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全科医学中文化敏感护理的障碍和促进因素:反思性主题分析。

Barriers and facilitators to culturally sensitive care in general practice: a reflexive thematic analysis.

机构信息

Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium.

Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium.

出版信息

BMC Prim Care. 2024 Oct 23;25(1):381. doi: 10.1186/s12875-024-02630-y.

Abstract

BACKGROUND

This study investigated the perceived barriers and potential facilitators for culturally sensitive care among general practitioners in Flanders. Understanding these dynamics is crucial for improving healthcare quality and equity.

METHODOLOGY

Twenty-one in-depth interviews were conducted with Flemish GPs. Braun and Clarke's reflexive thematic analysis was employed to develop and interpret themes that elucidate shared underlying meanings and capture the nuanced challenges and strategies related to cultural sensitivity in healthcare.

RESULTS

Two core themes were generated: GPs' uncertainty and opposition. These themes manifest in emotional responses such as frustration, miscomprehension, and feelings of helplessness, influencing relational outcomes marked by patient disconnect and reduced motivation for cultural sensitivity. The barriers identified are exacerbated by resource scarcity and limited intercultural contact. Conversely, facilitators include structural elements like interpreters and individual strategies such as engagement, aimed at enhancing GPs' confidence in culturally diverse encounters. A meta-theme of perceived lack of control underscores the challenges, particularly regarding language barriers and resource constraints, highlighting the critical role of GPs' empowerment through enhanced intercultural communication skills.

CONCLUSION

Addressing GPs' uncertainties and oppositions can mitigate related issues, thereby promoting comprehensive culturally sensitive care. Essential strategies include continuous education and policy reforms to dismantle structural barriers. Moreover, incentivizing culturally sensitive care through quality care financial incentives could bolster GP motivation. These insights are pivotal for stakeholders-practitioners, policymakers, and educators-committed to advancing culturally sensitive healthcare practices and, ultimately, for fostering more equitable care provision.

摘要

背景

本研究旨在调查弗拉芒地区全科医生对文化敏感护理的感知障碍和潜在促进因素。了解这些动态因素对于提高医疗保健质量和公平性至关重要。

方法

对 21 名弗拉芒全科医生进行了 21 次深入访谈。采用 Braun 和 Clarke 的反思性主题分析方法来发展和解释主题,阐明共同的潜在含义,并捕捉与医疗保健文化敏感性相关的细微挑战和策略。

结果

产生了两个核心主题:全科医生的不确定性和反对。这些主题表现为沮丧、误解和无助感等情绪反应,影响到关系结果,表现为患者脱节和减少对文化敏感性的动力。确定的障碍因资源匮乏和有限的跨文化接触而加剧。相反,促进因素包括口译员等结构性要素和参与等个人策略,旨在增强全科医生在多元文化环境中应对的信心。一个感知到缺乏控制的元主题强调了挑战,特别是语言障碍和资源限制方面的挑战,突出了通过增强跨文化沟通技巧赋予全科医生权力的重要作用。

结论

解决全科医生的不确定性和反对意见可以减轻相关问题,从而促进全面的文化敏感护理。基本策略包括持续的教育和政策改革,以消除结构性障碍。此外,通过提供高质量医疗保健的经济激励来鼓励文化敏感护理,可以增强全科医生的积极性。这些见解对于致力于推进文化敏感医疗保健实践的利益相关者——从业者、政策制定者和教育工作者——以及最终为提供更公平的医疗保健服务提供了关键信息。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef11/11515484/cb39117cccbe/12875_2024_2630_Fig1_HTML.jpg

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