The Braun School of Public Health and Community Medicine of the Hebrew University and Hadassah Medical Organization, Jerusalem, Israel.
Ethn Health. 2009 Oct;14(5):459-78. doi: 10.1080/13557850902890522.
Despite receiving full medical care and many social services, many Ethiopian immigrants in Israel feel frustrated, and even alienated, by the care they receive. This study uses a qualitative approach to explore the obstacles Ethiopian immigrants face regarding effective health seeking behavior and optimal interactions with healthcare providers in Israel.
We gained a three-cornered perspective by conducting semi-structured interviews with healthcare providers, immigrants, and interpreters who mediate between the two. An ecological system or socio-ecological model guided the data analysis. It allowed organizing the varied and complex relationship between the factors that influence healthcare delivery and receipt among this population.
The advanced analysis of our results delineated four themes which we grouped into two domains: the cultural divide and the interpreters. Within each of these themes, we explored influences on health or healthcare at each level of the socio-ecological model. We demonstrated that the problems surrounding health seeking behaviors and receiving treatment stem mainly from a cultural divide. This cultural incongruity and its effects are apparent at multiple levels of the ecological model and must be recognized and addressed programmatically at these levels.
Necessary program and service modifications include that cultural mediation become an integral part of health personnel's training for healthcare delivery and a necessary criterion for good practices. We recommend that professionals from within the health system be trained to act as interpreters. Lastly, the integration of traditional healers into the allopathic health system should be considered. These modifications require a system-wide change in policy, structure of services, and practices.
尽管埃塞俄比亚移民在以色列接受了全面的医疗护理和众多社会服务，但他们仍感到沮丧，甚至与所接受的护理产生隔阂。本研究采用定性方法，旨在探讨埃塞俄比亚移民在以色列有效寻求医疗服务和与医疗服务提供者最佳互动方面所面临的障碍。
我们通过对半结构化访谈，获得了医疗服务提供者、移民和口译员三方的视角，而口译员在移民和医疗服务提供者之间起到中介作用。生态系统或社会生态模型指导了数据分析，它使我们能够组织影响该人群医疗服务提供和接受的各种复杂因素之间的关系。
对我们研究结果的深入分析勾勒出四个主题，我们将其分为两个领域：文化鸿沟和口译员。在每个主题中，我们探讨了社会生态模型各个层面上影响健康或医疗保健的因素。我们表明，寻求医疗服务和接受治疗的问题主要源于文化鸿沟。这种文化的不和谐及其影响在生态模型的多个层面上都很明显，必须在这些层面上有针对性地加以认识和解决。
必要的计划和服务修改包括将文化调解作为医疗人员提供医疗服务培训的一个组成部分，以及良好实践的必要标准。我们建议在医疗系统内培训专业人员担任口译员。最后，应考虑将传统治疗师纳入对抗疗法医疗系统。这些修改需要在政策、服务结构和实践方面进行全系统的变革。
