Knowledge and attitudes in multicultural health care

Responding to cultural diversity at two Sydney-based children's hospitals

AIM

To study and document the challenges of culturally and linguistically diverse (CALD) families in tertiary paediatric settings.

METHODS

Mixed methods, both qualitative and quantitative, were used at Sydney Children's Hospital, Randwick and the Children's Hospital at Westmead, during 2006-2007. A telephone survey of 46 questions was implemented on 269 occasions in one of nine languages. In depth qualitative studies of seven families of various migration, settlement and health experiences were undertaken over a four month period, involving a total of 25 interviews in one of four languages. Members of the respective clinical teams were also engaged in 25 formal interviews and four focus groups. A further 25 combined meetings between the clinical teams and respective families were observed and documented. In addition, 16 senior managers were also interviewed.

RESULTS

Accessing hospital records for the study revealed that relevant demographic data were often incomplete. Quantitative analyses of the telephone survey demonstrated statistically significant differences between the CALD and Anglo-Australian cohorts in: access to appropriate information (language specific, accessible, non-technical and appropriately documented); as well as effective communication (with doctors, nurses, admission or clerical staff and other health staff). Comparisons contradicted assumptions of overuse of hospital resources by CALD clients. Interpreter services were moderately utilised but widely supplemented by informal and suboptimal channels. Qualitative exploration supported and further explained the findings.

CONCLUSIONS

The findings of this research have demonstrated important differences, as well as gaps and shortcomings, in service provision for CALD families that lend themselves to both further study and to interventions aimed at continuing improvement.

Meeting and treating cultural difference in primary care: a qualitative interview study

BACKGROUND

Primary care doctors see patients from diverse cultural backgrounds and communication plays an important role in diagnosis and treatment. Communication problems can arise when patient and doctor do not share the same cultural background.

OBJECTIVE

The aim of this study was to examine how consultations with immigrant patients are understood by GPs and how GPs manage these consultations.

METHODS

Semi-structured interviews with GPs about their experiences with immigrant patients were recorded on audio-tape, transcribed and analysed using a qualitative thematic analysis methodology. A constructivist approach was taken to analysis and interpretation.

RESULTS

Culture is not in focus when GPs meet immigrant patients. The consultation is seen as a meeting between individuals, where cultural difference is just one of many individual factors that influence how well doctor and patient understand each other. However, when mutual understanding is poor and the consultation not successful, cultural differences are central. The GPs try to conduct their consultations with immigrant patients in the same way that they conduct all their consultations. There is no specific focus on culture, instead, GPs tend to avoid addressing even pronounced cultural differences.

CONCLUSION

This study indicates that cultural difference is not treated in GPs consultation with immigrant patients. Learning about cultural difference's effect on mutual understanding between doctor and patient could improve GPs cross-cultural communication. Increased awareness of the culture the doctor brings to the consultation could facilitate management of cross-cultural consultations.