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Vandecasteele R, Robijn L, Stevens PAJ, Willems S, De Maesschalck S. "Trying to write a story together": general practitioners' perspectives on culturally sensitive care. Int J Equity Health 2024; 23:118. [PMID: 38844971 PMCID: PMC11154983 DOI: 10.1186/s12939-024-02200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs. METHODS In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses. RESULTS Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care. CONCLUSIONS This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.
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Affiliation(s)
- Robin Vandecasteele
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium.
| | - Lenzo Robijn
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Peter A J Stevens
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, Ghent, 9000, Belgium
| | - Sara Willems
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
| | - Stéphanie De Maesschalck
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
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Implicit and explicit ethnic biases in multicultural primary care: the case of trainee general practitioners. BMC PRIMARY CARE 2022; 23:91. [PMID: 35448943 PMCID: PMC9027448 DOI: 10.1186/s12875-022-01698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
General Practitioners (GPs) are the first point of contact for people from ethnic and migrant groups who have health problems. Discrimination can occur in this health care sector. Few studies, however, have investigated implicit and explicit biases in general practice against ethnic and migrant groups. This study, therefore, investigated the extent of implicit ethnic biases and willingness to adapt care to migrant patients among trainee GPs, and the factors involved therein, in order to measure explicit bias and explore a dimension of cultural competence.
Methods
In 2021, data were collected from 207 trainee GPs in the French-speaking part of Belgium. The respondents passed an Implicit Association Test (IAT), a validated tool used to measure implicit biases against ethnic groups. An explicit attitude of willingness to adapt care to diversity, one of the dimensions of cultural competence, was measured using the Hudelson scale.
Results
The overwhelming majority of trainee GPs (82.6%, 95% CI: 0.77 – 0.88) had implicit preferences for their ingroup to the detriment of ethnic and migrant groups. Overall, the majority of respondents considered it the responsibility of GPs to adapt their attitudes and practices to migrants’ needs. More than 50% of trainee GPs, however, considered it the responsibility of migrant patients to adapt to the values and habits of the host country.
Conclusions
This study found that the trainee GPs had high to very high levels of implicit ethnic bias and that they were not always willing to adapt care to the values of migrants. We therefore recommend that they are made aware of this bias and we recommend using the IAT and Hudelson scales as educational tools to address ethnic biases in primary care.
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Stoesslé P. “We Speak the Same Language, but They Don't Understand Us.” Use and Abuse of Culturalism in Medical Care for Central American Migrants in Transit Through Mexico. Front Public Health 2022; 10:880171. [PMID: 35774582 PMCID: PMC9237379 DOI: 10.3389/fpubh.2022.880171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
This article deals with cultural stereotypes toward Central American migrants in the Mexican healthcare system, which lead to the naturalization of the supposed cultural characteristics of these new users. Based on 21 interviews of health and administrative staff in the state of Nuevo Leon (northeastern Mexico), it shows the first recourse to culturalist explanations to describe any phenomenon related to migrants' health. According to this perspective, the health of migrants, their relation to illness, and their patterns of seeking healthcare would be mainly determined by characteristic cultural traits, which justify their penurious attendance at health centers, and their low adherence to treatments. The culturalist explanation of migrants' health behaviors may influence the care they receive, as well as their adherence to treatment, which ultimately reinforces the health inequalities initially highlighted. This culturalist excess is partly explained by the incorrect understanding of the directives of health authorities in favor of the integration of an intercultural perspective in healthcare. Despite some ongoing training in this area, it does not seem sufficient to correct this situation effectively.
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Affiliation(s)
- Philippe Stoesslé
- Departamento de Ciencias Sociales, Universidad de Monterrey, San Pedro Garza García, Mexico
- Université Paris Cité, Unité de Recherche Migrations et Société, Paris, France
- French Collaborative Institute on Migration, Paris, France
- *Correspondence: Philippe Stoesslé
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Bisnauth MA, Coovadia A, Kawonga M, Vearey J. Providing HIV Prevention of Mother to Child Transmission (PMTCT) Services to Migrants During the COVID-19 Pandemic in South Africa: Insights of Healthcare Providers. Health Serv Insights 2022; 15:11786329211073386. [PMID: 35095278 PMCID: PMC8793379 DOI: 10.1177/11786329211073386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: In March 2020, COVID-19 entered South Africa, resulting in 2.9 million cases, the country took preventative and precautionary measures to control the spread of COVID-19 infection. These measures limited population mobility especially for migrant women living with HIV (WLWH) and the provision of PMTCT services. The purpose of this research was to explore the challenges of the COVID-19 pandemic on PMTCT provision by healthcare providers and understand what strategies could be implemented with lifelong antiretroviral therapy (ART) for migrants to better manage the program. Methods: Twelve in-depth interviews were conducted with healthcare providers across city and provincial levels on how the changes to the healthcare system with COVID-19 affected highly mobile patients’ adherence and utilization of PMTCT services. A thematic content analysis was used for emerging themes and guided by The Utilization of PMTCT Services conceptual framework. Results: Five main themes emerged: (1) Facilitators and barriers to adherence, which included the need for multi-month dispensing for the long term supply of antiretrovirals (ARVs) and the fear of contracting COVID-19 at the hospital that disrupted patients’ continuum of care; (2) Healthcare providers work environment, where participants felt overwhelmed with the high patient demand and the lack of infrastructural resources to follow social distancing protocols; (3) Financial challenges and opportunity costs, PMTCT proved difficult for migrants due to border closures and documentation required to receive care, this resulted in treatment interruption and left many unable to receive support at the facility due to capacity restrictions; (4) Interpersonal interactions, mistreatment, and xenophobic attitudes existed toward the migrant HIV population; and (5) “Program sustainability” revealed three key areas for strengthening: longer duration of time allocated with counseling for same-day initiation, the increased use of technology, and translation services for migrants. Conclusions: It is important to take what was learned during the pandemic and integrate it into routine service delivery, which includes long-term medication supply to reduce risk with multiple visits to collect medication, and the use of technology to alleviate the high-burden of patient demand. Healthcare policies that work toward inclusion and sustainability for migrants are needed to improve the integration of safer and practical methods of PMTCT provision into health systems.
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Affiliation(s)
- Melanie A Bisnauth
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Centre for Migration and Society, Faculty of Humanities, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Melanie A Bisnauth, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand (Education Campus), 27 St. Andrews Rd, Parktown, 2193, Johannesburg, South Africa.
| | - Ashraf Coovadia
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Jo Vearey
- African Centre for Migration and Society, Faculty of Humanities, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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De Kock C. Equitable substance use treatment for migrants and ethnic minorities: the entwinement of micro and meso barriers and facilitators. J Ethn Subst Abuse 2021:1-27. [PMID: 34469280 DOI: 10.1080/15332640.2021.1960229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In Europe, the prerequisites of equitable substance use treatment (SUT) for migrants and ethnic minorities (MEM) remain understudied. This qualitative study maps barriers and facilitators identified by 14 professionals in Flanders, Belgium. The analysis identified micro and meso level barriers and how they intersect. Whereas barriers to treatment are often attributed to the client (vulnerabilities, language, trust, knowledge) our results demonstrate that they are also rooted in services (lack of expertise, issues with interpreters, diversity policies, waiting list and referral bias). These results emphasize the responsibility of meso and macro policymaking in resolving treatment mismatch problems.
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Affiliation(s)
- Charlotte De Kock
- Faculty of Law & Criminology, Institute for Social Drug Research, Ghent University, Ghent, Belgium
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6
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van Herwaarden A, Rommes EWM, Peters-Scheffer NC. Cultural competence in lifelong care and support for individuals with intellectual disabilities. ETHNICITY & HEALTH 2021; 26:922-935. [PMID: 30849248 DOI: 10.1080/13557858.2019.1591348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/28/2019] [Indexed: 06/09/2023]
Abstract
Objectives: Although an extensive amount of research has been devoted to models defining cultural competence of healthcare professionals in short-term care, there is unclarity about the cultural competencies that professionals providing lifelong care and support should have. The current study aimed to explore which cultural competencies are used by these healthcare professionals, and whether these competencies enabled them to make cultural adaptations to their regular care practices.Design: To investigate cultural competencies and cultural adaptations, semi-structured in-depth interviews were conducted with eight professionals who provide lifelong care and support to individuals with intellectual disabilities. Five cultural competencies were explored: awareness, knowledge, skills, motivation, and encounters.Results: A thematic analysis of the interviews revealed that professionals providing lifelong care and support used all cultural competencies in their care practices. Moreover, our analysis suggested that these competencies could be categorized as either practical or analytical cultural competencies. Although these competencies were conditional in order to make cultural adaptations to care practices, the presence of cultural competencies did not automatically lead to these cultural adaptations.Conclusions: All five cultural competencies were used by professionals in lifelong care and support. Our analysis revealed that both practical and analytical cultural competencies were essential in providing culturally sensitive lifelong care and support. We additionally suggest that the cultural competence of professionals is necessary, but not sufficient, for making cultural adaptations to lifelong care and support for individuals with intellectual disabilities. In many cases, other factors also played a role in a professional's final decision to adapt their care practices.
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Affiliation(s)
- Aniek van Herwaarden
- Behavioural Science Institute, Department of Learning and Plasticity, Radboud University Nijmegen, Nijmegen, the Netherlands
- Driestroom, Elst, The Netherlands
| | - Els W M Rommes
- Gender and Diversity Studies, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Nienke C Peters-Scheffer
- Behavioural Science Institute, Department of Learning and Plasticity, Radboud University Nijmegen, Nijmegen, the Netherlands
- Driestroom, Elst, The Netherlands
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Çilenti K, Rask S, Elovainio M, Lilja E, Kuusio H, Koskinen S, Koponen P, Castaneda AE. Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2229. [PMID: 33668241 PMCID: PMC7956472 DOI: 10.3390/ijerph18052229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/03/2023]
Abstract
Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor's treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.
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Affiliation(s)
- Katja Çilenti
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
| | - Shadia Rask
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
| | - Eero Lilja
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Hannamaria Kuusio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Anu E. Castaneda
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
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8
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Löfvander M, Rosenblad A. Mortality among immigrant patients 20-45 years of age with chronic back pain in primary care in Sweden: A 15-year follow-up cohort study. J Back Musculoskelet Rehabil 2021; 33:801-809. [PMID: 31903979 DOI: 10.3233/bmr-181273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mortality rates among immigrant patients undergoing rehabilitation for musculoskeletal backache are unknown. OBJECTIVE To study the association between marital status, severe psychosocial strain, receiving long-term time-limited sickness allowance (TLSA) and all-cause mortality (ACM) in a cohort of immigrants aged 20-45 years with long-standing backache in Sweden. METHODS We studied 318 patients (92% foreign-born, 76% non-European) of known marital status on sick-leave for musculoskeletal backache. They were followed up for ACM until 2015. Socio-demographic data, TLSA and psychosocial strain, including major depression, severe psychosocial stressors and pessimistic thoughts, were analysed using multiple-imputation Cox regression. RESULTS Over a mean (standard deviation) follow-up time of 15 (5.0) years, 11 (3.5%) participants died. At baseline, 34% were unmarried, 19% were receiving TLSA, and 71% had ⩾ 1 psychosocial strain component (38% depression; 47% severe stressors; 35% pessimistic thoughts). After concomitant risk factors were adjusted for, being unmarried and receiving TLSA were associated with higher mortality by factors of 6.2 (p= 0.005) and 5.8 (p= 0.006), respectively. Psychosocial strain was only significantly associated with higher mortality in the unadjusted analyses. CONCLUSIONS Being unmarried and receiving TLSA were associated with significantly higher ACM in this highly marginalized group of immigrant patients.
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Affiliation(s)
- Monica Löfvander
- Center for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.,Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.,Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Unit, Uppsala University, Uppsala, Sweden
| | - Andreas Rosenblad
- Center for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
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9
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Belintxon M, Dogra N, McGee P, Pumar-Mendez MJ, Lopez-Dicastillo O. Encounters between children's nurses and culturally diverse parents in primary health care. Nurs Health Sci 2020; 22:273-282. [PMID: 31943713 DOI: 10.1111/nhs.12683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/28/2023]
Abstract
The objective of this study was to analyze the healthcare encounters between nurses and parents of different cultural backgrounds in primary health care. An ethnographic study was carried out using participant observations in health centers and interviews with nurses. Data were analyzed using thematic content analysis and constant comparative method. Four main themes were identified when nurses met parents of other cultural backgrounds: lack of mutual understanding, electronic records hamper the interaction, lack of professionals' cultural awareness and skills, and nurses establish superficial or distant relationships. The concepts of ethnocentrism and cultural imposition are behind these findings, hampering the provision of culturally competent care in primary health services. There were difficulties in obtaining and registering culturally related aspects that influence children's health and development. This was due to e-records, language barriers, and the lack of cultural awareness and skills in health professionals making the encounters difficult for both nurses and parents. These findings show that there is a clear threat for health equity and safety in primary care if encounters between nurses and parents do not improve to enable nursing care to be tailored to any individual family needs.
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Affiliation(s)
- Maider Belintxon
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,ImPULS, Research Group, Pamplona, Spain
| | - Nisha Dogra
- Greenwood Institute of Child Health, University of Leicester, Westcotes House, Leicester, UK
| | - Paula McGee
- Faculty of Health, Education and life Sciences, Birmingham City University, Birmingham, UK
| | - Maria Jesus Pumar-Mendez
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,ImPULS, Research Group, Pamplona, Spain
| | - Olga Lopez-Dicastillo
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,ImPULS, Research Group, Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
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10
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van Herwaarden A, Rommes EWM, Peters-Scheffer NC. Providers' perspectives on factors complicating the culturally sensitive care of individuals with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 96:103543. [PMID: 31794907 DOI: 10.1016/j.ridd.2019.103543] [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: 02/27/2019] [Revised: 08/21/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Culturally sensitive care is essential for improving healthcare for ethnic minorities with intellectual disabilities (ID), who require intensive, sometimes lifelong, care and support. AIMS The present study aimed to uncover factors that may complicate the delivery of culturally sensitive care for ethnic minorities with ID, which have not previously been studied for this group. METHODS AND PROCEDURES By means of in-depth interviews with care professionals we identified these factors at the care receiver, professional, and institutional levels. OUTCOMES AND RESULTS Eight factors were found to complicate the delivery of culturally sensitive care: abilities of the individuals with ID, communication with the family of the care receiver, cultural competency of the professional, personal attitude and experience of the professional, job position and responsibilities of the professional, resources, legislation and protocols, and the team of colleagues. The factors at the care receiver level were specific for the delivery of culturally sensitive care to individuals with ID. CONCLUSIONS AND IMPLICATIONS In addition to the complicating factors previously identified for other forms of culturally sensitive healthcare, we identified novel complicating factors for the care of individuals with ID. Future research should investigate how these complicating factors could be overcome.
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Affiliation(s)
- Aniek van Herwaarden
- Behavioural Science Institute, Department of Learning and Plasticity, Radboud University Nijmegen, the Netherlands; Driestroom, Elst, the Netherlands.
| | - Els W M Rommes
- Gender and Diversity Studies, Radboud University Nijmegen, the Netherlands
| | - Nienke C Peters-Scheffer
- Behavioural Science Institute, Department of Learning and Plasticity, Radboud University Nijmegen, the Netherlands; Driestroom, Elst, the Netherlands
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11
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Ledoux C, Pilot E, Diaz E, Krafft T. Migrants' access to healthcare services within the European Union: a content analysis of policy documents in Ireland, Portugal and Spain. Global Health 2018; 14:57. [PMID: 29903036 PMCID: PMC6003193 DOI: 10.1186/s12992-018-0373-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background The current migration flow into Europe is leading to a growing ethnically diverse population in many European countries. Now more than ever, those populations have different healthcare needs, languages, traditions, and previous level of care. This higher level of diversity is likely to increase health inequalities that might challenge healthcare systems if not addressed. In this context, this study aims at reviewing the policy framework for migrants’ access to healthcare in Spain, Portugal and Ireland, countries with a long history of immigration, to identify lessons to be learned for policies on migrants’ health. Methods A content analysis of official policy documents was undertaken and the conceptual framework developed by Mladowsky was adapted to classify the actions indicated in the policies. Results The content analysis revealed that the policy aim for all three analysed countries is the improvement of the health status of the immigrant population based on equity and equality principles. The main strategies are the adaptation of services through actions targeting patients and providers, such as the implementation of cultural mediators and trainings for health professionals. Conclusion The three countries propose a great range of policies aiming at improving access to healthcare services for immigrants that can inspire other European countries currently welcoming refugees. Developing inclusive policies, however does not necessarily mean they will be implemented or felt on the ground. Inclusive policies are indeed under threat due to the economic and social crises and due to the respective nationalistic attitudes towards integration. The European Union is challenged to take a more proactive leadership and ensure that countries effectively implement inclusive actions to improve migrant’s access to health services.
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Affiliation(s)
- Céline Ledoux
- Maastricht Centre for Global Health, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Eva Pilot
- Maastricht Centre for Global Health, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Thomas Krafft
- Maastricht Centre for Global Health, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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12
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Dauvrin M, Lorant V. Cultural competence and social relationships: a social network analysis. Int Nurs Rev 2016; 64:195-204. [PMID: 27859147 DOI: 10.1111/inr.12327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This study investigated the role of social relationships in the sharing of cultural competence by testing two hypotheses: cultural competence is a socially shared behaviour; and central healthcare professionals are more culturally competent than non-central healthcare professionals. BACKGROUND Sustaining cultural competence in healthcare services relies on the assumption that being culturally competent is a socially shared behaviour among health professionals. This assumption has never been tested. INTRODUCTION Organizational aspects surrounding cultural competence are poorly considered. This therefore leads to a heterogeneous implementation of cultural competence - especially in continental Europe. METHODS We carried out a social network analysis in 24 Belgian inpatient and outpatient health services. All healthcare professionals (ego) were requested to fill in a questionnaire (Survey on social relationships of health care professionals) on their level of cultural competence and to identify their professional relationships (alter). We fitted regression models to assess whether (1) at the dyadic level, ego cultural competence was associated with alter cultural competence, and (2) health professionals of greater centrality had greater cultural competence. RESULTS At the dyadic level, no significant associations were found between ego cultural competence and alter cultural competence, with the exception of subjective exposure to intercultural situations. No significant associations were found between centrality and cultural competence, except for subjective exposure to intercultural situations. DISCUSSION Being culturally competent is not a shared behaviour among health professionals. The most central healthcare professionals are not more culturally competent than less central health professionals. CONCLUSIONS AND IMPLICATIONS FOR HEALTH POLICIES Culturally competent health care is not yet a norm in health services. Health care and training authorities should either make cultural competent health care a licensing criteria or reward culturally competent health care.
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Affiliation(s)
- M Dauvrin
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - V Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Lindenmeyer A, Redwood S, Griffith L, Teladia Z, Phillimore J. Experiences of primary care professionals providing healthcare to recently arrived migrants: a qualitative study. BMJ Open 2016; 6:e012561. [PMID: 27660320 PMCID: PMC5051449 DOI: 10.1136/bmjopen-2016-012561] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The main objectives of the study were to explore the experiences of primary care professionals providing care to recent migrants in a superdiverse city and to elicit barriers and facilitators to meeting migrants' care needs. This paper focuses on a strong emergent theme: participants' descriptions and understandings of creating a fit between patients and practices. DESIGN An exploratory, qualitative study based on the thematic analysis of semistructured interviews. SETTING AND PARTICIPANTS A purposive sample of 10 practices. We interviewed 6 general practitioners, 5 nurses and 6 administrative staff; those based at the same practice opted to be interviewed together. 10 interviewees were from an ethnic minority background; some discussed their own experiences of migration. RESULTS Creating a fit between patients and practice was complex and could be problematic. Some participants defined this in a positive way (reaching out, creating rapport) while others also focused on ways in which patients did not fit in, for example, different expectations or lack of medical records. A small but vocal minority put the responsibility to fit in on to migrant patients. Some participants believed that practice staff and patients sharing a language could contribute to achieving a fit but others outlined the disadvantages of over-reliance on language concordance. A clearly articulated, team-based strategy to create bridges between practice and patients was often seen as preferable. CONCLUSIONS Although participants agreed that a fit between patients and practice was desirable, some aimed to adapt to the needs of recently arrived migrants, while others thought that it was the responsibility of migrants to adapt to practice needs; a few viewed migrant patients as a burden to the system. Practices wishing to improve fit might consider developing strategies such as introducing link workers and other 'bridging' people; however, they could also aim to foster a general stance of openness to diversity.
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Affiliation(s)
- Antje Lindenmeyer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sabi Redwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Laura Griffith
- Health Services Management Centre, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Zaheera Teladia
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Phillimore
- Institute of Research into Superdiversity, College of Social Sciences, University of Birmingham, Birmingham, UK
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