Medical educators' experiences on medically unexplained symptoms and intercultural communication

Background Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS. Methods Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions. Results Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices. Conclusions The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects

Az Interkulturális Érzékenység Skála magyar változatának pszichometriai vizsgálata orvostanhallgatók és pszichológia szakos hallgatók mintáján

Háttér és célkitűzések: Az egyre növekvő kulturális diverzitás következtében az utóbbi évek nemzetközi és hazai tudományos irodalma egyre több figyelmet fordít az interkulturális kompetencia mérési és fejlesztési feladataira a gyógyításban. Jelen vizsgálatban célunk az Interkulturális Érzékenység Skála magyar változatának pszichometriai vizsgálata orvostan- és pszichológushallgatók körében, feltárva emellett az empátiával való konvergens validitását és a skálán különböző demográfiai változók mentén megjelenő különbségeket és együtt járásokat. Módszer: A kvantitatív, keresztmetszeti vizsgálatban 396 magyar, gyógyító szakmára készülő hallgató demográfiai és Interkulturális Érzékenység Skála, valamint Interperszonális Reaktivitás Index adatait elemeztük. Az eredeti 5 faktoros kérdőívstruktúra érvényességi és megbízhatósági vizsgálatai mellett korreláció, független mintás t-próba, egyutas ANOVA teszteket és lineáris regressziót alkalmaztunk. Eredmények: Az eredeti skála nem mutatott megfelelő és érvényes illeszkedést magyar mintán, helyette egy alternatív, rövidített, 3 faktoros struktúra bizonyult a legjobban illeszkedőnek, elfogadható vagy jó belső megbízhatósági mutatókkal. Eredményeink szerint a nyelvismeret és az empátia két dimenziója jelentős bejóslója az interkulturális érzékenységnek: a perspektíva- felvétel pozitívan, a személyes distressz pedig fordított irányban jelezte azt előre. Következtetések: Egy olyan magyar nyelvre adaptált mérőeszközt alakítottunk ki, mely megbízhatóan méri a magyar gyógyító szakmára készülők interkulturális érzékenységét. E készség fejlesztése napjainkban az egészségügyi képzések fontos feladata. A hallgatók nyelvtanulásának, kultúrközi tapasztalatszerzésének és empátiafejlesztésének támogatása mellett az interdiszciplináris és interkulturális felépítésű gyógyítói tanuló- vagy kutatócsoportok igen hasznos együtt- működésének irányába mutatnak a jelen kutatás eredményei

Health Psychology Services for People in Disadvantaged Regions of Hungary: Experiences from the Primary Health Care Development Model Program

Background: The importance of community health psychology in providing complex bio-psycho-social care is well documented. We present a mixed-method outcome-monitoring study of health psychology services in the public-health-focused Primary Health Care Development Model Program (2012–2017) in four disadvantaged micro-regions in northeast Hungary. Methods: Study 1 assessed the availability of the services using a sample of 17,003 respondents. Study 2 applied a follow-up design to measure the mental health outcomes of the health psychology services on a sample of 132 clients. In Study 3, we conducted focus-group interviews to assess clients’ lived experiences. Results: More mental health issues and higher education predicted a higher probability of service use. Follow-up showed that individual and group-based psychological interventions resulted in less depression and (marginally) higher well-being. Thematic analysis of the focus-group interviews indicated that participants deemed topics such as psychoeducation, greater acceptance of psychological support, and heightened awareness of individual and community support important. Conclusions: The results of the monitoring study demonstrate the important role health psychology services can play in primary healthcare in disadvantaged regions in Hungary. Community health psychology can improve well-being, reduce inequality, raise the population’s health awareness, and address unmet social needs in disadvantaged regions

Epidemiology and organisation of care in medically unexplained symptoms: A systematic review with a focus on cultural diversity and migrants

Background: Since the pathophysiology of medically unexplained symptoms (MUS) remains unclear, healthcare providers often struggle with these patients, especially with a different ethnic and/or cultural background. These challenges are insufficiently addressed in their training and in the organisation of care. Aim: To improve healthcare provider-patient interaction focused on MUS patients in general and in ethnic minorities and refugees in particular through a systematic review of syndromal definitions and epidemiology and organisation of care of MUS patients. Methods: Screening of PubMed, Web of Science, Cinahl and Cochrane Library on the keywords ‘Medical unexplained (physical) symptoms (MUPS)’, ‘Somatoform disorder’, ‘Functional syndrome’, ‘Diversity’, ‘Migrants’, ‘Ethnicity’, ‘Care models’, ‘Medical education’, ‘Communication skills’, ‘Health literacy’. Results: Different case definitions result in markedly different epidemiological estimates for MUS patients. Nevertheless, they are prevalent in a wide range of healthcare settings. Literature offers evidence of the effectiveness of structural frameworks in approaching MUS patients. Organisation of MUS care needs to transcend different levels of care: specialist tertiary and secondary care and primary care involving different qualifications of caregivers need to be aligned. Conclusion: The systematic review identified significant gaps and shortcomings in organisation of care. These need to be addressed in order to improve outcomes

Medical educators' experiences on medically unexplained symptoms and intercultural communication : an expert focus group study

Background Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS. Methods Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions. Results Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices. Conclusions The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects