22 research outputs found
Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study
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.The RESTORE project was funded by the EU Seventh Framework Programme
(FP7/2007–2013) under Grant Agreement No. 257258. RESTORE: REsearch
into Implementation STrategies to support patients of different ORigins and
language background in a variety of European primary care setting
Reporting mental health problems of undocumented migrants in Greece: A qualitative exploration
<p><b>Background:</b> Mental health problems are highly prevalent amongst undocumented migrants (UMs), and often part of their consultations with general practitioners (GPs). Little empirical data are available of how GPs and UMs engage around mental health in Greece, a country with a lack of balance between primary and secondary care and limited healthcare provisions for UMs.</p> <p><b>Objectives:</b> To acquire insight in the barriers and levers in the provision of mental healthcare for UMs by GPs in Greece.</p> <p><b>Methods:</b> This was a qualitative study using semi-structured interviews with 12 GPs in Crete, Greece with clinical expertise in the care of UMs. All interviews were audio-taped and transcribed verbatim and were analysed using thematic content analysis.</p> <p><b>Results:</b> Greek GPs recognized many mental health problems in UMs and identified the barriers that prevented them from discussing these problems and delivering appropriate care: growing societal resistance towards UMs, budget cuts in healthcare, administrative obstacles and lack of support from the healthcare system. To overcome these barriers, Greek GPs provided UMs with free access to care and psychotropic drugs free of charge, and referred to other primary care professionals rather than to mental healthcare institutions.</p> <p><b>Conclusion:</b> Greek GPs experienced substantial barriers in the provision of mental healthcare to UMs and political, economic and organizational factors played a major role.</p
General Practitioners' intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project
The aim of this paper is to explore general practitioners’ (GPs)
prescribing intentions and patterns across different European regions
using the Theory of Planned Behavior (TPB).
A cross-sectional study was undertaken in selected geographically
defined Primary Health Care areas in Cyprus, Czech Republic (CZ),
France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were
conducted using a TPB-based questionnaire. The number of GP participants
ranged from 39 to 145 per country. Possible associations between TPB
direct measures (attitudes, subjective norms (SN) and perceived
behavioral control (PBC)) and intention to prescribe were assessed by
country.
On average, GPs thought positively of, and claimed to be in control of,
prescribing. Correlations between TPB explanatory measures and
prescribing intention were weak, with TPB direct measures explaining
about 25% of the variance in intention to prescribe in Malta and CZ but
only between 3% and 5% in Greece, Sweden and Turkey. SN appeared
influential in GPs from Malta; attitude and PBC were statistically
significant in GPs from CZ. GPs’ prescribing intentions and patterns
differed across participating countries, indicating that
country-specific interventions are likely to be appropriate. Irrational
prescribing behaviors were more apparent in the countries where an
integrated primary care system has still not been fully developed and
policies promoting the rational use of medicines are lacking.
Demand-side measures aimed at modifying GPs prescribing behavior are
deemed necessary. (C) 2015 Elsevier Ireland Ltd. All rights reserved
Reducing the health care burden for marginalised migrants:the potential role for primary care in Europe
There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed
Exploring barriers to primary care for migrants in Greece in times of austerity: perspectives of service providers
Background: Migration in Europe is increasing at an unprecedented rate. There is an urgentneed to develop ‘migrant-sensitive healthcare systems’. However, there are many barriers to healthcare for migrants. Despite Greece’s recent, significant experiences of inward migration during a period of economic austerity, little is known about Greek primary care service providers’ experiences of delivering care to migrants.
Objectives: To identify service providers’ views on the barriers to migrant healthcare.
Methods: Qualitative study involving six participatory learning and action (PLA) focus group sessions with nine service providers. Data generation was informed by normalization process theory (NPT). Thematic analysis was applied to identify barriers to efficient migrant healthcare.
Results: Three main provider and system-related barriers emerged: (a) emphasis on major challenges in healthcare provision, (b) low perceived control and effectiveness to support migrant healthcare, and (c) attention to impoverished local population.
Conclusion: The study identified major provider and system-related barriers in the provision of primary healthcare to migrants. It is important for the healthcare system in Greece to provide appropriate supports for communication in cross-cultural consultations for its diversifying population
Using participatory learning & action (PLA) research techniques for inter-stakeholder dialogue in primary healthcare: an analysis of stakeholders’ experiences
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 apositive 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
Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries
International audienceBackground: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the " OTC SOCIOMED " , conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region.Methods: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre-and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs' intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs.Results: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale