Lionis Christos, Papadakaki Maria, Saridaki Aristoula, Dowrick Christopher, O'Donnell Catherine A, Mair Frances S, van den Muijsenbergh Maria, Burns Nicola, de Brún Tomas, O'Reilly de Brún Mary, van Weel-Baumgarten Evelyn, Spiegel Wolfgang, MacFarlane Anne
Faculty of Medicine, University of Crete, Heraklion, Greece.
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.
BMJ Open. 2016 Jul 22;6(7):e010822. doi: 10.1136/bmjopen-2015-010822.
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.
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.
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).
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.
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.
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.
现有指南和培训倡议（G/TIs）可支持跨文化会诊中的沟通，但在初级保健的日常实践中很少得到实施。作为欧盟RESTORE项目的一部分，我们的目标是探讨现有的G/TIs对移民和其他关键利益相关者是否有意义，以及他们是否能够共同选择G/TIs并参与其在初级保健机构中的实施。
作为对5个相关定性案例研究的比较分析的一部分，我们采用目的抽样和滚雪球抽样方法，在奥地利、英国、希腊、爱尔兰和荷兰的初级保健机构中招募移民和其他关键利益相关者。
共有78名利益相关者参与了该研究（奥地利15名、英国9名、爱尔兰11名、希腊16名、荷兰27名），涵盖了一系列群体（移民、全科医生、护士、行政人员、口译员、卫生服务规划人员）。
我们将规范化过程理论（NPT）和参与式学习与行动（PLA）研究相结合，开展了一系列PLA式焦点小组讨论。使用标准化方案，利益相关者关于一组G/TIs的讨论记录在PLA评注图表上，其选择过程通过PLA直接排序技术进行记录。我们进行了归纳和演绎主题分析，以调查对G/TIs的理解和参与情况。
大多数利益相关者强烈认可采用新的工作方式。利益相关者认为他们是推动这项工作的合适人选，并渴望招募其他人来支持实施工作。每个地区的利益相关者民主选择一个G/TI作为当地实施项目，这证明了这一点。
这种在5个具有不同医疗保健系统的国家中使用的具有理论依据的参与式方法，可用于其他环境，为G/TIs启动实施之旅创造积极条件，以改善移民的医疗保健。
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