初级保健咨询中的情绪困扰——难民背景患者文化适应过程的一部分：扎根理论方法。
Primary care consultations on emotional distress - a part of the acculturation process in patients with refugee backgrounds: a grounded theory approach.
机构信息
Culture Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden.
出版信息
BMC Fam Pract. 2021 Jun 30;22(1):138. doi: 10.1186/s12875-021-01487-9.
BACKGROUND
Considering the global refugee crisis, there is an increasing demand on primary care physicians to be able to adequately assess and address the health care needs of individual refugees, including both the somatic and psychiatric spectra. Meanwhile, intercultural consultations are often described as challenging, and studies exploring physician-patient communication focusing on emotional distress are lacking. Therefore, the aim was to explore physician-patient communication, with focus on cultural aspects of emotional distress in intercultural primary care consultations, using a grounded theory approach, considering both the physician's and the patient's perspective.
METHODS
The study was set in Region Stockholm, Sweden. In total, 23 individual interviews and 3 focus groups were conducted. Resident physicians in family medicine and patients with refugee backgrounds, originating from Somalia, Syria, Afghanistan and Iraq, were included. Data was analysed using a grounded theory approach.
RESULTS
Over time, primary care patients with refugee backgrounds seemed to adopt a culturally congruent model of emotional distress. Gradual acceptance of psychiatric diagnoses as explanatory models for distress and suffering was noted, which is in line with current tendencies in Sweden. This acculturation might be influenced by the physician. Three possible approaches used by residents in intercultural consultations were identified: "biomedical", "didactic" and "compensatory". They all indicated that diagnoses are culturally valid models to explain various forms of distress and may thus contribute to shifting patient perceptions of psychiatric diagnoses.
CONCLUSIONS
Physicians working in Swedish primary care may influence patients' acculturation process by inadvertently shifting their perceptions of psychiatric diagnoses. Residents expressed concerns, rather than confidence, in dealing with these issues. Focusing part of their training on how to address emotional distress in an intercultural context would likely be beneficial for all parties concerned.
背景
考虑到全球难民危机，初级保健医生需要能够充分评估和满足难民的医疗需求，包括躯体和精神方面。与此同时，跨文化咨询通常被描述为具有挑战性的，并且缺乏关注情感困扰的医患沟通研究。因此，本研究旨在使用扎根理论方法，从医生和患者的角度探讨跨文化初级保健咨询中的医患沟通，重点关注情感困扰的文化方面。
方法
该研究在瑞典斯德哥尔摩地区进行。共进行了 23 次个体访谈和 3 次焦点小组。参与者包括家庭医学住院医师和来自索马里、叙利亚、阿富汗和伊拉克的难民背景的患者。使用扎根理论方法对数据进行分析。
结果
随着时间的推移，难民背景的初级保健患者似乎采用了一种与文化相符的情感困扰模式。逐渐接受精神科诊断作为困扰和痛苦的解释模型，这与瑞典目前的趋势一致。这种文化适应可能受到医生的影响。在跨文化咨询中，住院医师可能采用三种方法：“生物医学”、“说教”和“补偿”。它们都表明，诊断是解释各种形式困扰的文化有效模型，因此可能有助于改变患者对精神科诊断的看法。
结论
在瑞典初级保健工作的医生可能会通过无意中改变患者对精神科诊断的看法，影响患者的文化适应过程。住院医师对处理这些问题表示关注，而不是信心。将他们的部分培训重点放在如何在跨文化背景下处理情感困扰上，可能对所有相关方都有益。
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