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Sharma N, Mehta TS, Wahab RA, Patel MM. Facilitating Culturally Competent Breast Imaging Care in South Asian Patients. JOURNAL OF BREAST IMAGING 2024:wbae026. [PMID: 38787594 DOI: 10.1093/jbi/wbae026] [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: 09/29/2023] [Indexed: 05/25/2024]
Abstract
South Asians are a rapidly growing subset of the Asian population in the United States. They comprise people from multiple countries with diverse beliefs, languages, and cultural identities and values. The incidence of breast cancer is rising in South Asian women in the United States, with earlier onset and predilection for HER2-enriched tumors. Despite the rising incidence of breast cancer, participation in screening remains lower than other populations. Health care inequities in South Asian women are multifactorial and may be due to traditional health beliefs and practices, language barriers, cultural differences, and lack of overall awareness. Developing a culturally sensitive environment in breast imaging clinic practice can lead to improved patient care and adherence. Given the scarcity of data specific to the South Asian population in United States, there is a need for health service researchers and practice leaders to obtain more high-quality data to understand the needs of South Asian patient populations.
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Affiliation(s)
- Nidhi Sharma
- Department of Radiology, Texas A&M University, Dallas, TX, USA
| | - Tejas S Mehta
- Department of Radiology, UMass Memorial Medical Center/UMass Chan Medical School, Worcester, MA, USA
| | - Rifat A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Miral M Patel
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Auer S, Penikalapati R, Parekh N, Merdjanoff AA, DiClemente RJ, Ali SH. 'We know what he likes, even if he doesn't know': how the children of South Asian immigrants characterize and influence the diets of their parents. HEALTH EDUCATION RESEARCH 2024; 39:131-142. [PMID: 37625004 DOI: 10.1093/her/cyad036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Foreign-born (first-generation) South Asians face a growing diet-related chronic disease burden. Little is known about whether the adult US-born (second-generation) children of South Asian immigrants can provide unique insights as changemakers in their parents' dietary behaviors. This study aims to assess how second-generation South Asians describe and influence the dietary behaviors of their parents. Between October and November 2020, 32 second-generation South Asians [mean age 22.4 (SD 2.9), 53% female] participated in online interviews centered around factors involved in their (and their parents) eating behaviors. Thematic analysis revealed three types of parental dietary drivers (socioecological factors that impact the dietary choices of parents): goal-oriented (i.e., parents' dietary intentionality), capacity-related (e.g., environmental barriers) and sociocultural (cultural familiarity, religion and traditions). Participants described three major mechanisms of influence: recommending new foods, cooking for parents, and bringing new foods home. These influences primarily occurred in the household and often involved participants leveraging their own nutritional knowledge and preferences to expand dietary diversity and healthier behaviors among their parents. Evidence suggests that second-generation South Asians may act as powerful agents of dietary change within their households and can provide novel insights to help address and overcome sociocultural, linguistic, and other structural barriers to better understanding and intervening in the health of the South Asian community.
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Affiliation(s)
- Sian Auer
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Rushitha Penikalapati
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Niyati Parekh
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
- New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10016, USA
- New York University Rory College of Nursing, 433 1st Ave, New York, NY 10010, USA
| | - Alexis A Merdjanoff
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Ralph J DiClemente
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Shahmir H Ali
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
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Small N, Masood Y, Stevenson F, Brown BC, Sanders C, McMillan B, Atherton H, Mazumdar T, Ara N, Haqqani H, Cheraghi‐Sohi S. Exploring the experiences and preferences of South Asian patients' of primary care in England since COVID-19. Health Expect 2024; 27:e13982. [PMID: 39102699 PMCID: PMC10844758 DOI: 10.1111/hex.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Remote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operate on a remote-first (digital-first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care. METHODS Qualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in-person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data. FINDINGS Three major interlinked themes were identified: (1) reduced access, (2) reduced patient choice and (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face-to-face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non-verbal aspects of communication and 'hands-on' care leading to perceptions of reduced psycho-social safety. CONCLUSION SA patients' experiences of remote-led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face-to-face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South-Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future. PUBLIC CONTRIBUTION Members of the public were involved in all phases of research in the study. This included co-working in partnership throughout the study including, reviewing patient-facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co-authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components.
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Affiliation(s)
- Nicola Small
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine, and Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Yumna Masood
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine, and Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College LondonLondonUK
| | - Benjamin C. Brown
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine, and Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Caroline Sanders
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine, and Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Brian McMillan
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine, and Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | | | | | | | - Sudeh Cheraghi‐Sohi
- Division of Psychology and Mental Health, Faculty of Biology, Medicine, and Health, School of Health SciencesUniversity of ManchesterManchesterUK
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Garcia ME, Williams M, Mutha S, Diamond LC, Jih J, Handley MA, Pathak S, Karliner LS. Language-Concordant Care: a Qualitative Study Examining Implementation of Physician Non-English Language Proficiency Assessment. J Gen Intern Med 2023; 38:3099-3106. [PMID: 37620723 PMCID: PMC10651569 DOI: 10.1007/s11606-023-08354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Language concordance can increase access to care for patients with language barriers and improve patient health outcomes. However, systematically assessing and tracking physician non-English language skills remains uncommon in most health systems. This is a missed opportunity for health systems to maximize language-concordant care. OBJECTIVE To determine barriers and facilitators to participation in non-English language proficiency assessment among primary care physicians. DESIGN Qualitative, semi-structured interviews. PARTICIPANTS Eleven fully and partially bilingual primary care physicians from a large academic health system with a language certification program (using a clinician oral proficiency interview). APPROACH Interviews aimed to identify barriers and facilitators to participation in non-English language assessment. Two researchers independently and iteratively coded transcripts using a thematic analysis approach with constant comparison to identify themes. KEY RESULTS Most participants were women (N= 9; 82%). Participants reported proficiency in Cantonese, Mandarin, Russian, and Spanish. All fully bilingual participants (n=5) had passed the language assessment; of the partially bilingual participants (n=6), four did not test, one passed with marginal proficiency, and one did not pass. Three themes emerged as barriers to assessment participation: (1) beliefs about the negative consequences (emotional and material) of not passing the test, (2) time constraints and competing demands, and (3) challenging test format and structure. Four themes emerged as facilitators to increase assessment adoption: (1) messaging consistent with professional ethos, (2) organizational culture that incentivizes certification, (3) personal empowerment about language proficiency, and (4) individuals championing certification. CONCLUSIONS To increase language assessment participation and thus ensure quality language-concordant care, health systems must address the identified barriers physicians experience and leverage potential facilitators. Findings can inform health system interventions to standardize the requirements and process, increase transparency, provide resources for preparation and remediation, utilize messaging focused on patient care quality and safety, and incentivize participation.
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Affiliation(s)
- Maria Esteli Garcia
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA.
- Department of Epidemiology and Biostatistics, Implementation Science Training Program, UCSF, San Francisco, CA, USA.
- PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA.
| | - Mia Williams
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA
| | - Sunita Mutha
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA
- Healthforce Center, University of California, San Francisco, CA, USA
| | - Lisa C Diamond
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jane Jih
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA
- Asian American Research Center on Health, San Francisco, CA, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, Implementation Science Training Program, UCSF, San Francisco, CA, USA
- PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, San Francisco, CA, USA
| | - Sarita Pathak
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA
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Agarwala A, Satish P, Al Rifai M, Mehta A, Cainzos-Achirica M, Shah NS, Kanaya AM, Sharma GV, Dixon DL, Blumenthal RS, Natarajan P, Nasir K, Virani SS, Patel J. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S. JACC. ADVANCES 2023; 2:100258. [PMID: 38089916 PMCID: PMC10715803 DOI: 10.1016/j.jacadv.2023.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/20/2023]
Abstract
South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Anurag Mehta
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona, Spain
- Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Garima V. Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Dave L. Dixon
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
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Patel T, Umeh K, Poole H, Vaja I, Ramtoola S, Newson L. Health professionals interface with cultural conflict in the delivery of type 2 diabetes care. Psychol Health 2023; 38:230-248. [PMID: 34351821 DOI: 10.1080/08870446.2021.1960346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.
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Affiliation(s)
- Tasneem Patel
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Kanayo Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Helen Poole
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ishfaq Vaja
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Shenaz Ramtoola
- Endocrinology and Metabolic Medicine, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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A Qualitative Investigation of Factors Affecting Saudi Patients' Communication Experience with Non-Saudi Physicians in Saudi Arabia. Healthcare (Basel) 2022; 11:healthcare11010118. [PMID: 36611579 PMCID: PMC9819697 DOI: 10.3390/healthcare11010118] [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: 11/08/2022] [Revised: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
(1) Background: Communication is the main issue between the patient and physician. Communication gaps lead to medical errors, mistakes, and wrong diagnoses and treatments. It would certainly be a cause of patient dissatisfaction, the physicians' job dissatisfaction, and the increase in the cost of health services. (2) Objectives: The objective of the study was to explore the perception of Saudi patients when they meet non-Saudi consultants at hospitals. (3) Material and Methods: This study is exploratory in nature. Semi-structured face to face interviews were conducted. Study participants were patients from the outpatient department of the Hospitals of Qassim province, Saudi Arabia. A total of eight respondents, four male and four female, participated in the study. (4) Results: Interviews were transcribed verbatim and analyzed using a thematic analysis approach. Two main themes emerged: the first theme is encountering difference, with three sub-themes, while the second one is the absence of partnering, with four sub-themes. (5) Conclusions: The analysis of the patients' experiences of their medical encounters revealed that the effectiveness of the physician-patient communication was jeopardized by two challenges: encountering differences and the absence of partnering. (6) Limitations: This study was conducted in one site only and hence findings must be tested in application to other sites in other parts of Saudi Arabia and in other similar countries. A further limitation of this study was the cultural barrier that was encountered by the researcher during the interview process.
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Bregio C, Finik J, Baird M, Ortega P, Roter D, Karliner L, Diamond LC. Exploring the Impact of Language Concordance on Cancer Communication. JCO Oncol Pract 2022; 18:e1885-e1898. [PMID: 36112970 PMCID: PMC9653203 DOI: 10.1200/op.22.00040] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/13/2022] [Accepted: 07/24/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Patients with cancer who have limited English proficiency are more likely to experience inequities in cancer knowledge, timely care, and access to clinical trials. Matching patients with language-concordant clinicians and working with professional interpreters can effectively reduce language-related disparities, but little data are available regarding the impact of language-concordant interactions in oncology care. This study aimed to assess the use of the Roter Interaction Analysis System (RIAS) in language-concordant and -discordant interactions for patients with non-English language preference presenting for an initial oncology visit at four New York City hospitals. METHODS We used the RIAS, a validated tool for qualitative coding and quantitative analysis, to evaluate interactions between 34 patients and 16 clinicians. The pairings were stratified into dyads: English language-concordant (n = 12); professionally interpreted (n = 11); partially language-concordant (n = 4, partially bilingual clinicians who communicated in Spanish and/or used ad hoc interpreters); and Spanish language-concordant (n = 7). A trained Spanish-speaking coder analyzed the recordings using established RIAS codes. RESULTS Spanish language-concordant clinicians had almost two-fold greater number of statements about biomedical information than English language-concordant clinicians. Spanish language-concordant patients had a higher tendency to engage in positive talk such as expressing agreement. The number of partnership/facilitation-related statements was equivalent for English and Spanish language-concordant groups but lower in professionally interpreted and partially language-concordant dyads. CONCLUSION Language concordance may facilitate more effective biomedical counseling and therapeutic relationships between oncology clinicians and patients. Future research should further explore the impact of language concordance on cancer-specific health outcomes.
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Affiliation(s)
- Celyn Bregio
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Jackie Finik
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Morgan Baird
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pilar Ortega
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL
- Department of Emergency Medicine, University of Illinois College of Medicine, Chicago, IL
| | - Debra Roter
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Leah Karliner
- Center for Aging in Diverse Communities, University of California, San Francisco, CA
- Multiethnic Health Equity Research Center, University of California, San Francisco, CA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA
| | - Lisa C. Diamond
- Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Patel P, Muscat DM, Trevena L, Zachariah D, Nosir H, Jesurasa N, Hadi A, Bernays S. Exploring the expectations, experiences and tensions of refugee patients and general practitioners in the quality of care in general practice. Health Expect 2021; 25:639-647. [PMID: 34951092 PMCID: PMC8957721 DOI: 10.1111/hex.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/16/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background Refugees and asylum seekers arrive in the Australian community with complex health needs and expectations of healthcare systems formed from elsewhere. Navigating the primary healthcare system can be challenging with communication and language barriers. In multicultural societies, this obstacle may be removed by accessing language‐concordant care. Emerging evidence suggests language‐concordance is associated with more positive reports of patient experience. Whether this is true for refugees and asylum seekers and their expectation of markers of quality patient‐centred care (PCC) remains to be explored. This study aimed to explore the expectations around the markers of PCC and the impacts of having language‐concordant care in Australian primary healthcare. Methods We conducted semi‐structured individual in‐language (Arabic, Dari, and Tamil) remote interviews with 22 refugee and asylum seekers and 9 general practitioners (GPs). Interview transcripts were coded inductively and deductively, based on the research questions, using Thematic Analysis. Extensive debriefing and discussion took place within the research team throughout data collection and analysis. Results Community member expectations of markers of PCC are constantly evolving and adapting based on invisible and visible actions during clinical encounters. Challenges can occur in the clinical encounter when expectations are ‘unsaid’ or unarticulated by both community members and GPs due to the assumption of shared understanding with language concordant care. Expectations of what constitutes satisfactory, quality PCC are dynamic outcomes, which are influenced by prior and current experiences of healthcare. Conclusion This study highlights the importance of understanding that language concordant care does not always support aligned expectations of the markers of quality PCC between community members and their GP. We recommend that GPs encourage community members to provide explicit descriptions about how their prior experiences have framed their expectations of what characterizes quality PCC. In addition, GPs could develop a collaborative approach, in which they explain their own decision‐making processes in providing PCC to refugees and asylum seekers. Patient or Public Contribution Bilingual researchers from multicultural backgrounds and experience working with people from refugee backgrounds were consulted on study design and analysis. This study included individuals with lived experiences as refugees and asylum seekers and clinicians as participants.
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Affiliation(s)
- Pinika Patel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Danielle M Muscat
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dipti Zachariah
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Hanaa Nosir
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Nishanthie Jesurasa
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Amina Hadi
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Sarah Bernays
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Intercultural Communication between Long-Stay Immigrants and Catalan Primary Care Nurses: A Qualitative Approach to Rebalancing Power. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062851. [PMID: 33799637 PMCID: PMC7999544 DOI: 10.3390/ijerph18062851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022]
Abstract
There is a gap between the preferences of immigrant patients and their experiences with intercultural communication. This study aims to explore the experiences and perspectives of long-stay immigrants on intercultural communication in encounters with primary care (PC) nurses. Participants were selected by purposive sampling at the Maresme Primary Care Center. A focus group and five in-depth interviews with long-stay immigrants from eight countries were carried out. Data collection was guided by a script previously validated by a group of experts. We conducted a qualitative analysis following Charmaz's approach, and data saturation was reached with 11 patients (one focus group and five interviews). Long-stay immigrants would like closer and more personalized communication exchanges with greater humanity, as well as polite and respectful manners as they perceive signs of an asymmetrical care relationship. Those who had negative communication experiences tried to justify some of the behaviors as a result of having free access to public health services. This is one of the few existing studies from the point of view of long-stay immigrants. Achieving effective intercultural communication requires a process of self-reflection, awareness-raising and commitment, both on a personal and institutional level, to eliminate the asymmetry in the nurse-patient relationship. Nurses should be trained in person-centered intercultural communication.
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van Zyl M, Haynes EMK, Batchelar D, Jakobi JM. Examining gender diversity growth as a model for inclusion of all underrepresented persons in medical physics. Med Phys 2020; 47:5976-5985. [PMID: 33034047 PMCID: PMC7839666 DOI: 10.1002/mp.14524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/27/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022] Open
Abstract
The labor force of Medical Physics is one of the most gender diverse in the field of Physics, as it has attained the proportional achievement of ~30% women worldwide (Tsapaki et al. Phys Medica. 2018;55:33-39). While great strides have been made toward a gender diverse workforce, women still comprise an underrepresented group. Many strategies have been suggested to increase the participation of underrepresented persons by addressing unconscious biases, increasing opportunities, dedicated hiring policies, and providing support networks in science and medicine (Barabino et al. Sci Eng Ethics. 2019; Coe et al. Lancet. 2019), yet the personnel landscape remains largely uniform. Herein, the conditions, strategies, and approaches that facilitated gender diversity in Medical Physics are considered as a means to further the inclusion of other underrepresented groups through exemplars of mentorship, addressing unconscious biases and the implementation of inclusive practices. Furthermore, the potential for gender diversity to act as a catalyst to create an environment that is more accepting of diversity and supports and encourages inclusive practices for the participation and inclusion of other underrepresented groups in Medical Physics is discussed.
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Affiliation(s)
- Maxine van Zyl
- Department of PsychologyFaculty of Arts and Social ScienceUniversity of British Columbia Okanagan3333 University WayKelownaBCV1V 1V7Canada
| | - Elijah M. K. Haynes
- School of Health and Exercise ScienceFaculty of Health and Social DevelopmentUniversity of British Columbia Okanagan3333 University WayKelownaBCV1V 1V7Canada
| | - Deidre Batchelar
- Department of Computer ScienceMathematics, Physics and StatisticsFaculty of ScienceUniversity of British Columbia Okanagan3333 University WayKelownaBCV1V 1V7Canada
- Department of Medical PhysicsBC Cancer – Kelowna399 Royal AveKelownaBCV1Y 5L3Canada
| | - Jennifer M. Jakobi
- School of Health and Exercise ScienceFaculty of Health and Social DevelopmentUniversity of British Columbia Okanagan3333 University WayKelownaBCV1V 1V7Canada
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Lor M, Martinez GA. Scoping review: Definitions and outcomes of patient-provider language concordance in healthcare. PATIENT EDUCATION AND COUNSELING 2020; 103:1883-1901. [PMID: 32507590 DOI: 10.1016/j.pec.2020.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To conduct a scoping literature review to understand the conceptualization and nature of the research on patient-provider language concordance (LC) in health care. METHODS We searched PubMed, EMBASE, CINAHL, PsycINFO, and Scopus to identify peer-reviewed articles between January 1961 and August 2018. We extracted study characteristics, content, definitions, and findings. RESULTS Fifty studies were included. Forty studies were quantitative, seven were qualitative, and three were mixed methods. Overall, the studies revealed inconsistent definitions and measures of patient-provider LC. Outcomes studied in connection to LC included: (1) interpersonal relationships, (2) access to health information, (3) access to care, (4) satisfaction and health-care experience, and (5) patient-related health outcomes. While four studies found that LC care had a negative or no impact on health outcomes, 46 studies reported positive outcomes associated with LC care. CONCLUSIONS The study findings highlight the need for more research on LC care and a consistent definition of LC using multiple measures of LC to capture the complex and multidimensional nature of language in social interaction. PRACTICAL IMPLICATIONS The study findings highlight the importance of how ideologies of language shape the perceptions of language and LC, thereby influence resource allocation and priorities.
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Affiliation(s)
- Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, WI, United States.
| | - Glenn A Martinez
- Department of Spanish and Portuguese, Ohio State University, OH, United States.
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Social networks, health and identity: exploring culturally embedded masculinity with the Pakistani community, West Midlands, UK. BMC Public Health 2020; 20:1432. [PMID: 32957934 PMCID: PMC7507824 DOI: 10.1186/s12889-020-09504-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Migrants from South Asia living in developed countries have an increased risk for developing cardiovascular disease (CVD), with limited research into underlying social causes. Methods We used social capital as an interpretive lens to undertake analysis of exploratory qualitative interviews with three generations of at-risk migrant Pakistani men from the West Midlands, UK. Perceptions of social networks, trust, and cultural norms associated with access to healthcare (support and information) were the primary area of exploration. Results Findings highlighted the role of social networks within religious or community spaces embedded as part of ethnic enclaves. Local Mosques and gyms remained key social spaces, where culturally specific gender differences played out within the context of a diaspora community, defined ways in which individuals navigated their social spheres and influenced members of their family and community on health and social behaviours. Conclusions There are generational and age-based differences in how members use locations to access and develop social support for particular lifestyle choices. The pursuit of a healthier lifestyle varies across the diverse migrant community, determined by social hierarchies and socio-cultural factors. Living close to similar others can limit exposure to novel lifestyle choices and efforts need to be made to promote wider integration between communities and variety of locations catering to health and lifestyle.
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Solomon A, Calotta N, Kolarich A, Enumah Z, Al Efishat M, Kovler M, Azar F, Haut ER, Garcia AV. Surgical Residents as Certified Bilingual Speakers: A Quality Improvement Initiative. Jt Comm J Qual Patient Saf 2020; 46:359-364. [PMID: 32165106 DOI: 10.1016/j.jcjq.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this quality improvement initiative was to identify general surgery residents proficient in a non-English language and have each attempt the Clinician Cultural and Linguistic Assessment (CCLA) to become qualified bilingual staff speakers. METHODS General surgery house staff were asked to self-identify as proficient in a language other than English. Fees for the certification examination were waived, and each resident was excused from clinical duties to complete the exam. McNemar's test was used for statistical analysis. RESULTS All residents responded to the initial survey, with 18/65 reporting a non-English language proficiency. Of the 12 residents who sat for the CCLA exam, 9 (75.0%) passed, with 5 certifying in the most commonly spoken non-English languages at this institution. The number of certified residents increased from 1 to 10 (1.5 % to 15.4%, p = 0.004). CONCLUSION Language barriers result in health care disparities for patients with limited English proficiency. This reproducible quality improvement initiative significantly increased the number of qualified bilingual speakers, while 25.0% of self-described proficient speakers did not demonstrate adequate language proficiency. These newly certified providers allow for increased language concordant care, which may be associated with improved outcomes.
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Ayre J, Bonner C, Bramwell S, McClelland S, Jayaballa R, Maberly G, McCaffery K. Implications for GP endorsement of a diabetes app with patients from culturally diverse backgrounds: a qualitative study. Aust J Prim Health 2019; 26:52-57. [PMID: 31718769 DOI: 10.1071/py19062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 08/23/2019] [Indexed: 11/23/2022]
Abstract
Although many diabetes self-management apps exist, these are not tailored for people from culturally and linguistically diverse (CALD) backgrounds. This study aimed to explore GP perceptions of how diabetes app features could help GPs better support their patients from CALD backgrounds. Twenty-five semi-structured interviews with GPs in Western Sydney explored attitudes towards a proposed app's suitability for CALD patients. Interviews were audio-recorded, transcribed and coded using Framework Analysis. Theme 1 explored the implications of perceptions that patients' health literacy is dependent on the language used. Theme 2 explored the influence of messaging from sources that share the patient's language and culture (including misinformation from community sources). Theme 3 described the suitability of the app platform for CALD patients, and its potential challenges in this group. GPs perceived that a diabetes app could be useful for providing support to patients from CALD backgrounds. Findings suggest app features should be optimised to address existing challenges that GPs face and carefully consider strategies for recruiting CALD patients. It is important that GPs feel comfortable promoting an app to their CALD patients to help increase participation rates by people in the CALD community.
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Affiliation(s)
- Julie Ayre
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia
| | - Carissa Bonner
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia; and The University of Sydney, Discipline of General Practice, Ask, Share, Know: Rapid Evidence for General Practice Decisions Centre for Research Excellent, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia
| | - Sian Bramwell
- Western Sydney Diabetes, Western Sydney Local Health District, Level 3, Administration and Education Building, Blacktown Hospital Campus, Marcel Crescent, Blacktown, NSW 2148, Australia
| | - Sharon McClelland
- Western Sydney Diabetes, Western Sydney Local Health District, Level 3, Administration and Education Building, Blacktown Hospital Campus, Marcel Crescent, Blacktown, NSW 2148, Australia
| | - Rajini Jayaballa
- Western Sydney Diabetes, Western Sydney Local Health District, Level 3, Administration and Education Building, Blacktown Hospital Campus, Marcel Crescent, Blacktown, NSW 2148, Australia; and Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Western Sydney Local Health District, Level 3, Administration and Education Building, Blacktown Hospital Campus, Marcel Crescent, Blacktown, NSW 2148, Australia; and The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia
| | - Kirsten McCaffery
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia; and Corresponding author
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A Systematic Review of the Impact of Patient-Physician Non-English Language Concordance on Quality of Care and Outcomes. J Gen Intern Med 2019; 34:1591-1606. [PMID: 31147980 PMCID: PMC6667611 DOI: 10.1007/s11606-019-04847-5] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/08/2018] [Accepted: 01/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Approximately 25 million people in the USA are limited English proficient (LEP). When LEP patients receive care from physicians who are truly language concordant, some evidence show that language disparities are reduced, but others demonstrate worse outcomes. We conducted a systematic review of the literature to compare the impact of language-concordant care for LEP patients with that of other interventions, including professional and ad hoc interpreters. METHODS Data was collected through a systematic review of the literature using PubMed, PsycINFO, Web of Science, Cochrane Library, and EMBASE in October 2017. The literature search strategy had three main components, which were immigrant/minority status, language barrier/proficiency, and healthcare provider/patient relationship. The quality of the articles was appraised using the Downs and Black checklist. RESULTS The 33 studies were grouped by the outcome measure studied, including quality of care (subdivided into primary care, diabetes, pain management, cancer, and inpatient), satisfaction with care/communication, medical understanding, and mental health. Of the 33, 4 (6.9%) were randomized controlled trials and the remaining 29 (87.9%) were cross-sectional studies. Seventy-six percent (25/33) of the studies demonstrated that at least one of the outcomes assessed was better for patients receiving language-concordant care, while 15% (5/33) of studies demonstrated no difference in outcomes, and 9% (3/33) studies demonstrated worse outcomes in patients receiving language-concordant care. DISCUSSION The findings of this review indicate that, in the majority of situations, language-concordant care improves outcomes. Although most studies included were of good quality, none provided a standardized assessment of provider language skills. To systematically evaluate the impact of truly language-concordant care on outcomes and draw meaningful conclusions, future studies must include an assessment of clinician language proficiency. Language-concordant care offers an important way for physicians to meet the unique needs of their LEP patients.
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Batra M, Gupta S, Erbas B. Oral Health Beliefs, Attitudes, and Practices of South Asian Migrants: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111952. [PMID: 31159420 PMCID: PMC6603871 DOI: 10.3390/ijerph16111952] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 12/15/2022]
Abstract
Oral health is a burden among all populations and is linked with major chronic diseases such as cardiovascular diseases. Migrants, in particular South Asians, have poor oral health which requires further understanding to better inform oral health interventions by targeting specific aspects of this heterogenous South Asian population. This review is undertaken to systematically synthesize the evidence of oral health understandings, knowledge, attitudes, beliefs, practices, and behaviors of South Asian migrants residing in high-income countries. A comprehensive systematic search of seven electronic databases and hand-searching for peer-reviewed studies was conducted. All study designs were included, and quality assessment conducted. Of the 1614 records identified, 17 were included for synthesis and 12 were quantitative in design. These studies were primarily conducted in the UK, USA, Canada, and Europe. South Asian migrants had inadequate oral health knowledge, attitudes, and practices—influenced by culture, social norms, and religiosity. In the absence of symptoms, preventive oral hygiene practices were limited. Barriers to access varied with country of origin; from lack of trust in dentists and treatment cost in studies with India as the country of origin, to religiosity, among poorer nations such as Bangladesh. Fewer studies focused on recent arrivals from Bhutan or the Maldives. Culturally and socially appropriate strategies must be developed to target oral health issues and a “one-size” fits all approach will be ineffective in addressing the needs of South Asian migrants.
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Affiliation(s)
- Mehak Batra
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Sabrina Gupta
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria 3086, Australia.
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Umeh KF. Ethnic inequalities in doctor-patient communication regarding personal care plans: the mediating effects of positive mental wellbeing. ETHNICITY & HEALTH 2019; 24:57-72. [PMID: 28385036 DOI: 10.1080/13557858.2017.1315056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE There is limited understanding of ethnic inequalities in doctor-patient communication regarding personal care plans (PCPs). This study investigated the mediating effects of positive mental wellbeing on differences in PCP-related doctor-patient communication amongst South Asian and Caucasian UK residents. DESIGN Data from 10,980 respondents to the 2013 Health Survey for England was analysed using bootstrapping methods. Constructs from the WEMWBS (Warwick and Edinburgh Mental Wellbeing Scale) (Stewart-Brown, S., and K. Janmohamed. 2008. Warwick, UK) were assessed as mediators of relations between ethnicity and several doctor-patient communication variables, including PCP-related interactions; (a) had a PCP-related discussion about a long-term condition with a doctor/nurse, and (b) had this conversation within the past year, (c) agreed to a PCP with a health professional; and (d) talked to a doctor in the past 2 weeks. RESULTS Bootstrapped mediation analysis (Hayes, A. F. 2013. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. New York, NY: The Guilford Press) showed that three positive mind-sets mediated associations between ethnicity and doctor-patient contact, including PCP-related communication. Being able to make up one's mind (ab = -0.05; BCa CI [-0.14, 0.01]) mediated the effect of ethnicity on agreeing to a PCP, while having energy to spare (ab = 0.07; BCa CI [-0.04, 0.12]), and feeling good about oneself (ab = 0.03; BCa CI [0.01, 0.07]), mediated ethnic effects on talking to a doctor during the past fortnight. The mediating effect of reported energy persisted after controlling for medical history, perceived health, and other covariates. CONCLUSIONS Ethnic disparities in doctor-patient interaction, including PCP-related communication, are partly explained by positive mental wellbeing. Gauging positive psychological moods in patients, particularly self-worth, self-perceived vigour and decisiveness, are relevant to addressing ethnic inequalities in doctor-patient communication. As PCPs may have direct implications for patient health it is important for health professionals to address deficits in psychological functioning that may precipitate ethnic inequalities in setting up PCPs.
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Affiliation(s)
- Kanayo F Umeh
- a School of Natural Sciences & Psychology , Liverpool John Moores University , Liverpool , UK
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Waibel S, Wong ST, Katz A, Levesque JF, Nibber R, Haggerty J. The influence of patient-clinician ethnocultural and language concordance on continuity and quality of care: a cross-sectional analysis. CMAJ Open 2018; 6:E276-E284. [PMID: 30026191 PMCID: PMC6182102 DOI: 10.9778/cmajo.20170160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Concordance refers to shared characteristics between a clinician and patient, such as ethnicity or language. The purpose of this study was to examine whether patient-clinician concordance is associated with patient-reported continuity of care (relational, informational and management) and patient-reported impacts of care (quality and empowerment). METHODS This is a secondary analysis of cross-sectional patient surveys that were administered across British Columbia, Manitoba and Quebec using random digit dialling. Participants were adults who spoke English, French, Mandarin, Cantonese or Punjabi and who had visited a primary care clinician in the previous 12 months (n = 3156). Patients self-identified as being of European, Chinese, South Asian and Indigenous descent. Outcome measures included patients' perceptions of continuity, quality and empowerment. Adjusted logistic regression models and odds ratio were generated. RESULTS More than 64% of non-Indigenous respondents reported ethnocultural concordance. Ethnocultural concordance was associated with higher odds of relational and management continuity. This same pattern held when there was both ethnocultural and language concordance. No association was found between language concordance and any outcome measure. Chinese participants reported lower quality (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.12-0.48), as did South Asian participants (OR 0.17, 95% CI 0.09-0.31) than did participants of European descent. INTERPRETATION Higher relational and management continuity is more likely with the presence of patient-clinician ethnocultural and language concordance. Lower continuity and quality reported by Chinese and South Asian particpants could indicate important health care disparities.
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Affiliation(s)
- Sina Waibel
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
| | - Sabrina T Wong
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que.
| | - Alan Katz
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
| | - Jean-Frederic Levesque
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
| | - Raji Nibber
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
| | - Jeannie Haggerty
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
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Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey. Br J Gen Pract 2018; 68:e469-e477. [PMID: 29914881 DOI: 10.3399/bjgp18x697673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/12/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients' overall experiences of general practice. AIM To examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours. DESIGN AND SETTING Analysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011-2012 until 2013-2014. These covered 8289 general practice surgeries in England. METHOD Data from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression. RESULTS In total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices. CONCLUSION Patient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients' overall experience of general practice.
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Du FH. Gray Areas in Language-Concordant Healthcare: a Graduating Medical Student's Reflection on the Experience and Research on Language and Cultural Competence. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:493-496. [PMID: 27402122 DOI: 10.1007/s13187-016-1077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Fanny Huynh Du
- University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI, 48109, USA.
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Baldie DJ, Guthrie B, Entwistle V, Kroll T. Exploring the impact and use of patients' feedback about their care experiences in general practice settings-a realist synthesis. Fam Pract 2018; 35:13-21. [PMID: 28985368 PMCID: PMC6191909 DOI: 10.1093/fampra/cmx067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Policy encourages health care providers to listen and respond to feedback from patients, expecting that it will enhance care experiences. Enhancement of patients' experiences may not yet be a reality, particularly in primary health care settings. Objective To identify the issues that influence the use and impact of feedback in this context. Design and Setting A realist synthesis of studies of the use of patient feedback within primary health care settings. Methods Structured review of published studies between 1971 and January 2015. Results Eighteen studies were reported in 20 papers. Eleven studies reported patient survey scores as a primary outcome. There is little evidence that formal patient feedback led to enhanced experiences. The likelihood of patient feedback to health care staff stimulating improvements in future patients' experiences appears to be influenced predominantly by staff perceptions of the purpose of such feedback; the validity and type of data that is collected; and where, when and how it is presented to primary health care teams or practitioners and teams' capacity to change. Conclusions There is limited research into how patient feedback has been used in primary health care practices or its usefulness as a stimulant to improve health care experience. Using a realist synthesis approach, we have identified a number of contextual and intervention-related factors that appear to influence the likelihood that practitioners will listen to, act on and achieve improvements in patient experience. Consideration of these may support research and improvement work in this area.
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Affiliation(s)
- Deborah J Baldie
- Centre for Person-centred Practice Research, Division of Nursing, Queen Margaret University, Edinburgh, UK
- NHS Tayside, Ninewells Hospital, Dundee, UK
| | - Bruce Guthrie
- Quality, Safety and Informatics Research Group, School of Medicine, University of Dundee, Dundee, UK
| | - Vikki Entwistle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Thilo Kroll
- School Of Nursing, Midwifery & Health Sys, Health Sciences Centre, University of Dublin, Dublin, Ireland
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Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, Bower P, Calitri R, Carter M, Davey A, Elliott MN, Elmore N, Farrington C, Haque HW, Henley W, Lattimer V, Llanwarne N, Lloyd C, Lyratzopoulos G, Maramba I, Mounce L, Newbould J, Paddison C, Parker R, Richards S, Roberts M, Setodji C, Silverman J, Warren F, Wilson E, Wright C, Roland M. Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Gary Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Exeter Medical School, Exeter, UK
| | - Ahmed Aboulghate
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Faraz Ahmed
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Julia Beckwith
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Olga Boiko
- University of Exeter Medical School, Exeter, UK
| | - Pete Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Mary Carter
- University of Exeter Medical School, Exeter, UK
| | | | | | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Conor Farrington
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Hena Wali Haque
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Val Lattimer
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nadia Llanwarne
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health & Social Care, The Open University, Milton Keynes, UK
| | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Luke Mounce
- University of Exeter Medical School, Exeter, UK
| | - Jenny Newbould
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charlotte Paddison
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Richard Parker
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | | | - Ed Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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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: 23] [Impact Index Per Article: 2.9] [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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Burt J, Abel G, Elmore N, Lloyd C, Benson J, Sarson L, Carluccio A, Campbell J, Elliott MN, Roland M. Understanding negative feedback from South Asian patients: an experimental vignette study. BMJ Open 2016; 6:e011256. [PMID: 27609844 PMCID: PMC5020840 DOI: 10.1136/bmjopen-2016-011256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In many countries, minority ethnic groups report poorer care in patient surveys. This could be because they get worse care or because they respond differently to such surveys. We conducted an experiment to determine whether South Asian people in England rate simulated GP consultations the same or differently from White British people. If these groups rate consultations similarly when viewing identical simulated consultations, it would be more likely that the lower scores reported by minority ethnic groups in real surveys reflect real differences in quality of care. DESIGN Experimental vignette study. Trained fieldworkers completed computer-assisted personal interviews during which participants rated 3 video recordings of simulated GP-patient consultations, using 5 communication items from the English GP Patient Survey. Consultations were shown in a random order, selected from a pool of 16. SETTING Geographically confined areas of ∼130 households (output areas) in England, selected using proportional systematic sampling. PARTICIPANTS 564 White British and 564 Pakistani adults recruited using an in-home face-to-face approach. MAIN OUTCOME MEASURE Mean differences in communication score (on a scale of 0-100) between White British and Pakistani participants, estimated from linear regression. RESULTS Pakistani participants, on average, scored consultations 9.8 points higher than White British participants (95% CI 8.0 to 11.7, p<0.001) when viewing the same consultations. When adjusted for age, gender, deprivation, self-rated health and video, the difference increased to 11.0 points (95% CI 8.5 to 13.6, p<0.001). The largest differences were seen when participants were older (>55) and where communication was scripted to be poor. CONCLUSIONS Substantial differences in ratings were found between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gary Abel
- University of Exeter Medical School, Exeter, UK
| | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
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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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Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey. Br J Gen Pract 2015; 66:e47-52. [PMID: 26541182 PMCID: PMC4684035 DOI: 10.3399/bjgp15x687637] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/22/2015] [Indexed: 11/03/2022] Open
Abstract
Background Doctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. Aim To determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender. Design and setting Analysis of data from the English GP Patient Survey from 2012–2013 and 2013–2014, including 1 599 801 responders. Method A composite score was created for doctor–patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. Results There was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP–patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor–patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as ‘Any other white’. Conclusion The identification of groups with particularly marked differences in experience of GP–patient communication — older, female, Asian patients and younger ‘Any other white’ patients — underlines the need for a renewed focus on quality of care for these groups.
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