|
1
|
Fong M, Liu A, Lung B, Alayche I, Sayfi S, Kirenga RY, Chomienne MH, Saad A, Grenier J, Kassam A, Ahmed R, Pottie K. From struggle to strength in African and Middle Eastern newcomers' integration stories to Canada: A participatory health equity research study. PLoS One 2024; 19:e0302591. [PMID: 38687776 PMCID: PMC11060515 DOI: 10.1371/journal.pone.0302591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Newcomers (immigrants, refugees, and international students) face many personal, gender, cultural, environmental and health system barriers when integrating into a new society. These struggles can affect their health and social care, reducing access to mental health care. This study explores the lived experiences of African and Middle Eastern newcomers to Ontario, Canada. An understanding of newcomer integration challenges, successes and social justice issues is needed to improve health equity and social services. METHODS In this qualitative study, we used a participatory research approach to collect stories reflecting participants' integration perspectives and experiences. Beginning with our immigrant community network, we used snowball sampling to recruit newcomers, ages 18 to 30, originating from Africa or the Middle East. We used qualitative narrative analysis to interpret stories, identifying context themes, integrating related barriers and facilitators, and resolutions and learnings. We shared our findings and sought final feedback from our participants. FINDINGS A total of 18 newcomers, 78% female and approximately half post-secondary students, participated in the study. Participants described an unknown and intimidating migration context, with periods of loneliness and isolation aggravated by cold winter conditions and unfamiliar language and culture. Amidst the struggles, the support of friends and family, along with engaging in schoolwork, exploring new learning opportunities, and participating in community services, all facilitated integration and forged new resilience. CONCLUSIONS Community building, friendships, and local services emerged as key elements for future immigrant service research. Utilizing a participatory health research approach allowed us to respond to the call for social justice-oriented research that helps to generate scientific knowledge for promoting culturally adaptive health care and access for marginalized populations.
Collapse
Affiliation(s)
- Maggie Fong
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amy Liu
- Department of Interdisciplinary Medical Sciences, Western University, London, Ontario, Canada
| | - Bryan Lung
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
- Department of Biochemistry, Western University, London, Ontario, Canada
| | - Ibrahim Alayche
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shahab Sayfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Yuhi Kirenga
- The Vulnerability, Trauma, Resilience and Culture Research Laboratory (V-TRaC), University of Ottawa, Ottawa, Ontario, Canada
| | - Marie Hélène Chomienne
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Ammar Saad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean Grenier
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Rukhsana Ahmed
- Department of Communication, University at Albany, State University of New York, Albany, New York, United States of America
| | - Kevin Pottie
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
| |
Collapse
|
|
2
|
Hinchey LM, Khalil D, Javanbakht A. Practical approaches to conducting biopsychosocial research with refugee and internally displaced communities. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 16:100217. [PMID: 38108032 PMCID: PMC10724820 DOI: 10.1016/j.cpnec.2023.100217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/17/2023] [Accepted: 10/28/2023] [Indexed: 12/19/2023] Open
Abstract
Refugees and internally displaced people comprise one percent of the world population. Forced migration involves a multitude of ongoing stressful and traumatic experiences, often resulting in lasting psychological symptoms for people resettling as refugees. Despite these risks, the underrepresentation of refugee populations in research-particularly in biological sciences-has impeded the allocation of effective resources and the development of novel interventions for these groups. This paper identifies and addresses key methodological challenges to successfully and appropriately conducting research with refugee and internally displaced communities, many of which have served as barriers to improving research representation for these populations. Methodological challenges discussed include language and literacy barriers; political fears; differing cultural dynamics between participants and researchers; and others. We provide practical recommendations for overcoming each challenge, often sourced from our experience conducting multi-year studies and interventions in refugee mental health. Several key strategies include the recruitment of researchers and research assistants from similar cultural and linguistic backgrounds as participants; providing detailed, ongoing communication about informed consent; avoiding assumptions regarding participants' understanding of concepts that may vary based on culture or experience (e.g., "voluntary" research; confidentiality); and adopting flexible data collection procedures compatible with participants' needs and restrictions. Finally, we discuss the role of the researcher in regard to cultural competencies and partnering with the refugee community. Given the increasing global population of refugees, the strategies discussed in this paper are suggested in order to encourage future research in this underrepresented population and empower investigators to logistically carry out studies with refugees.
Collapse
Affiliation(s)
- Liza M.E. Hinchey
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Dalia Khalil
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
|
3
|
Filmer T, Ray R, Glass BD. Barriers and facilitators experienced by migrants and refugees when accessing pharmaceutical care: A scoping review. Res Social Adm Pharm 2023; 19:977-988. [PMID: 36868911 DOI: 10.1016/j.sapharm.2023.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 02/03/2023] [Accepted: 02/25/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Pharmacists in the community are often among the first health professionals encountered by new arrivals. Their accessibility and the longevity of the relationship gives pharmacy staff unique opportunities to work with migrants and refugees to meet their health needs. While the language, cultural and health literacy barriers that cause poorer health outcomes are well documented in medical literature, there is a need to validate the barriers to accessing pharmaceutical care and to identify facilitators for efficient care in the migrant/refugee patient-pharmacy staff interaction. OBJECTIVE The purpose of this scoping review was to investigate the barriers and facilitators that migrant and refugee populations experience when accessing pharmaceutical care in host countries. METHODS A comprehensive search of Medline, Emcare on Ovid, CINAHL and SCOPUS databases, guided by the PRISMA-ScR statement, was undertaken to identify the original research published in English between 1990 and December 2021. The studies were screened based on inclusion and exclusion criteria. RESULTS A total of 52 articles from around the world were included in this review. The studies revealed that the barriers to migrants and refugees accessing pharmaceutical care are well documented and include language, health literacy, unfamiliarity with health systems, and cultural beliefs and practises. Empirical evidence was less robust for facilitators, but suggested strategies included improvement of communication, medication review, community education and relationship building. CONCLUSIONS While barriers experienced are known, there is a lack of evidence for facilitators for provision of pharmaceutical care to refugees and migrants and poor uptake of available tools and resources. There is a need for further research to identify facilitators that are effective in improving access to pharmaceutical care and practical for implementation by pharmacies..
Collapse
Affiliation(s)
- Tamara Filmer
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, QLD, 4811, Australia.
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, QLD, 4811, Australia.
| | - Beverley D Glass
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, QLD, 4811, Australia.
| |
Collapse
|
|
4
|
Barriers to the use of trained interpreters in consultations with refugees in four resettlement countries: a qualitative analysis using normalisation process theory. BMC FAMILY PRACTICE 2020; 21:259. [PMID: 33278882 PMCID: PMC7719256 DOI: 10.1186/s12875-020-01314-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
Background Increasing numbers of primary care practitioners in refugee resettlement countries are providing care to refugees. Access to trained interpreters is a priority for these practitioners, but there are many barriers to the implementation of interpreted consultations in routine care. There is a lack of international, theoretically informed research. The purpose of this paper is to understand barriers to interpreter use in primary care consultations in four resettlement countries using Normalisation Process Theory. Method We conducted a cross-sectional online survey with networks of primary care practitioners (PCPs) who care for refugees in Australia, Canada, Ireland and the US (n = 314). We analysed qualitative data from the survey about barriers to interpreter use (n = 178). We completed an inductive thematic analysis, iteratively developed a Normalisation Process Theory (NPT)-informed coding frame and then mapped the emergent findings onto the theory’s construct about enacting interpreted consultations. Results In all four countries, the use of an interpreter presented communication and interaction challenges between providers and patients, which can impede the goals of primary care consultations. Primary care practitioners did not always have confidence in interpreted consultations and described poor professional practice by some interpreters. There was variation across countries, and inconsistency within countries, in the availability of trained interpreters and funding sources. Conclusion There are shared and differential barriers to implementation of interpreted consultations in a consistent and sustained way in the four countries studied. These findings can be used to inform country-specific and international level policies and interventions focusing on improving skills and resources for interpreted consultations to improve implementation of interpreted primary care consultations. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01314-7.
Collapse
|
|
5
|
Gene Hallford H, Coffman MA, Obregon‐Tito AJ, Morales AH, Williamson Dean L. Access barriers to genetic services for Spanish-speaking families in states with rapidly growing migrant populations. J Genet Couns 2020; 29:365-380. [PMID: 31828856 PMCID: PMC7318121 DOI: 10.1002/jgc4.1195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 11/18/2022]
Abstract
Hispanics are among the fastest growing U.S. population segments, accounting for the majority of growth since 2000. Hispanics are heterogeneous and include foreign-born and U.S. citizens, monolingual fluent English speakers, monolingual Spanish-speakers, multilingual speakers, and socioeconomically and educationally diverse subgroups. States within the central United States (U.S.), referred to as the Heartland, have numerically small Hispanic populations, but rapidly growing Hispanic populations that are expanding faster than the overall U.S. Hispanic population. The Hispanic populations across the U.S. are widely known to be medically underserved. This qualitative study identifies barriers native Spanish-speakers experience when locating and accessing genetic services for their children. After providing informed consent, 29 parents in three Heartland states were interviewed and asked about their awareness of available genetic services, utilization of available services and difficulties they encountered when using them. Interviewees reported delayed genetic service referrals, limited availability and inadequate interpretation services, verbal and written communication problems during clinic visits, culturally incongruent healthcare expectations and limited appreciation for how genetic services benefit them. Necessary efforts to understand and improve genetic service access and usefulness for Hispanic populations are underway in the Heartland and elsewhere and should continue to be expanded.
Collapse
Affiliation(s)
- Henry Gene Hallford
- Department of PediatricsSection of GeneticsCollege of MedicineUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Mary Ann Coffman
- Department of Genetic CounselingCollege of Health ProfessionsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Alexandra Juana Obregon‐Tito
- Department of Genetic CounselingCollege of Health ProfessionsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Anayeli Herrera Morales
- Department of Genetic CounselingCollege of Health ProfessionsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Lori Williamson Dean
- Department of Genetic CounselingCollege of Health ProfessionsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| |
Collapse
|
|
6
|
Salkar M, Rosenthal M, Thakur T, Arnold A. Patient Centered Studies Focusing on Diabetes Self-Management: A Scoping Review. Curr Diabetes Rev 2020; 16:557-569. [PMID: 31886751 DOI: 10.2174/1573399816666191230112657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/01/2019] [Accepted: 12/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 2 diabetes continues to be a significant burden to patients and health systems globally. Addressing this condition from an alternative perspective, patients and various other stakeholders from three northern Mississippi communities co-created patient-centered research questions focused on type 2 diabetes management. OBJECTIVE The objective of this scoping review was to explore current literature focusing on nine patient- centered research questions to establish current knowledge and identify future research needs in the area of type 2 diabetes. METHODS A scoping review was conducted to obtain an overview of research related to the study purpose. The PubMed database was searched from March 2013 to March 2018 to identify patient-centered studies focused on type 2 diabetes and relevant to one of the nine research questions. RESULTS A total of 33 studies were identified and included. For five of the research questions, there was either no previous research literature or only "related" studies could be identified. These largely unexplored topics included how the understanding of guidelines by healthcare providers, specialty, and communication of medication side-effects impact patients' understanding and outcomes, the impact of improving patients' preparedness to communicate with providers, and whether younger patients require weight management programs that account for this populations' needs. CONCLUSION This lack of previous literature presents a unique opportunity to partner with patients to conduct this study and help improve the management of type 2 diabetes.
Collapse
Affiliation(s)
- Monika Salkar
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, MS, United States
| | - Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, MS, United States
| | - Tanvee Thakur
- Social and Administrative Science Division, School of Pharmacy, University of Wisconsin, Madison, WI, United States
| | - Austin Arnold
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, MS, United States
| |
Collapse
|
|
7
|
Dubus N, LeBoeuf HS. A qualitative study of the perceived effectiveness of refugee services among consumers, providers, and interpreters. Transcult Psychiatry 2019; 56:827-844. [PMID: 31042119 DOI: 10.1177/1363461519844360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored the perceptions of accessibility and cultural effectiveness of refugee services in the northeast region of the United States from refugees, interpreters who work with refugees in accessing these services, and the providers of the refugee services. The study examined the perceptions of 51 refugees from 10 countries, five individual interviews with providers and 26 provider survey responses representing 31 different agencies, and four interviews from interpreters. Qualitative interviews were conducted using a semi-structured interview schedule, were audiotaped, and transcribed. Further data were collected through a survey. All data were analyzed using constant comparative analysis. Participants shared feelings of frustration that services seemed poorly coordinated among the agencies and that the agencies appeared ill-prepared for the unique experiences of separate refugee groups. The three perspectives of refugee service delivery, as a consumer, a provider, or an interpreter, shared the perception that there was not a mechanism for the different services to collaborate effectively with each other, to create a network of coordinated services that would enhance services while decreasing burdens on individual centers, nor was there a system to best prepare the centers for new refugees.
Collapse
Affiliation(s)
- Nicole Dubus
- San José State University.,Pathways for Change Inc
| | | |
Collapse
|
|
8
|
Pottie K, Agic B, Archibald D, Ratnayake A, Tapia M, Thanos J. HEIA tools: inclusion of migrants in health policy in Canada. Health Promot Int 2019; 34:697-705. [PMID: 29672682 DOI: 10.1093/heapro/day016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper introduces the Migrant Populations Equity Extension for Ontario's Health Equity Impact Assessment (HEIA) initiatives. It provides a mechanism to address the needs of migrant populations, within a program and policy framework. Validation of an equity extension framework using community leaders and health practitioners engaged in HEIA workshops across Ontario. Participants assessed migrants' health needs and discussed how to integrate these needs into health policy. The Migrant Populations Equity Extension's framework assists decision makers assess relevant populations, collaborate with immigrant communities, improve policy development and mitigate unintended negative impacts of policy initiatives. The tool framework aims to build stakeholder capacity and improve their ability to conduct HEIAs while including migrant populations. The workshops engaged participants in equity discussions, enhanced their knowledge of migrant policy development and promoted HEIA tools in health decision-making. Prior to these workshops, many participants were unaware of the HEIA tool. The workshops informed the validation of the equity extension and support materials for training staff in government and public health. Ongoing research on policy implementation would be valuable. Public health practitioners and migrant communities can use the equity extension's framework to support decision-making processes and address health inequities. This framework may improve policy development and reduce health inequities for Ontario's diverse migrant populations. Many countries are now using health impact assessment and health equity frameworks. This migration population equity extension is an internationally unique framework that engages migrant communities.
Collapse
Affiliation(s)
- Kevin Pottie
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Cresc. Suite 201, Ottawa, ON, Canada.,Department of Epidemiology and Community Medicine, Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Cresc. Suite 201, Ottawa, ON, Canada
| | - Ayesha Ratnayake
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | | | | |
Collapse
|
|
9
|
de Brún T, O’Reilly - de Brún M, Van Weel-Baumgarten E, Burns N, Dowrick C, Lionis C, O’Donnell C, Mair FS, Papadakaki M, Saridaki A, Spiegel W, Van Weel C, Van den Muijsenbergh M, MacFarlane A. Using Participatory Learning & Action (PLA) research techniques for inter-stakeholder dialogue in primary healthcare: an analysis of stakeholders' experiences. RESEARCH INVOLVEMENT AND ENGAGEMENT 2017; 3:28. [PMID: 29225922 PMCID: PMC5718138 DOI: 10.1186/s40900-017-0077-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/06/2017] [Indexed: 05/12/2023]
Abstract
PLAIN ENGLISH SUMMARY It is important for health care workers to know the needs and expectations of their patients. Therefore, service users have to be involved in research. To achieve a meaningful dialogue between service users, healthcare workers and researchers, participatory methods are needed. This paper describes how the application of a specific participatory methodology, Participatory Learning and Action (PLA) can lead to such a meaningful dialogue. In PLA all stakeholders are regarded as equal partners and collaborators in research.During 2011-2015, a European project called RESTORE used PLA in Austria, Greece, Ireland, The Netherlands and the UK to investigate how communication between primary health care workers and their migrant patients could be improved.Seventy eight migrants, interpreters, doctors, nurses and other key stakeholders (see Table 2) participated in 62 PLA sessions. These dialogues (involving discussions, activities, PLA techniques and evaluations) were generally 2-3 h long and were recorded and analysed by the researchers.Participants reported many positive experiences about their dialogues with other stakeholders. There was a positive, trusting atmosphere in which all stakeholders could express their views despite differences in social power. This made for better understanding within and across stakeholder groups. For instance a doctor changed her view on the use of interpreters after a migrant explained why this was important. Negative experiences were rare: some doctors and healthcare workers thought the PLA sessions took a lot of time; and despite the good dialogue, there was disappointment that very few migrants used the new interpreting service. ABSTRACT Background In order to be effective, primary healthcare must understand the health needs, values and expectations of the population it serves. Recent research has shown that the involvement of service users and other stakeholders and gathering information on their perspectives can contribute positively to many aspects of primary healthcare. Participatory methodologies have the potential to support engagement and dialogue between stakeholders from academic, migrant community and health service settings. This paper focuses on a specific participatory research methodology, Participatory Learning and Action (PLA) in which all stakeholders are regarded as equal partners and collaborators in research.Our research question for this paper was: "Does the application of PLA lead to meaningful engagement of all stakeholders, and if so, what elements contribute to a positive and productive inter-stakeholder dialogue?". Methods We explored the use of PLA in RESTORE, a European FP7-funded project, during 2011-2015 in 5 countries: Austria, Greece, Ireland, the Netherlands and the UK. The objective of RESTORE was to investigate and support the implementation of guidelines and training initiatives (G/TIs) to enhance communication in cross-cultural primary care consultations with migrants.Seventy eight stakeholders (migrants, interpreters, doctors, nurses and others - see Table 2) participated in a total of 62 PLA sessions (discussions, activities, evaluations) of approximately 2-3 h' duration across the five sites. During the fieldwork, qualitative data were generated about stakeholders' experiences of engagement in this dialogue, by means of various methods including participatory evaluations, researchers' fieldwork reports and researcher interviews. These were analysed following the principles of thematic analysis. Results Stakeholders involved in PLA inter-stakeholder dialogues reported a wide range of positive experiences of engagement, and very few negative experiences. A positive atmosphere during early research sessions helped to create a sense of safety and trust. This enabled stakeholders from very different backgrounds, with different social status and power, to offer their perspectives in a way that led to enhanced learning in the group - they learned with and from each other. This fostered shifts in understanding - for example, a doctor changed her view on interpreted consultations because of the input of the migrant service-users. Conclusion PLA successfully promoted stakeholder involvement in meaningful and productive inter-stakeholder dialogues. This makes it an attractive approach to enhance the further development of health research partnerships to advance primary healthcare.
Collapse
Affiliation(s)
- T. de Brún
- Centre for Participatory Strategies (CPS), Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - M. O’Reilly - de Brún
- Centre for Participatory Strategies (CPS), Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - E. Van Weel-Baumgarten
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - N. Burns
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YW UK
| | - C. Dowrick
- Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, UK
| | - C. Lionis
- University of Crete, Faculty of Medicine, Clinic of Social and Family Medicine, Heraklion, Greece
| | - C. O’Donnell
- General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - F. S. Mair
- General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M. Papadakaki
- Technological Educational Institute of Crete, School of Health and Social Welfare, Department of Social Work, Heraklion, Greece
| | - A. Saridaki
- University of Crete, Faculty of Medicine, Clinic of Social and Family Medicine, Heraklion, Greece
| | - W. Spiegel
- Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, A-1090, Vienna, Austria
| | - C. Van Weel
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - M. Van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Pharos, centre of expertise on health disparities, Utrecht, The Netherlands
| | - A. MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| |
Collapse
|
|
10
|
Teunissen E, Gravenhorst K, Dowrick C, Van Weel-Baumgarten E, Van den Driessen Mareeuw F, de Brún T, Burns N, Lionis C, Mair FS, O'Donnell C, O'Reilly-de Brún M, Papadakaki M, Saridaki A, Spiegel W, Van Weel C, Van den Muijsenbergh M, MacFarlane A. Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study. Int J Equity Health 2017; 16:32. [PMID: 28222736 PMCID: PMC5320766 DOI: 10.1186/s12939-017-0525-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/23/2017] [Indexed: 12/03/2022] Open
Abstract
Background Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice. Methods We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers’ fieldwork reports, were coded and thematically analysed by each team using NPT. Results In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants’ needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP’s diagnoses and GPs reported a clearer understanding of migrants’ symptoms. Conclusions Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.
Collapse
Affiliation(s)
- E Teunissen
- Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, the Netherlands
| | - K Gravenhorst
- Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, United Kingdom
| | - C Dowrick
- Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, United Kingdom
| | - E Van Weel-Baumgarten
- Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, the Netherlands
| | | | - T de Brún
- Discipline of General Practice, School of Medicine, National University ofIreland, Galway, Ireland
| | - N Burns
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK and General Practice & Primary Care, Institute of Health & Wellbeing, College of MVLS, University of Glasgow, Glasgow, UK
| | - C Lionis
- Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece
| | - F S Mair
- General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - C O'Donnell
- General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M O'Reilly-de Brún
- Discipline of General Practice, School of Medicine, National University ofIreland, Galway, Ireland
| | - M Papadakaki
- Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece.,Department of Social Work, School of Health and Social Welfare Technological Educational Institute of Crete Heraklion, Crete, Greece
| | - A Saridaki
- Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece
| | - W Spiegel
- Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, A-1090, Vienna, Austria
| | - C Van Weel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Australian Primary Health Care Research Institute, Nijmegen, the Netherlands
| | - M Van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands. .,Pharos, Centre of Expertise for Health Disparities, Utrecht, the Netherlands.
| | - A MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| |
Collapse
|
|
11
|
Salami B, Kirova A, Hegadoren K, Meherali S, Chiu Y, Nsaliwa C. The Challenges Encountered by Immigrant-Serving Agencies in Addressing the Health of Temporary Foreign Workers. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:599-606. [PMID: 27326750 DOI: 10.1080/19371918.2016.1160347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study sought to examine the challenges encountered by immigrant-serving agencies in meeting the health needs of temporary foreign workers and their families in one Canadian province. The authors interviewed 11 representatives of immigrant-serving agencies and two policy makers. Some of the challenges that agencies face in delivering programs and services for temporary foreign workers and their families include the time required to build trust with this population, temporary foreign workers' reluctance to use services due to fear that it will affect their immigration status, and the emotional labor associated with working with temporary foreign workers.
Collapse
Affiliation(s)
- Bukola Salami
- a Faculty of Nursing, University of Alberta , Edmonton , Alberta , Canada
| | - Anna Kirova
- b Faculty of Education, University of Alberta , Edmonton , Alberta , Canada
| | - Kathleen Hegadoren
- a Faculty of Nursing, University of Alberta , Edmonton , Alberta , Canada
| | - Salima Meherali
- a Faculty of Nursing, University of Alberta , Edmonton , Alberta , Canada
| | - Yvonne Chiu
- c Multicultural Health Brokers Co-op , Edmonton , Alberta , Canada
| | - Christina Nsaliwa
- d Edmonton Immigrant Services Association , Edmonton , Alberta , Canada
| |
Collapse
|
|
12
|
Lionis C, Papadakaki M, Saridaki A, Dowrick C, O'Donnell CA, Mair FS, van den Muijsenbergh M, Burns N, de Brún T, O'Reilly de Brún M, van Weel-Baumgarten E, Spiegel W, MacFarlane A. Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: a theoretically informed participatory study. BMJ Open 2016; 6:e010822. [PMID: 27449890 PMCID: PMC4964217 DOI: 10.1136/bmjopen-2015-010822] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Guidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings. SETTING As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands. PARTICIPANTS A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners). PRIMARY AND SECONDARY OUTCOME MEASURES We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs. RESULTS The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project. CONCLUSIONS This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants.
Collapse
Affiliation(s)
| | - Maria Papadakaki
- Faculty of Medicine, University of Crete, Heraklion, Greece
- Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Heraklion, Greece
| | | | - Christopher Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Catherine A O'Donnell
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Frances S Mair
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Pharos Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Nicola Burns
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
- Faculty of Health and Medicine, Lancaster Medical School, Furness College, University of Lancaster, Lancaster University, Lancaster, UK
| | - Tomas de Brún
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Mary O'Reilly de Brún
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | | | - Wolfgang Spiegel
- Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Anne MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| |
Collapse
|
|
13
|
Yip MP, Calhoun RE, Painter IS, Meischke HW, Tu SP. Emergency communications within the limited English proficient Chinese community. J Immigr Minor Health 2016; 16:769-71. [PMID: 24158381 DOI: 10.1007/s10903-013-9935-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Limited English speaking communities face communication challenges during emergencies. Our objective was to investigate Chinese limited English proficiency individuals' perceptions of and inclination to interact with emergency communication systems. A telephone survey was conducted in Mandarin or Cantonese with 250 ethnic Chinese individuals who spoke little or no English. Respondents who spoke no English were less likely to name 9-1-1 as their first source of help for a medical emergency than those who spoke some English (p < 0.01). Those reporting higher levels of confidence in handling the situation were more likely to name 9-1-1 as their first source of help, as were those who listed 9-1-1 as their most trusted source of help (p < 0.01). For this group, the results indicate that calling 9-1-1 may require a sense of self-efficacy. Not calling 9-1-1 in a medical emergency can have serious health consequences, thus interventions are needed to increase confidence in accessing 9-1-1.
Collapse
Affiliation(s)
- Mei-Po Yip
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA,
| | | | | | | | | |
Collapse
|
|
14
|
O'Reilly-de Brún M, MacFarlane A, de Brún T, Okonkwo E, Bonsenge Bokanga JS, Manuela De Almeida Silva M, Ogbebor F, Mierzejewska A, Nnadi L, van den Muijsenbergh M, van Weel-Baumgarten E, van Weel C. Involving migrants in the development of guidelines for communication in cross-cultural general practice consultations: a participatory learning and action research project. BMJ Open 2015; 5:e007092. [PMID: 26391628 PMCID: PMC4577965 DOI: 10.1136/bmjopen-2014-007092] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this research was to involve migrants and other key stakeholders in a participatory dialogue to develop a guideline for enhancing communication in cross-cultural general practice consultations. In this paper, we focus on findings about the use of formal versus informal interpreters because dialogues about these issues emerged as central to the identification of recommendations for best practice. DESIGN This qualitative case study involved a Participatory Learning and Action (PLA) research methodology. PARTICIPANTS The sample comprised 80 stakeholders: 51 from migrant communities; 15 general practitioners (GPs) and general practice staff; 7 established migrants as peer researchers; 5 formal, trained interpreters; and 2 service planners from the national health authority. SETTING Galway, Ireland. RESULTS There was 100% consensus across stakeholder groups that while informal interpreters have uses for migrants and general practice staff, they are not considered acceptable as best practice. There was also 100% consensus that formal interpreters who are trained and working as per a professional code of practice are acceptable as best practice. CONCLUSIONS Policymakers and service planners need to work in partnership with service providers and migrants to progress the implementation of professional, trained interpreters as a routine way of working in general practice.
Collapse
Affiliation(s)
| | | | | | - Ekaterina Okonkwo
- National University of Ireland, Galway, Ireland
- Galway Migrant Service, Galway, Ireland
| | | | | | | | | | | | | | | | - Chris van Weel
- Radboud University Nijmegen Medical Centre, Radboud University, the Netherlands
- Australian National University, Australian Primary Health Care Research Institute, Canberra, Australia
| |
Collapse
|