Barrett B, Shadick K, Schilling R, Spencer L, del Rosario S, Moua K, Vang M
Department of Family Medicine, University of Wisconsin-Madison, USA.
Fam Med. 1998 Mar;30(3):179-84.
There are now more than 100,000 Hmong (Southeast Asian) refugees in the United States. This study examined interactions between Hmong patients and their health care providers and identified specific factors that either enable or obstruct health care delivery.
We used semistructured interview techniques to investigate patients' and providers' experiences, looking for attitudes, ideas, or behaviors that could be modified to improve health care delivery. Interviews with 23 Hmong patients, 18 health care providers, and six translators were audiotaped, transcribed, and analyzed by a multidisciplinary team. Methods included text analysis, theme identification, rank ordering, participant observation, immersion-crystallization, and open-ended discussion.
Hmong patients and their US-trained health care providers have different health belief systems. Both linguistic and cultural translation were seen as problematic. Additionally, an overwhelming number of patients identified kindness, caring, and a positive attitude as important provider characteristics. Providers noted difficulties in understanding Hmong conceptions of acute versus chronic diseases, illness prevention, and pain, both physical and psychological. Many respondents gave suggestions for improvement: 1) learn more about each other's cultures, 2) be patient, kind, and positive, 3) avoid negative statements or predictions, 4) improve translation quality, 5) explain medical terms using visual aids, 6) respect Hmong family-centered decision making, 7) increase the time allotted for translated clinical encounters, and 8) train Hmong health care providers.
Many basic issues in relations between clinicians and Hmong patients must be addressed to improve health care communication.
美国现有超过10万名苗族（东南亚地区）难民。本研究调查了苗族患者与其医疗服务提供者之间的互动情况，并确定了促进或阻碍医疗服务提供的具体因素。
我们采用半结构化访谈技术来调查患者和提供者的经历，寻找可以改变以改善医疗服务提供的态度、观念或行为。对23名苗族患者、18名医疗服务提供者和6名翻译人员的访谈进行了录音、转录，并由一个多学科团队进行分析。方法包括文本分析、主题识别、排序、参与观察、沉浸-结晶以及开放式讨论。
苗族患者和在美国接受培训的医疗服务提供者有着不同的健康信念体系。语言和文化翻译都被视为存在问题。此外，绝大多数患者认为友善、关怀和积极的态度是提供者的重要特征。提供者指出，在理解苗族对急性病与慢性病、疾病预防以及身体和心理疼痛的概念方面存在困难。许多受访者提出了改进建议：1）更多地了解彼此的文化，2）要有耐心、友善和积极，3）避免负面陈述或预测，4）提高翻译质量，5）使用视觉辅助工具解释医学术语，6）尊重苗族以家庭为中心的决策方式，7）增加为翻译后的临床问诊分配的时间，8）培训苗族医疗服务提供者。
为改善医疗沟通，必须解决临床医生与苗族患者关系中的许多基本问题。
