How do patients with a Turkish background evaluate their medical care in Germany? An observational study in primary care

Immigrant and ethnic minority patients` reported experiences in psychiatric care in Europe - a scoping review

BACKGROUND

There is little evidence on experiences in psychiatric care treatment among patients with immigrant or ethnic minority background. Knowledge about their experiences is crucial in the development of equal and high-quality services and is needed to validate instruments applied in national patient experience surveys in Norway. The aim of this scoping review is to assess and summarize current evidence on immigrant and ethnic minorities` experiences in psychiatric care treatment in Europe.

METHODS

Guidelines from the Joanna Briggs Institute were followed and the research process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The literature search was carried out in Medline, Cinahl, Web of Science, Cochrane database of systematic reviews, Embase, and APA PsychInfo, up to Dec 2022, for articles on immigrant patients` experiences in psychiatric care. Reference lists of included articles were screened for additional relevant articles. Titles and abstracts were screened, and potentially relevant articles read in full-text, by two researchers. Evidence was extracted using an a priori extraction form and summarized in tables and text. Any disagreement between the reviewers regarding inclusion of articles or extracted information details were resolved through discussion between authors.

RESULTS

We included eight studies in the scoping review. Immigrant and ethnic minority background patients did not differ from the general population in quantitative satisfaction questionnaires. However, qualitative studies showed that they experience a lack of understanding and respect of own culture and related needs, and difficulties in communication, which do not seem to be captured in questionnaire-based studies.

CONCLUSION

Raising awareness about the importance of respect and understanding for patients` cultural background and communication needs for treatment satisfaction should be addressed in future quality improvement work.

Perspectives of physicians and pharmacists on rational use of antibiotics in Turkey and among Turkish migrants in Germany, Sweden and the Netherlands: a qualitative study

Background

Antimicrobial resistance may result from inappropriate use of antibiotics in health care. Turkey is one of the countries with the highest antibiotic consumption in the world. Considering the role of transnational ties between Turkish migrants and their social contacts in Turkey, the attitudes and behaviors relating to rational antibiotic use in Turkey can also affect the use of antibiotics by Turkish migrants residing abroad. This study explores physicians’ and pharmacists’ experiences and perspectives on rational antibiotic use among Turkish adults in Turkey and among Turkish migrants in Germany, Sweden, and the Netherlands, three European countries with large populations of Turkish migrants.

Methods

Following a qualitative study design using convenience and snowball sampling, in-depth interviews with 21 family physicians and 24 pharmacists were conducted in the aforementioned countries. We transcribed all interviews verbatim and performed content analysis separately in the countries, followed by translation, pooling and joint interpretation of the findings.

Results

Physicians and pharmacists encountered irrational use of antibiotics among their patients in Turkey. Physicians interviewed in the three European countries explained that Turkish migrants differ from non-migrants with respect to their attitudes towards antibiotics, for example by more often expecting to be prescribed antibiotics. All physicians and pharmacists in the selected countries reported to inform their patients on how to use antibiotics upon prescription; however, Turkish migrants’ poor language proficiency was considered as a substantial communication barrier by the physicians and pharmacists interviewed in the European countries.

Conclusions

The study illustrated some aspects of irrational antibiotic use among the population in Turkey and Turkish migrants in selected European countries. It emphasized the need for closer community participation, adequate information campaigns, as well as in-service training of health care providers in Turkey. The strategies and interventions on rational antibiotic use should also be supported and encouraged by health care providers, who need to reach out to people with various cultural backgrounds.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01636-8.

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Background

Patient experience is an important indicator of quality of health care. In Norway, little is known about the quality of health care for immigrants. The aim of this study was to compare patient-reported experiences with general practice between the Norwegian-born population and immigrant groups.

Methods

We performed secondary analyses of data from a national survey on patient experiences with general practice, including assessments of general practitioners (GPs) and their GP offices. The survey was carried out in Norway in 2018–19. The total number of respondents was 2029, with a response rate of 42.6%. Region of birth was available for 1981 participants, and these were included in the analyses (“Norway” (N = 1756), “Asia, Africa or South America” (N = 95), “Eastern Europe” (N = 70) and “Western Europe, North America or Oceania” (N = 60)). Five indicators of patient experiences were used as dependent variables in bivariate and multivariate analyses, with region of birth as the main exposure variable and other background variables about the patient as adjustment variables: “the GP” (measures related to communication and competency), “auxiliary staff” (politeness, competency, organization), “accessibility” (waiting times), “coordination” (with other services) and `enablement` (GP facilitates coping with/understanding illness).

Results

Immigrants as a whole reported poorer experiences with general practice than the majority population, with significantly poorer scores on four of five patient experience indicators. Patients from Asia/Africa/South America reported poorer experiences than those from Norway on the indicators “GP”, “auxiliary staff”, “accessibility” and “coordination”: on a scale from 0 to 100 where 100 is the best, the difference ranged from 7.8 (GP) to 20.3 (accessibility). Patients from Eastern Europe reported lower scores on “GP” and patients from Western Europe/North America/Oceania reported lower scores on “auxiliary staff”. These associations were still significant after adjustment for sex, age, self-rated physical and mental health, number of contacts with the GP and education.

Conclusions

For countries with a substantial proportion of foreign-born patients in the health system, immigrant background is an important parameter in quality improvement work. Immigrant background is also an important parameter in health service research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05963-3.

Psychometric properties of the Arabic version of the EUROPEP questionnaire

BACKGROUND

The evaluation of quality of primary health care from the perspective of refugees is very underdeveloped. It depends mainly on the availability of instruments in the language of the refugees. The aim of this study was to translate, culturally adapt, and examine the psychometric properties especially the internal consistency and convergent construct validity of the Arabic version of the European Project on Patient Evaluation of General Practice Care (EUROPEP) questionnaire.

METHODS

The German version of the EUROPEP questionnaire was translated into Arabic language. In total, 619 Arabic-speaking people were invited to participate in this study. Refugees who lived in collective living quarters in the German federal state of Schleswig-Holstein were recruited. The EUROPEP questionnaire is a multidimensional instrument that comprises 23 items, each with a 5-point Likert-type response. Cronbach's alpha, descriptive statistics, and principal component analysis were used to assess a part of psychometric properties. Convergent construct validity was assessed with the validated questionnaire on satisfaction with ambulatory care - quality from the patient perspective (ZAP questionnaire) by using Spearman rank-order correlation test.

RESULTS

A total of 136 questionnaires of refugees were returned (response rate 22%). Of these respondents, 95 participants who had visited a general practitioner were included in the validation study. The exploratory factor analysis extracted four factors, namely, "medical care," "physician-patient relationship," "coordination of care," and "accessibility to care." The internal consistency ranged between α=0.942 for "medical care" and α=0.869 for "coordination of care." The convergent construct validity is supported by a significant positive correlation between the overall score of the EUROPEP questionnaire and the overall score of the ZAP questionnaire (r_rho=0.820; p<0.01).

CONCLUSION

The Arabic version of the EUROPEP questionnaire shows appropriate internal consistency and convergent construct validity. The availability of this instrument in Arabic language encourages further research in the field of outcome quality from refugees' perspective in other health service research projects.