turkish-Dutch patients compared to native-Dutch patients. Turkish-Dutch patients' cue expression strongly influenced GPs' perceptions about the presence of psychosocial problems. CONCLUSION Migrant patient-related factors influence the amount of emotional cue expression in primary care. GPs perceive these cues as indicating the presence of psychosocial problems and provide space for patients to elaborate on their emotional distress. PRACTICE IMPLICATIONS GPs should be trained in using more affective communication techniques to enhance elicitation of the underlying reasons for migrant patients' enhanced emotional cue expression.
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Affiliation(s)
- Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, The Netherlands.
| | - Sanne Schinkel
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, The Netherlands
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Lin MY, Kressin NR. Race/ethnicity and Americans' experiences with treatment decision making. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30025-2. [PMID: 26254315 DOI: 10.1016/j.pec.2015.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Despite widespread documentation of racial/ethnic disparities in medical care, population-wide variation in Americans' experiences with care are not well understood. We examined whether race/ethnicity is associated with information received from physicians regarding treatment recommendations. METHODS We conducted a secondary analysis of cross-sectional survey data from a nationally representative sample (N=1238). We assessed patients' personal experiences of receiving information about the rationale for treatment recommendations from their physicians. RESULTS Overall, respondents of minority race/ethnicity received less information from their doctors about the rationale for treatment recommendations. After adjustment for possible confounders, doctors talked less often with patients of 'other' race/ethnicity about reasons for treatment recommendations. Both Blacks' and Hispanics' doctors less often cited their own experiences, or scientific research as a reason for treatment recommendations. CONCLUSION Americans' experiences with information communicated by physicians regarding treatment rationale varies significantly on some dimensions by race/ethnicity, suggesting that differences in key elements of shared decision making are evident in the care of racial/ethnic minorities. PRACTICE IMPLICATIONS Physicians should evaluate the extent to which their communication with patients varies by patient race/ethnicity, and make efforts to ensure that they share equally with all patients regarding the rationale for treatment recommendations.
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Affiliation(s)
- Meng-Yun Lin
- Section of General Internal Medicine, Boston University School of Medicine, Boston, USA; Health Policy and Management Department, Boston University School of Public Health, Boston, USA.
| | - Nancy R Kressin
- Section of General Internal Medicine, Boston University School of Medicine, Boston, USA; VA BostonHealthcare System, Boston, USA.
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Hsieh E, Nicodemus B. Conceptualizing emotion in healthcare interpreting: A normative approach to interpreters' emotion work. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30001-X. [PMID: 26162955 DOI: 10.1016/j.pec.2015.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES By juxtaposing literature in signed language interpreting with that of spoken language interpreting, we provide a narrative review to explore the complexity of emotion management in interpreter-mediated medical encounters. METHODS We conduct literature search through library databases and Google Scholar using varied combinations of search terms, including interpreter, emotion, culture, and health care. RESULTS We first examine (a) interpreters' management and performance of others' emotions, (b) interpreters' management and performance of their own emotions, and (c) impacts of emotion work for healthcare interpreters. CONCLUSION By problematizing the roles and functions of emotion and emotion work in interpreter-mediated medical encounters, we propose a normative model to guide future research and practices of interpreters' emotion management in cross-cultural care. PRACTICE IMPLICATIONS Quality and equality of care should serve as the guiding principle for interpreters' decision-making about their emotions and emotion work. Rather than adopting a predetermined practice, interpreters should evaluate and prioritize the various clinical, interpersonal, and therapeutic objectives as they consider the best practice in managing their own and other speakers' emotions.
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Affiliation(s)
- Elaine Hsieh
- Department of Communication, University of Oklahoma, 610 Elm Avenue #101, Norman, OK 73019, USA.
| | - Brenda Nicodemus
- Department of Interpretation, Gallaudet University, 800 Florida Avenue, NE Washington, DC 20002-3695, USA.
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Paternotte E, van Dulmen S, van der Lee N, Scherpbier AJJA, Scheele F. Factors influencing intercultural doctor-patient communication: a realist review. PATIENT EDUCATION AND COUNSELING 2015; 98:420-45. [PMID: 25535014 DOI: 10.1016/j.pec.2014.11.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/23/2014] [Accepted: 11/17/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works. METHODS A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication. RESULTS In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training. CONCLUSION The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication. PRACTICE IMPLICATIONS Training for improving ICC can be developed as an extension of the existing training for patient-centered communication.
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Affiliation(s)
- Emma Paternotte
- Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway.
| | - Nadine van der Lee
- Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands.
| | - Albert J J A Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Fedde Scheele
- Medical School of Sciences, Vu University Medical Center, Amsterdam, The Netherlands.
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Mothers’ Experiences of Genetic Counselling in Johannesburg, South Africa. J Genet Couns 2014; 24:158-68. [DOI: 10.1007/s10897-014-9748-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
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Subtypes of potentially inappropriate medications in older Chinese-Americans during care transitions: cross sectional retrospective study. Int J Nurs Stud 2014; 51:1221-9. [PMID: 24560167 DOI: 10.1016/j.ijnurstu.2014.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 01/26/2014] [Accepted: 01/28/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND The number of Chinese Americans is growing and nearly 20% of older Chinese-American home care patients have at least one potentially inappropriate medications (PIMs) prescribed at hospital discharge. Further examination of PIMs during care transition is warranted, especially among older Chinese-Americans. OBJECTIVES To describe, during care transitions from hospital to home care: (i) the subtypes of PIMs, (ii) the difference of PIM prevalence prescribed at hospital discharge as compared to home care admission, (iii) the relationship between subtypes of PIMs, and (iv) issues affecting medication reconciliation among older Chinese-Americans. METHODS This cross-sectional, retrospective study was conducted in a large urban home care agency from June 2010 to July 2011. From data collected by in-home survey and chart abstraction, PIMs were identified using 2002 diagnosis-independent Beers criteria. The difference of PIM prevalence at hospital discharge and at home care admission was analyzed by Wilcoxon Signed Ranks test. The relationship between subtypes of PIMs was evaluated using Phi coefficient. PARTICIPANTS 82 older (age 65 years and above) Chinese-American home care patients following recent hospital discharge. RESULTS 3.38% (22) and another 3.72% (28) of prescribed medications were identified as PIMs at hospital discharge and home care admission, respectively. There was no statistically significant difference in PIM prevalence identified at hospital discharge and at homecare admission (z=-1.732, p=.083). PIMs included: long-term use of stimulant laxatives and high-dosages of ferrous sulfate, and a significant relationship between these two PIMS (r=.224, p=.04). More than 80% (n=65) of study participants reported low education levels and limited English proficiency. CONCLUSIONS Subtypes of PIMs were ordered during the post-hospital transfers, indicating the necessity to review the appropriateness of medications during this transition. Guidelines such as Beer's criteria regarding appropriateness of medications should be incorporated in medication reconciliation before adding new medications to treat the older adult's health problems. The medication management process needs to be both culturally sensitive and adapted to literacy level; validating the patients' full understanding of their medications is paramount.
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Abstract
Culture is an important concept, especially when applied to nursing. A concept analysis of culture is essential to understanding the meaning of the word. This article applies Rodgers’ (2000) concept analysis template and provides a definition of the word culture as it applies to nursing practice. This article supplies examples of the concept of culture to aid the reader in understanding its application to nursing and includes a case study demonstrating components of culture that must be respected and included when providing health care.
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Schinkel S, Schouten BC, van Weert JCM. Are GP patients' needs being met? Unfulfilled information needs among native-Dutch and Turkish-Dutch patients. PATIENT EDUCATION AND COUNSELING 2013; 90:261-7. [PMID: 23228377 DOI: 10.1016/j.pec.2012.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/07/2012] [Accepted: 11/11/2012] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study aims to assess unfulfilled information needs of native-Dutch and Turkish-Dutch general practitioner (GP) patients in the Netherlands. In addition, the relation between perceived and recorded information provision by GPs is studied. METHODS Unfulfilled information needs of native-Dutch (N=117) and Turkish-Dutch patients (N=74) were assessed through pre- and post-consultation questionnaires. Audiotapes of GP consultations were made to code GPs' information provision. RESULTS Turkish-Dutch patients experience more unfulfilled information needs than native-Dutch patients, in particular those who identify equally with Dutch and Turkish culture. Overall, perceived information provision is hardly related to recorded information provision. CONCLUSION GPs insufficiently provide Turkish-Dutch patients and, to a lesser extent, native-Dutch patients as well, the information they need. PRACTICE IMPLICATIONS GPs should be trained in giving adequate, tailored information to patients with various ethnic and cultural backgrounds.
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Affiliation(s)
- Sanne Schinkel
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
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Keikelame MJ, Swartz L. Lost opportunities to improve health literacy: observations in a chronic illness clinic providing care for patients with epilepsy in Cape Town South Africa. Epilepsy Behav 2013. [PMID: 23207515 DOI: 10.1016/j.yebeh.2012.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Low health literacy (LHL) is reported globally as a barrier to achieving quality of life of patients with epilepsy. In South Africa, despite reports that epilepsy is poorly managed and understood, little attention has been paid to promote health literacy of patients suffering from the condition and those providing their care. We used observation to gain a picture of interactions between patients with epilepsy and health care providers in a chronic illness clinic serving the marginalized population groups in Cape Town. The observation data were compiled into descriptive field notes which were content analyzed. Our findings revealed some patient and health care provider health literacy-related factors affecting the understanding of epilepsy and treatment outcomes. There were also some lost opportunities where health literacy could have been promoted. However, these results cannot be generalized, but they highlight a true picture of contextual health system factors that need to be addressed.
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Affiliation(s)
- Mpoe Johannah Keikelame
- Primary Health Care Directorate, Faculty of Health Sciences University of Cape Town, South Africa.
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People-centred care: new research needs and methods in doctor-patient communication. Challenges in mental health. Epidemiol Psychiatr Sci 2012; 21:145-9. [PMID: 22789161 DOI: 10.1017/s2045796012000091] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Communication in psychiatry is nowadays called to create bridges between different levels of observation (biological, functional and relational levels) and therapeutic intervention (social and educational) with important implications for therapeutic practice and communication research in the mental health context. New research challenges and windows of opportunity for therapeutic practice will be addressed in this contribution, as they relate to the three main tasks that psychiatrists have to meet when talking with their patients: understanding patient's problems and concerns; establishing the therapeutic alliance by acknowledging and responding to patient's emotion; informing and involving patients and their families, when appropriate. Therapeutic decisions need the elaboration of valid strategies of shared decision-making, which still have to be implemented and adapted to psychiatric context. Moreover, in the research field, emerging biomarker research may contribute to better explain what makes the difference in an empathic relationship either in terms of psycho-physiological reactions and in brain changes. Finally, the influence of new technologies and of Internet has to be more and more considered during clinical consultations.
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Zimmermann C, de Haes H, Visser A. Enhancing the patient position in the world of health care: contributions from the EACH conference 2010 in Verona. PATIENT EDUCATION AND COUNSELING 2011; 84:283-286. [PMID: 21854990 DOI: 10.1016/s0738-3991(11)00393-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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