Teunissen E, Gravenhorst K, Dowrick C, Van Weel-Baumgarten E, Van den Driessen Mareeuw F, de Brún T, Burns N, Lionis C, Mair F S, O'Donnell C, O'Reilly-de Brún M, Papadakaki M, Saridaki A, Spiegel W, Van Weel C, Van den Muijsenbergh M, MacFarlane A
Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, the Netherlands.
Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, United Kingdom.
Int J Equity Health. 2017 Feb 10;16(1):32. doi: 10.1186/s12939-017-0525-y.
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.
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.
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.
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.
基层医疗中的跨文化交流往往困难重重，导致医疗服务不尽人意、水准低下。现已有基于证据的支持性指南和培训举措（G/TIs）来加强跨文化交流，但它们在实际应用中并不常见。本文的目的是阐明移民及其他利益相关者如何在日常临床实践中调整、引入和评估此类G/TIs。
我们在五个欧洲国家开展了相关联的定性案例研究，以实施旨在加强基层医疗中跨文化交流的G/TIs。我们将规范化过程理论（NPT）作为分析框架，与参与式学习与行动（PLA）相结合作为研究方法，让移民、基层医疗服务提供者及其他利益相关者参与进来。在所有五个地点，66名利益相关者在19个月的时间里参加了62次PLA式焦点小组讨论，并参与了调整、引入和评估G/TIs的活动。各团队使用NPT对包括小组会议记录和研究人员实地工作报告在内的数据进行编码和主题分析。
在所有情况下，让移民和其他利益相关者参与进来都具有挑战性，但切实可行。利益相关者对G/TIs进行了重大调整以适应当地情况，例如，将一个G/TI的重点从姑息治疗改为心理健康；或将目标受众从全科医生（GPs）扩大到更广泛的多学科团队。他们还推进了在常规实践中实施这些举措的计划，例如就培训课程的时间和地点与全科医生诊所进行联络，并评估其影响。所有利益相关者都报告了已实施的G/TIs在日常实践中的益处。对基层医疗团队（临床医生和管理人员）的培训带来了更宽容的态度和更有效的沟通，对移民需求的关注也更好。口译服务的实施困难主要是由于资金和其他资源限制。然而，一旦使用，移民更有可能信任全科医生的诊断，而全科医生也表示对移民的症状有了更清晰的了解。
移民、基层医疗服务提供者和其他关键利益相关者可以有效合作，调整和实施G/TIs，以改善跨文化咨询中的沟通，并增进全科医生与移民患者之间的理解和信任。
