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Vandecasteele R, Schelfhout S, D'hondt F, De Maesschalck S, Derous E, Willems S. Intercultural effectiveness in GPs' communication and clinical assessment: An experimental study. Patient Educ Couns 2024; 122:108138. [PMID: 38237531 DOI: 10.1016/j.pec.2024.108138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE This study aimed to investigate potential disparities in general practitioners' overall communication and clinical assessments based on patient ethnicity, while examining the influence of intercultural effectiveness. METHODS Employing a 2 × 2 experimental study design, online video recorded consultations with simulated patients were conducted and analyzed using OSCEs. Each GP (N = 100) completed a consultation with both an ethnic majority and an ethnic minority patient. Additionally, a follow-up survey was administered to gather supplementary data. Paired sample t-tests explored ethnic disparities, correlation and regression analyses determined associations with intercultural attitudes, traits and capabilities. RESULTS No statistically significant differences in GPs' communication or clinical assessment were found based on patients' ethnic background. Positive associations were observed between all aspects of intercultural effectiveness and GPs' consultation behavior. Intercultural traits emerged as a strong and robust predictor of clinical assessment of ethnic minority patients. CONCLUSION Intercultural traits, such as ethnocultural empathy, may play a critical role in GPs' clinical assessment skills during intercultural consultations. PRACTICE IMPLICATIONS Findings provide valuable insights into the determinants of intercultural effectiveness in healthcare, fostering promising targets for interventions and training programs aiming to ensure higher-quality and more equitable care delivery.
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Affiliation(s)
- Robin Vandecasteele
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stijn Schelfhout
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental Psychology, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Fanny D'hondt
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, 9000 Ghent, Belgium
| | - Stéphanie De Maesschalck
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Eva Derous
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Erasmus University Rotterdam, Erasmus School of Social and Behavioural Sciences, Burgemeester Oudlaan 50, 3062 Rotterdam, the Netherlands
| | - Sara Willems
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium
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Barcelona V, Scharp D, Moen H, Davoudi A, Idnay BR, Cato K, Topaz M. Using Natural Language Processing to Identify Stigmatizing Language in Labor and Birth Clinical Notes. Matern Child Health J 2024; 28:578-586. [PMID: 38147277 DOI: 10.1007/s10995-023-03857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Stigma and bias related to race and other minoritized statuses may underlie disparities in pregnancy and birth outcomes. One emerging method to identify bias is the study of stigmatizing language in the electronic health record. The objective of our study was to develop automated natural language processing (NLP) methods to identify two types of stigmatizing language: marginalizing language and its complement, power/privilege language, accurately and automatically in labor and birth notes. METHODS We analyzed notes for all birthing people > 20 weeks' gestation admitted for labor and birth at two hospitals during 2017. We then employed text preprocessing techniques, specifically using TF-IDF values as inputs, and tested machine learning classification algorithms to identify stigmatizing and power/privilege language in clinical notes. The algorithms assessed included Decision Trees, Random Forest, and Support Vector Machines. Additionally, we applied a feature importance evaluation method (InfoGain) to discern words that are highly correlated with these language categories. RESULTS For marginalizing language, Decision Trees yielded the best classification with an F-score of 0.73. For power/privilege language, Support Vector Machines performed optimally, achieving an F-score of 0.91. These results demonstrate the effectiveness of the selected machine learning methods in classifying language categories in clinical notes. CONCLUSION We identified well-performing machine learning methods to automatically detect stigmatizing language in clinical notes. To our knowledge, this is the first study to use NLP performance metrics to evaluate the performance of machine learning methods in discerning stigmatizing language. Future studies should delve deeper into refining and evaluating NLP methods, incorporating the latest algorithms rooted in deep learning.
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Affiliation(s)
- Veronica Barcelona
- School of Nursing, Columbia University, 560 West 168th St, Mail Code 6, New York, NY, 10032, USA.
| | - Danielle Scharp
- School of Nursing, Columbia University, 560 West 168th St, Mail Code 6, New York, NY, 10032, USA
| | - Hans Moen
- Department of Computer Science, Aalto University, Espoo, Finland
| | | | - Betina R Idnay
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Kenrick Cato
- School of Nursing, Columbia University, 560 West 168th St, Mail Code 6, New York, NY, 10032, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Maxim Topaz
- School of Nursing, Columbia University, 560 West 168th St, Mail Code 6, New York, NY, 10032, USA
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Gea-Caballero V, Pellín-Carcelén A, Piera-Gomar JL, Mármol-López MI, Santolalla-Arnedo I, Tejada Garrido CI, Burgos-Esteban A, Rasal Sánchez M, Rasal Sánchez A, Carboneres-Tafaner MI, Juárez-Vela R. Evaluation of the impact of "speak out" and "human libraries" educational methodologies on nursing students' attitudes toward immigration. Front Public Health 2024; 12:1308973. [PMID: 38371238 PMCID: PMC10869608 DOI: 10.3389/fpubh.2024.1308973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Measuring and understanding attitudes toward migrants is crucial in Health Sciences professionals. Nursing students, as future professionals in the healthcare system, must be comprehensively trained and prepared from the undergraduate level to effectively face the challenges of caring for health and disease processes in an increasingly globalized world. Our study aims to determine the level of attitudinal change in nursing students for immigrants, based on a training intervention with sessions of coexistence with immigrants in Spain. Methods Quasi-experimental controlled and non-randomized study, carried out in 2019 in Nursing School La Fe, Valencia (Spain), with 201 participants (74 intervention group, 127 control group). Instrument: Attitudes toward Immigration Instrument (IAHI) questionnaire. Educational techniques of the training intervention: Speak outs and Human Libraries. Descriptive statistical analysis and comparison of results between groups was performed. Results The participants in the intervention group showed significant changes in attitude modification, both in the total score of the questionnaire and in 4 of the 5 dimensions (pre-post intervention medition). When comparing the differences between the intervention group and the control group, we observed significant differences in 3 of the 5 dimensions: equality principles and policies, positive favorability, and negative favorability. Conclussion Sessions involving coexistence, discussion, and reflection with immigrants, as educational intervention methods for nursing students (Speak outs and Human Libraries), are useful and effective tools to promote positive attitudinal changes toward immigrants within the healthcar context in nursing students.
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Affiliation(s)
- Vicente Gea-Caballero
- Faculty of Health Science, Research Group in Community Health and Care, Valencia International University, Valencia, Spain
| | - Ana Pellín-Carcelén
- Faculty of Health Science, Research Group in Community Health and Care, Valencia International University, Valencia, Spain
| | - José Luís Piera-Gomar
- Nursing School La Fe, Adscript Centre, Research Group GREIACC, Health Research Institute La Fe (IISLaFe), University of Valencia, Valencia, Spain
| | - María Isabel Mármol-López
- Nursing School La Fe, Adscript Centre, Research Group GREIACC, Health Research Institute La Fe (IISLaFe), University of Valencia, Valencia, Spain
| | - Iván Santolalla-Arnedo
- Predepartamental Unity of Nursing, Research Group GRUPAC, Faculty of Health Sciences, La Rioja University, Logroño, Spain
| | - Clara Isabel Tejada Garrido
- Predepartamental Unity of Nursing, Research Group GRUPAC, Faculty of Health Sciences, La Rioja University, Logroño, Spain
| | - Amaya Burgos-Esteban
- Predepartamental Unity of Nursing, Research Group GRUPAC, Faculty of Health Sciences, La Rioja University, Logroño, Spain
| | | | | | | | - Raúl Juárez-Vela
- Predepartamental Unity of Nursing, Research Group GRUPAC, Faculty of Health Sciences, La Rioja University, Logroño, Spain
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Luig T, Ofosu NN, Chiu Y, Wang N, Omar N, Yip L, Aleba S, Maragang K, Ali M, Dormitorio I, Lee KK, Yeung RO, Campbell-Scherer D. Role of cultural brokering in advancing holistic primary care for diabetes and obesity: a participatory qualitative study. BMJ Open 2023; 13:e073318. [PMID: 37709303 PMCID: PMC10921915 DOI: 10.1136/bmjopen-2023-073318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Diabetes and obesity care for ethnocultural migrant communities is hampered by a lack of understanding of premigration and postmigration stressors and their impact on social and clinical determinants of health within unique cultural contexts. We sought to understand the role of cultural brokering in primary healthcare to enhance chronic disease care for ethnocultural migrant communities. DESIGN AND SETTING Participatory qualitative descriptive-interpretive study with the Multicultural Health Brokers Cooperative in a Canadian urban centre. Cultural brokers are linguistic and culturally diverse community health workers who bridge cultural distance, support relationships and understanding between providers and patients to improve care outcomes. From 2019 to 2021, we met 16 times to collaborate on research design, analysis and writing. PARTICIPANTS Purposive sampling of 10 cultural brokers representing eight different major local ethnocultural communities. Data include 10 in-depth interviews and two observation sessions analysed deductively and inductively to collaboratively construct themes. RESULTS Findings highlight six thematic domains illustrating how cultural brokering enhances holistic primary healthcare. Through family-based relational supports and a trauma-informed care, brokering supports provider-patient interactions. This is achieved through brokers' (1) embeddedness in community relationships with deep knowledge of culture and life realities of ethnocultural immigrant populations; (2) holistic, contextual knowledge; (3) navigation and support of access to care; (4) cultural interpretation to support health assessment and communication; (5) addressing psychosocial needs and social determinants of health and (6) dedication to follow-up and at-home management practices. CONCLUSIONS Cultural brokers can be key partners in the primary care team to support people living with diabetes and/or obesity from ethnocultural immigrant and refugee communities. They enhance and support provider-patient relationships and communication and respond to the complex psychosocial and economic barriers to improve health. Consideration of how to better enable and expand cultural brokering to support chronic disease management in primary care is warranted.
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Affiliation(s)
- Thea Luig
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Nicole N Ofosu
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Yvonne Chiu
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nancy Wang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nasreen Omar
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Lydia Yip
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Sarah Aleba
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Kiki Maragang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Mulki Ali
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Irene Dormitorio
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Karen K Lee
- Division of Preventive Medicine, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Denise Campbell-Scherer
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Dumke L, Wilker S, Kotterba A, Neuner F. The role of psychotherapists' perceived barriers in providing psychotherapy to refugee patients. Clin Psychol Psychother 2023; 30:1071-1082. [PMID: 37114524 DOI: 10.1002/cpp.2859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
Access to psychotherapy is critical to improving mental health, but only a small proportion of refugees receive treatment in the regular psychotherapeutic care system in high-income countries. In previous research, outpatient psychotherapists reported several barriers to more frequent treatment of refugee patients. However, it is unclear to what extent these perceived barriers contribute to the poor provision of services to refugees. In a survey of N = 2002 outpatient psychotherapists in Germany, we collected data on perceived treatment barriers and on the integration of refugees into regular psychotherapeutic practice. Half of the psychotherapists reported that they do not treat refugee patients. In addition, therapies provided for refugees were, on average, 20% shorter than for other patients. Regression analyses showed direct negative associations between psychotherapists' overall perception of barriers with the number of refugees treated and the number of sessions offered to refugee patients, even when controlling for sociodemographic and workload-related characteristics. Correlation analyses on the level of specific types of barriers further revealed that particularly language-related barriers and lack of contact with the refugee population are negatively correlated with the number of refugees treated and the number of sessions for refugees. Our findings indicate that the integration of refugees into regular psychotherapeutic care could be improved by measures to connect psychotherapists with refugee patients as well as professional interpreters and to ensure coverage of costs for therapy, interpreters and related administrative tasks.
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Affiliation(s)
- Lars Dumke
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Sarah Wilker
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Anna Kotterba
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Kelly ML, Parente V, Redmond R, Willis R, Railey K. Development of a curriculum in cultural determinants of health and health disparities. J Natl Med Assoc 2023; 115:428-435. [PMID: 37407380 PMCID: PMC10977997 DOI: 10.1016/j.jnma.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Current sociopolitical events coupled with requirement modifications by the Liaison Committee on Medical Education have reinvigorated a need for training in cultural awareness and health disparities in undergraduate medical education. Many institutions, however, have not established longitudinal courses designed to address this content. Additionally, little is known about the change in learners' awareness of cultural determinants of health and health disparities after enrollment in such curricula. In 2016, the authors developed a yearlong required course entitled Cultural Determinants of Health and Health Disparities for first year medical students at a large university medical school in the United States. The course launched in the 2017 academic year. METHODS Two cohorts participated in twelve 2.5 to 3-hour multi-modal sessions focused on various aspects of healthcare delivery for marginalized populations and factors that contribute to health disparities. The Multicultural Assessment Questionnaire was used pre and post course to assess students' self-evaluated changes in knowledge, skills, and awareness related to cultural competency in healthcare. RESULTS Students' self-reported knowledge, skills, and awareness scores regarding cultural competence in health care increased from pre to post-course assessment. On the knowledge scale, students' mean score increased from 2.63 to 2.97 (P < .001), with 16% reporting a decreased score, 30% reporting no change, and 54% reporting growth. On the skills scale, students' mean score increased from 2.64 to 3.38 (P < .001), with 11% reporting a decreased score, 17% reporting no change, and 72% reporting growth. On the awareness scale, students' overall score increased from 3.76 to 3.97 (P < .05), with 16% reporting a decreased score, 50% reporting no change, and 34% reporting growth. There were no changes in KSA scores across cohorts pre and post course. CONCLUSION Perceived knowledge, skills, and awareness related to the importance of cultural competence in healthcare delivery increased at the end of the academic year. This type of longitudinal course model could be broadly adopted at other institutions to enhance patient, peer, and future provider awareness regarding cultural impacts on care and health disparities among vulnerable populations.
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Affiliation(s)
- Megan L Kelly
- Medical Scientist Training Program, Department of Biochemistry, Duke University School of Medicine, Durham, NC, USA
| | - Victoria Parente
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca Redmond
- Office of Diversity and Inclusion, Duke University School of Medicine, Durham, NC, USA
| | - Rheaya Willis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenyon Railey
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA.
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Akca A, Ayaz-Alkaya S. Determinants of attitudes towards refugees and intercultural sensitivity of nursing students: A descriptive and correlational study. Nurse Educ Today 2023; 124:105772. [PMID: 36889047 DOI: 10.1016/j.nedt.2023.105772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The number of refugees, asylum seekers, and migrants is increasing worldwide. It is crucial to determine attitudes and intercultural sensitivities of nursing students towards refugees and individuals from different cultures. These nursing students will be providing healthcare in the future to these diverse communities. OBJECTIVES To determine the attitudes towards refugees and intercultural sensitivity of nursing students and to identify the determinants of these parameters. DESIGN The study was conducted with a descriptive and correlational design. SETTINGS Nursing departments of two universities in Ankara, Turkey. PARTICIPANTS The population of the study consisted of nursing students at two universities (N = 1530). A total of 905 students were included in the study. METHODS Data were obtained by a personal information form, the Attitudes Towards Refugees Scale, and the Intercultural Sensitivity Scale. Linear regression analysis was used to analyze the data obtained from the scales. RESULTS The participants' mean Attitudes Towards Refugees Scale score was 82.49 ± 16.66 and the Intercultural Sensitivity Scale score was 91.31 ± 11.15. Caring for refugees, intercultural sensitivity, interaction engagement, and respect for cultural differences were associated with attitudes towards refugees. Academic level, income, place of residence, and attitude towards refugees were associated with intercultural sensitivity. CONCLUSIONS Most of the nursing students displayed a negative attitude towards refugees, although they presented a high level of intercultural sensitivity. Integration of refugee-related topics into the nursing education curriculum and designing education programs are recommended to increase awareness and positive attitudes, and to improve cultural competence of nursing students.
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Affiliation(s)
- Ayşegül Akca
- Ankara Yildirim Beyazit University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey
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Dumke L, Neuner F. Othering refugees: Psychotherapists’ attitudes toward patients with and without a refugee background. Psychother Res 2022; 33:654-668. [DOI: 10.1080/10503307.2022.2150097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lars Dumke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Cruz-Riveros C, Urzúa A, Macaya-Aguirre G, Cabieses B. Meanings and Practices in Intercultural Health for International Migrants. Int J Environ Res Public Health 2022; 19:ijerph192013670. [PMID: 36294247 PMCID: PMC9602989 DOI: 10.3390/ijerph192013670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 05/22/2023]
Abstract
UNLABELLED In this article, meanings and practices in intercultural health for international migrants in health establishments are described from the perspective of health personnel in the city of Antofagasta in northern Chile. METHODOLOGY The methodology was qualitative with a phenomenological descriptive design, through which discourses from health personnel in the public primary and secondary care system were explored (n = 23). Next, meanings and practices in intercultural health for international migrants in health establishments are described from the perspective of health personnel in the northern Chilean city of Antofagasta. RESULTS The participants presented trees of thematic categories. There were three thematic categories overall: (1) The meaning of interculturality included features of understanding of the concept, with respect for culture being the transversal axis in all discourses. (2) Practices in health care, where voluntariness, references, and the adequacy or non-technicality of the language are fundamental axes. (3) Training in the intercultural approach, where there is often self-knowledge and lack of supply in the health system. CONCLUSIONS The findings show essential elements to consider in the care of international migrants, including the training and awareness of staff about the intercultural approach through strategies following the local reality in which each health establishment exists.
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Affiliation(s)
- Consuelo Cruz-Riveros
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta 1270709, Chile
- Escuela de Enfermería, Facultad de Salud, Universidad Santo Tomás, Concepción 3460000, Chile
- Correspondence:
| | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta 1270709, Chile
| | | | - Báltica Cabieses
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
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Adedokun C, Tang J, Cavanaugh C. English-as-a-second language baccalaureate prelicensure nursing students' perception of simulation experiences. J Prof Nurs 2022; 41:149-156. [DOI: 10.1016/j.profnurs.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/07/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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Odhiambo AJ, Forman L, Nelson LE, O'Campo P, Grace D. Legislatively Excluded, Medically Uninsured and Structurally Violated: The Social Organization of HIV Healthcare for African, Caribbean and Black Immigrants with Precarious Immigration Status in Toronto, Canada. Qual Health Res 2022; 32:847-865. [PMID: 35380883 PMCID: PMC9152595 DOI: 10.1177/10497323221082958] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
African, Caribbean and Black immigrants face persistent legislative barriers to accessing healthcare services in Canada. This Institutional Ethnography examines how structural violence and exclusionary legislative frameworks restrict the right to HIV healthcare access for many Black immigrants. We conducted semi-structured interviews with Black immigrants living with HIV (n = 20) and healthcare workers in Toronto, Canada (n = 15), and analyzed relevant policy texts. Findings revealed that exclusionary immigration and healthcare legislation shaping and regulating immigrants' right to health restricted access to public resources, including health insurance and HIV healthcare and related services, subjecting Black immigrants with precarious status to structural violence. Healthcare providers and administrative staff worked as healthcare gatekeepers. These barriers undermine public health efforts of advancing health equity and ending HIV "while leaving no one behind." We urge continued policy reforms in Canada's immigration and healthcare systems regarding HIV care access for Canada's precarious status immigrants.
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Delaruelle K, Buffel V, Van Canegem T, Bracke P, Ceuterick M. Mind the Gate: General Practitioner's Attitudes Towards Depressed Patients with Diverse Migration Backgrounds. Community Ment Health J 2022; 58:499-511. [PMID: 34085187 DOI: 10.1007/s10597-021-00844-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
This study aims to examine (a) whether there are differences in general practitioners' (GPs) attitudes towards native Belgian patients, patients of foreign descent and asylum seeking patients who all express symptoms of major depression, and (b) whether these differences depend on GPs' experience with cultural competency training and interethnic contact. Using a video vignette study among 404 Flemish (Belgium) GPs, we find evidence of a provider bias. While GPs regard a patient of foreign descent as less trustworthy and less able to adhere to medical recommendations than a native Belgian patient, they also hold more pessimistic views on a potential recovery of an asylum seeking patient. In addition, we find that cultural competency training might alter GPs' attitudes of asylum seeking patients in a positive way. Summarized, our research highlights the need to target stereotypes among GPs for interventions designed to reduce migration-based disparities in healthcare use and health status.
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Dyrehave C, Nielsen D, Wejse C, Maindal HT, Rodkjaer LO. Development of a Complex Intervention for Health Care Professionals' Care of Patients With African Background and HIV Infection Using the Behavior Change Wheel Method. J Transcult Nurs 2022; 33:259-267. [PMID: 35257609 DOI: 10.1177/10436596221075989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Insufficient cultural competences among health care professionals (HCPs) working with ethnic minorities may result in poorer quality of care. This study aimed to develop a cultural intervention for HCPs. Method. The intervention was designed using the Behavior Change Wheel. The development phase contained empirical studies of patients with HIV and African background, literature review, observations from a migrant health clinic, and transcultural care theory. Results. Systematic development will facilitate an intervention tailored to focus on nurses' sensitivity and awareness, and aims to give them tools to identify narratives about patients' life situation and self-management as well as provide effective, compassionate, and culturally competent care. Discussion. Higher cultural competence among nurses may improve their support of patients to manage their disease.
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Affiliation(s)
- Charlotte Dyrehave
- Aarhus University, Denmark.,Aarhus University Hospital, Denmark.,Odense University Hospital, Denmark
| | - Dorthe Nielsen
- Odense University Hospital, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Christian Wejse
- Aarhus University, Denmark.,Aarhus University Hospital, Denmark
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El Ghaziri N, Blaser J, Malebranche M, Pahud-Vermeulen B, Gyuriga T, Suris JC, Gehri M, Bodenmann P. Medical Facilities for Refugees in Europe: Creating a Consultation for Resettled Syrian Families. Front Med (Lausanne) 2021; 8:728878. [PMID: 34901053 PMCID: PMC8662520 DOI: 10.3389/fmed.2021.728878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022] Open
Abstract
The wave of migration that has hit Europe in recent years has led to several changes in the organization of asylum systems and medical care provided to migrants. Previous studies indicate that asylum seekers and refugees face multiple barriers in accessing health care. For that reason, adapted structures are needed. In this context, a family consultation service was implemented in our medical center in Lausanne, Switzerland. It aimed at addressing the unique health care needs of recently resettled families from Syria, which has been the leading source country for refugees since 2014. This intervention, developed through collaboration between the University Center for Primary Care and Public Health (Unisanté) and the Children's Hospital of Lausanne (HEL) involved a multidisciplinary team comprising a pediatrician, a general practitioner and a pediatric nurse. Bringing together a multidisciplinary team optimized care coordination, facilitated communication between care providers and enabled a more global vision of the family system with the aim of enhancing quality of care.
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Affiliation(s)
- Nahema El Ghaziri
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Jeremie Blaser
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Mary Malebranche
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Brigitte Pahud-Vermeulen
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Teresa Gyuriga
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Joan-Carles Suris
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland.,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Mario Gehri
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
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15
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Monrouxe LV, Bloomfield JG. Specialty Grand Challenge: Diversity Matters in Healthcare Professions Education Research. Front Med (Lausanne) 2021; 8:765443. [PMID: 34869474 PMCID: PMC8634362 DOI: 10.3389/fmed.2021.765443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lynn V Monrouxe
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jacqueline G Bloomfield
- Faculty of Medicine and Health, School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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16
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Daoud N, Abu-Hamad S, Berger-Polsky A, Davidovitch N, Orshalimy S. Mechanisms for racial separation and inequitable maternal care in hospital maternity wards. Soc Sci Med 2021; 292:114551. [PMID: 34763969 DOI: 10.1016/j.socscimed.2021.114551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Abstract
Few studies have examined mechanisms of racial maternal separation (RMS) of birthing mothers in hospital maternity wards (MWs), and how separation might reinforce institutional healthcare racism and discrimination, leading to inequitable maternal care (MC). In Israel, while birth mothers report mostly pleasant experiences, RMS has become a matter of public debate. Although the Ministry of Health (MoH) condemns the practice, birthing Palestinian-Arab women have sued hospitals for discrimination after being assigned to separate MW rooms from other women. We drew on critical race theory (CRT) and intersectionality to uncover mechanisms for RMS and inequitable MC in hospital MWs at three levels-policy, practice, and women's experiences. In 2019-2020 we conducted 10 in-depth interviews with hospital directors (HDs) and 8 focus groups (FGs) with 40 midwives and nurses; then, in 2020-2021, we held 26 in-depth Zoom interviews with birthing women. Our findings reveal intersecting mechanisms for RMS through which structural racism and institutional discrimination outside hospitals in the form of ethno-racial residential segregation penetrate hospitals via women's requests to maintain separation in MWs. While all HDs opposed RMS and prized quality care, they instituted insufficient mechanisms to prohibit racial separation, which helped to institutionalize the practice. Commodification of Healthcare services (HCS) accelerates RMS as hospitals compete for funds derived from birthing mothers' care. Under the guise of cultural sensitivity and indirect pressure of hospital management, nursing staff comply with requests for RMS. Nurses assigned rooms based on stereotypical categorizations of women's group membership (ethno-national, religiosity level, class). RMS targeted mostly visibly religious Muslim Palestinian-Arab women. These mothers felt MC discrimination; others normalized RMS as preference. While the MoH cannot eliminate outside-hospital structural discrimination, more efforts should be made to eradicate inside-hospital RMS, as the practice violates the principle of universality enshrined in the National Health Insurance Law.
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Affiliation(s)
- Nihaya Daoud
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel.
| | - Sirat Abu-Hamad
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel
| | - Alexandra Berger-Polsky
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel
| | - Sharon Orshalimy
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel
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17
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Granero-Molina J, Jiménez-Lasserrotte MDM, Fernández-Medina IM, Ruiz-Fernández MD, Hernández-Padilla JM, Fernández-Sola C. Nurses' experiences of emergency care for undocumented migrants who travel by boats. Int Nurs Rev 2021; 69:69-79. [PMID: 34628657 DOI: 10.1111/inr.12723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim of our study is to describe and understand the experiences of nurses providing emergency care to undocumented migrants who arrive in Spain in small boats. BACKGROUND Spain receives thousands of undocumented migrants every year who arrive by sea. Provision of appropriate emergency care to undocumented migrants is a public health problem. INTRODUCTION Nurses, along with other health care providers, such as doctors or cultural mediators, make up the Spanish Red Cross Emergency Response Team. Nurses, in particular, are associated with all phases of emergency care to undocumented migrants who arrive in small boats, offering first aid as well as clinical and humanitarian care. METHODS Qualitative descriptive study. Seventeen nurses from the Spanish Red Cross Emergency Response Team participated in face-to-face interviews. Thematic analysis was used to analyse the qualitative data. FINDINGS Three main themes emerged: (i) guaranteeing comprehensive emergency care, (ii) the nurse, the key member of the multidisciplinary care team for undocumented migrants and (iii) 'making a difference', volunteering as a nurse's role. CONCLUSIONS Nurses try to guarantee comprehensive care provision for undocumented migrants, even though they face stigma, ethical concerns or an impossibility to prescribe pharmacological treatments. Personalised care, more time and protocols, better training and the incorporation of debriefing are elements that are required to improve the emergency care given to undocumented migrants. IMPLICATIONS FOR NURSING AND HEALTH POLICY Institutions must develop policies to support provsion of emergency care to undocumented migrants. A public health issue cannot depend upon volunteer healthcare providers. Governments must guarantee funding, training and established care teams. Understanding nurses' experiences could increase awareness of the problem, reduce stigma and improve the comprehensive emergency care provided to undocumented migrants.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Research Associate, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | | | | | | | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Research Associate, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
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18
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Hayward R. Editorial. Disparities in access to healthcare and the neurosurgeon. Neurosurg Focus 2021; 50:E14. [PMID: 33794494 DOI: 10.3171/2021.1.focus2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Nielsen DS, Abdulkadir LS, Rehling C, Sodemann M. Interpreters' experiences of participating in an introduction course in the healthcare sector. An ethnographic field observation study. Nurs Open 2021; 8:1201-1208. [PMID: 34482651 PMCID: PMC8046114 DOI: 10.1002/nop2.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/24/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
AIM We aimed to explore how interpreters experienced being part of a special designed health introduction course and to obtain their perspectives on the learning process. The overall aim was to improve health care to patients with language barriers. DESIGN With a hermeneutic phenomenological approach, we used participant observations as a method for collecting data. METHOD The teaching methods used were case-based learning, role-play and active involvement including dialogs, discussions and critical reflections. The interpreters were divided into teams of 10-15 interpreters. Over the duration of 6 weeks, teaching sessions were conducted, with 3 hr/week planned. RESULTS The findings emphasize the importance of providing the interpreters with education, supervision and a work environment where they can confidentially share and get competent feedback on their experiences and linguistic skills, in order to ensure patients get the correct information in their native language.
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Affiliation(s)
- Dorthe S. Nielsen
- Migrant Health ClinicOdense University HospitalOdenseDenmark
- Center for Global HealthUniversity of Southern DenmarkOdenseDenmark
- Health Sciences Research CenterUniversity Colle of LillebaeltOdenseDenmark
| | | | | | - Morten Sodemann
- Migrant Health ClinicOdense University HospitalOdenseDenmark
- Center for Global HealthUniversity of Southern DenmarkOdenseDenmark
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20
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Abstract
BACKGROUND Social science models find the ecological impacts of climate change (EICC) contribute to internal migration in developing countries and, less so, international migration. Projections expect massive climate-related migration in this century. Nascent research calls to study health, migration, population, and armed conflict potential together, accounting for EICC and other factors. System science offers a way: develop a dynamic simulation model (DSM). We aim to validate the feasibility and usefulness of a pilot DSM intended to serve as a proof-of-concept and a basis for identifying model extensions to make it less simplified and more realistic. METHODS Studies have separately examined essential parts. Our DSM integrates their results and computes composites of health problems (HP), health care (HC), non-EICC environmental health problems (EP), and environmental health services (ES) by origin site and by immigrants and natives in a destination site, and conflict risk and intensity per area. The exogenous variables include composites of EICC, sociopolitical, economic, and other factors. We simulate the model for synthetic input values and conduct sensitivity analyses. RESULTS The simulation results refer to generic origin and destination sites anywhere on Earth. The effects' sizes are likely inaccurate from a real-world view, as our input values are synthetic. Their signs and dynamics are plausible, internally consistent, and, like the sizes, respond logically in sensitivity analyses. Climate migration may harm public health in a host area even with perfect HC/ES qualities and full access; and no HP spillovers across groups, conflict, EICC, and EP. Deviations from these conditions may worsen everyone's health. We consider adaptation options. CONCLUSIONS This work shows we can start developing DSMs to understand climate migration and public health by examining each case with its own inputs. Validation of our pilot model suggests we can use it as intended. We lay a path to making it more realistic for policy analysis.
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Affiliation(s)
- Rafael Reuveny
- School of Public and Environmental Affairs, Indiana University, Bloomington, USA.
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21
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Ramos-Roure F, Feijoo-Cid M, Manresa-Dominguez JM, Segura-Bernal J, García-Sierra R, Fernández-Cano MI, Toran-Monserrat P. Intercultural Communication between Long-Stay Immigrants and Catalan Primary Care Nurses: A Qualitative Approach to Rebalancing Power. Int J Environ Res Public Health 2021; 18:2851. [PMID: 33799637 DOI: 10.3390/ijerph18062851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022]
Abstract
There is a gap between the preferences of immigrant patients and their experiences with intercultural communication. This study aims to explore the experiences and perspectives of long-stay immigrants on intercultural communication in encounters with primary care (PC) nurses. Participants were selected by purposive sampling at the Maresme Primary Care Center. A focus group and five in-depth interviews with long-stay immigrants from eight countries were carried out. Data collection was guided by a script previously validated by a group of experts. We conducted a qualitative analysis following Charmaz's approach, and data saturation was reached with 11 patients (one focus group and five interviews). Long-stay immigrants would like closer and more personalized communication exchanges with greater humanity, as well as polite and respectful manners as they perceive signs of an asymmetrical care relationship. Those who had negative communication experiences tried to justify some of the behaviors as a result of having free access to public health services. This is one of the few existing studies from the point of view of long-stay immigrants. Achieving effective intercultural communication requires a process of self-reflection, awareness-raising and commitment, both on a personal and institutional level, to eliminate the asymmetry in the nurse-patient relationship. Nurses should be trained in person-centered intercultural communication.
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22
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Mohan G. The influence of caregiver's migration status on child's use of healthcare services: evidence from Ireland. Sociol Health Illn 2021; 43:557-574. [PMID: 33636049 DOI: 10.1111/1467-9566.13239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/20/2020] [Accepted: 12/14/2020] [Indexed: 05/26/2023]
Abstract
Large-scale international migration continues apace. From a health-care services perspective, it is important to understand the influence of migrant heritage on utilization, to allocate resources appropriately and facilitate equity. However, the differences in utilization across different migrant groups remain poorly understood, particularly so for paediatric populations. This paper contributes to filling this gap in knowledge, examining the health-care contact of children for whom their primary caregiver is foreign-born, using longitudinal data from two nationally representative surveys. The study setting is Ireland, which provides an interesting case as a small, open European country, which for the first-time experienced net inward migration in the past two decades. For both cohorts, panel regression models, adjusting for socioeconomic and health indicators, demonstrated lower utilization of general practitioner (GP) services for children of caregivers from 'less-advanced, non-Anglosphere, non-European Union (EU)' nations, relative to native-born counterparts. Relatively lower attendances at Emergency Departments and hospital nights were also observed for this group, as well as for children born to EU (non-UK) caregivers. The insights provided are instructive for policymakers for which immigration is a substantial phenomenon in current and future population demographics.
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Affiliation(s)
- Gretta Mohan
- Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College, Dublin, Ireland
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23
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Mantzoukas S, Schärli-Lim S, Kelly H, Falk K, Frey S, Van Der Aa C. The impact of The Florence Network in advancing nursing and midwifery in Europe. Nurse Educ Pract 2021; 50:102919. [PMID: 33227617 DOI: 10.1016/j.nepr.2020.102919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022]
Abstract
Diversity of the nursing workforce and multiculturalism of European cities have mandated the need for culturally sensitive nurses and midwives able to provide effective, engaging, high quality and socially just healthcare. The Florence Network is a professional network that aims to bring together like-minded professionals and to cultivate relationships amongst nurses and midwives from different European Union (EU) countries to create synergies on matters of common interest by transcending national and cultural barriers. A qualitative study based upon a focus group interview was conducted with six former Presidents and one present President of the Florence Network, each with a tenure of two years. The study explored the impact of the Florence Network in advancing cultural awareness and promoting educational, research and professional synergies. The outcome of the study identified that from the Presidents perspectives networks create awareness of cultural diversity, enable the delivery of multicultural nursing care and develop future leaders regarding global health-related issues. Furthermore, professional networks contribute to the refining of educational curricula, in developing applicable research evidence, and in sharing formal and informal professional knowledge.
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24
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Guo S, Liu M, Chong SY, Zendarski N, Molloy C, Quach J, Perlen S, Nguyen MT, O'Connor E, Riggs E, O'Connor M. Health service utilisation and unmet healthcare needs of Australian children from immigrant families: A population-based cohort study. Health Soc Care Community 2020; 28:2331-2342. [PMID: 32573864 DOI: 10.1111/hsc.13054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/08/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Compared with most other Organization for Economic Co-operation and Development (OECD) countries, information about the patterns of health service use for children from immigrant families in Australia is currently limited, and internationally, data on unmet healthcare needs are scarce. This study aims to examine the distribution of health service utilisation and unmet healthcare needs for immigrant children aged 10-11 years in Australia. We drew on data from the Longitudinal Study of Australian Children Birth (B; n = 5,107) and Kindergarten (K; n = 4,983) cohorts. The exposure was family immigration background collected at 0-1 (B-cohort) and 4-5 (K-cohort) years. Outcomes were parent-reported child health service use and unmet healthcare needs (defined as the difference between services needed and services received) at 10-11 years. Logistic regression analyses were used to examine associations between family immigration background and health service use/unmet healthcare needs, adjusting for potential confounders. Results showed that one-third of Australian children (B-cohort: 29.0%; K-cohort: 33.4%) came from immigrant families. There were similar patterns of health service use and unmet healthcare needs between children from English-speaking immigrant and Australian-born families. However, children from non-English-speaking immigrant families used fewer health services, including paediatric, dental, mental health and emergency ward services. There was a disparity between the services used when considering children's health needs, particularly for paediatric specialist services (B-cohort: OR = 2.43, 95% CI 1.11-5.31; K-cohort: OR = 2.72, 95% CI 1.32-5.58). Findings indicate that Australian children from non-English-speaking immigrant families experience more unmet healthcare needs and face more barriers in accessing health services. Further effort is needed to ensure that the healthcare system meets the needs of all families.
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Affiliation(s)
- Shuaijun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Mengjiao Liu
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Shiau Yun Chong
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Nardia Zendarski
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Carly Molloy
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Jon Quach
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Australia
| | - Susan Perlen
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Minh Thien Nguyen
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Elodie O'Connor
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Elisha Riggs
- Intergenerational Health Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Meredith O'Connor
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
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25
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Ceuterick M, Bracke P, Van Canegem T, Buffel V. Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study. Community Ment Health J 2020; 56:1457-72. [PMID: 32133547 DOI: 10.1007/s10597-020-00590-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.
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26
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Feinberg I, O'Connor MH, Owen-Smith A, Ogrodnick MM, Rothenberg R. The Relationship Between Refugee Health Status and Language, Literacy, and Time Spent in the United States. Health Lit Res Pract 2020; 4:e230-e236. [PMID: 33313933 PMCID: PMC7751446 DOI: 10.3928/24748307-20201109-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background: There are 3 million refugees living in the United States today whose health and wellbeing may be diminished by not being able to understand and use health information. Little is known about these barriers to health in multiethnic refugee communities. Objective: This present study examined (1) the relationship between English proficiency, health literacy, length of time in the US, and health status; and (2) differences in poor health status caused by limited English proficiency and low health literacy individually and in combination to better understand which barriers might be addressed by improving refugee health. Methods: Refugees (N = 136) age 18 to 65 years were recruited using health clinics and refugee resettlement agencies. Survey questions included demographics, health status, health literacy, English language proficiency, social determinants of health, and barriers to getting health care. Interpreters were used as necessary. We used a cross-sectional study with purposeful sampling. Key Results: There is a high correlation (Pearson's r = 0.77) between health literacy and English proficiency; they were moderately correlated with health status (r = 0.40 and 0.37, respectively). Length of time in the US only modestly correlated with health status (r = 0.16). Health literacy and English proficiency taken individually were strong predictors of health status (health literacy odds ratio [OR] = 4.0; 95% confidence interval [1.6–9.9], English proficiency OR = 3.6, confidence interval [1.5–9.0]) but not significant. Their interaction, however, was significant and accounted for most of the effect (log odds for interaction = 1.67, OR = 5.1, p < .05). Conclusions: English proficiency and health literacy individually and in combination facilitate poor health and present health-related barriers for refugees. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population. [HLRP: Health Literacy Research and Practice. 2020;4(4):e230–e236.] Plain Language Summary: The combined effects of limited English proficiency and low health literacy can create significant barriers to good health outcomes in refugee populations. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population.
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Affiliation(s)
- Iris Feinberg
- Address correspondence to Iris Feinberg, PhD, Adult Literacy Research Center, Georgia State University, PO Box 3978, Atlanta, GA 30302;
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Abstract
Background: Increasing numbers of torture-survivors are presenting to UK healthcare
services with persistent pain. However, there is a paucity of evidence
surrounding the management of persistent pain among torture-survivors and
their experience of healthcare services for pain is currently unknown. This
qualitative study explores their experiences of services for managing pain,
to inform clinical practice and service provision. Methods: Thirteen participants were recruited from a specialist pain clinic for
torture-survivors in the United Kingdom. Utilising an ethnographic approach,
data were collected via clinic appointment observations, interviews and
medical records and analysed using inductive thematic analysis. Results: Three themes emerged in relation to torture-survivors’ experiences of
healthcare services for pain: the patient–clinician
relationship; multiplicity of diagnoses and
treatments; lack of service integration.
Participants described limited engagement in decision-making processes
regarding their care. Lack of recognition of torture experience when
diagnosing and treating pain, alongside multiple unsuccessful treatments,
led to confusion, frustration and hopelessness. These issues were
exacerbated by the disconnect between physical and mental health
services. Conclusion: This study provides new insight into the challenges faced by
torture-survivors when accessing healthcare services for pain. Our findings
suggest current service provision is not meeting their complex needs.
Clinical implications include the need for integrated care systems and
better recognition of the influence of torture experience on persistent
pain. Strategies to engage and empower torture-survivors in the management
of their pain are suggested.
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Affiliation(s)
- Daniel Board
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Faculty of Health, Social Care and Education, St George's, University of London and Kingston University, London, UK
| | - Susan Childs
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Richard Boulton
- Faculty of Health, Social Care and Education, St George's, University of London and Kingston University, London, UK
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28
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Cailhol J, Lebon MC, Sherlaw W. Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France. BMC Med Ethics 2020; 21:59. [PMID: 32660550 PMCID: PMC7359478 DOI: 10.1186/s12910-020-00500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND France has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid and since 1998 has had a humanitarian policy for granting temporary residence permits for medical reason (TRPMR) to migrants. Within a context of political debate, reform and tightening immigration control we will examine this latter policy focusing especially on the dilemmas that arise for physicians of migrant patients when they are requested to write medical certificates as part of a TRPMR application. In a 2017 reform the key role of making recommendations on the granting or not of permits was handed over to Ministry of the Interior health inspectors. Recommendations are made after perusal of medical certificates established by the migrant's physician and complementary evidence. MAIN BODY The writing of medical certificates by a physician would seem straightforward. This is far from the case since it raises a number of ethical dilemmas. These occur within a physician-patient relationship embedded within a social contract between the State, the physician and the migrant patient. To clarify the ethical issues arising 3 vignettes based on practice within an infectious disease unit at a large Paris hospital have been developed. The vignettes highlight ethical dilemmas in the care for migrants with tuberculosis (dilemma in defining health and disease), chronic hepatitis (dilemma between beneficence and do not harm), and HIV / AIDS (issue of deservingness). We will go on to reflect on issues of social justice and responsibility for the health of migrants within a globalized world. CONCLUSIONS Criteria for residence permit delivery appear less than clear-cut and are interpreted in a restrictive way. Neither are the consequences of refusing a residence permit taken into account. We call for an empirical transnational ethics study involving countries implementing similar TRPMR policies. We also call for inclusion of lobbying competences into the medical undergraduate curricula, in order to breed future generations of physicians skilled in defending social justice.
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Affiliation(s)
- Johann Cailhol
- Laboratoire Educations et Pratiques de Santé, Université Paris 13, 74 rue Marcel Cachin, Bobigny, France. .,Infectious diseases unit, Avicenne teaching hospital, APHP, 125 route de Stalingrad, 93000, Bobigny, France. .,Institut Convergences Migrations, Campus Condorcet, Hôtel à projets, 8 cours des Humanités, 93300, Aubervilliers, France.
| | - Marie-Christine Lebon
- Infectious diseases unit, Avicenne teaching hospital, APHP, 125 route de Stalingrad, 93000, Bobigny, France
| | - William Sherlaw
- Laboratoire d'Etudes et de Recherche en Sociologie, Université de Bretagne Occidentale, 20 rue Duquesne, 29200, Brest, France.,Ecole des Hautes Etudes en Santé Publique, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France
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Morris MC, Cooper RL, Ramesh A, Tabatabai M, Arcury TA, Shinn M, Im W, Juarez P, Matthews-Juarez P. Preparing Medical Students to Address the Needs of Vulnerable Patient Populations: Implicit Bias Training in US Medical Schools. Med Sci Educ 2020; 30:123-127. [PMID: 34457650 PMCID: PMC8368413 DOI: 10.1007/s40670-020-00930-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Little is known about how medical students are trained to identify and reduce their own biases toward vulnerable patient groups. A survey was conducted among US medical schools to determine whether their curricula addressed physician implicit biases toward three vulnerable patient groups: lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals, persons experiencing homelessness, and migrant farmworkers. Of 141 US medical schools, 71 (50%) responded. Survey respondents indicated that implicit bias is not routinely addressed in medical education, and training specific to vulnerable populations is infrequent. Recommendations for incorporating implicit bias training in medical school curricula are discussed.
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Affiliation(s)
- Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS USA
| | - Robert Lyle Cooper
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN USA
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN USA
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN USA
| | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Marybeth Shinn
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN USA
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN USA
| | - Paul Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN USA
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Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B, Salt K. Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.
Objectives
Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.
Review methods
An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.
Results
We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.
Limitations
Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.
Conclusions
Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.
Future work
Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.
Study registration
This study is registered as PROSPERO CRD42015023605.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gina MA Higginbottom
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Karen Salt
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
- Centre for Research into Race and Rights, University of Nottingham, Nottingham, UK
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Abstract
Modern medicine's investment in the disembodied, objective 'science' of biomedicine, where patients are transformed from suffering subjects to objects of investigation, calls for heightened ethical awareness. Around the world, ethical codes of conduct emphasise beneficence and non-maleficence. Lately, we have also seen a quest for autonomy and equitable healthcare for diverse populations. However, these tenets alone do not effectively address the problems which regularly occur in transcultural consultations. By developing a 'space for reflection' based on selected writings of the moral philosophers Axel Honneth, Emmanuel Levinas and Hans Jonas, my aim is to cast light on this issue. Given the differing aspects of the doctor-patient relationship, clearly there are no clear-cut rules to obey. However, a thematic analysis of a quote from a Somali, female refugee, supported by some other studies on medical practice, suggests that, metaphorically speaking, within the developed space for reflection, medical practice has worked itself into a corner. By neglecting the patient as a social being, lacking openness to alterity, and not conveying needed information, they make it very difficult for patients to take responsibility for their situation. In spite of doctors' benevolence, the result is alienation, increased suffering and thus, potential harm. Similar tendencies are reflected in a number of recent studies on medical consultations. Therefore, rather than blaming the single doctor for moral deceit, we should see these tendencies as a 'forgetfulness of recognition' that affects the medical profession, a disturbance which source probably is hidden in doctors training.
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Affiliation(s)
- Arild Kjell Aambø
- Unit for Migration and Health, NIPH, Norwegian Institute of Public Health, Oslo, Norway
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Couto E Cruz C, Salom C, Parsell C, Dietze P, Burns L, Alati R. Social domains of discrimination against people who inject drugs: Links with health and wellbeing. Int J Drug Policy 2020; 77:102620. [PMID: 31931474 DOI: 10.1016/j.drugpo.2019.102620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/10/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022]
Abstract
AIMS People who inject drugs frequently experience discrimination. However, little is known about how discrimination experienced in different social domains is linked to health and wellbeing. DESIGN We used data collected in 2016 from the Illicit Drug Reporting System (IDRS), an Australian survey of people who inject drugs. We used a modified version of the Discrimination Scale (DISC-12) to assess discriminatory behaviours in diverse social domains, including public institutions, neighbours, family and friends. We used the Kessler-10 scale, the Personal Wellbeing Index and specific items from the IDRS questionnaire to assess participants' health and wellbeing. FINDINGS Sixty three percent of participants who responded to the discrimination module included in the IDRS 2016 (N = 796) reported ever having experienced discrimination due to their injecting drug use and 53% reported having experienced discrimination in the past month. Discrimination in all social domains analysed was linked with poor health and wellbeing, except for housing. Self-reported mental health problems and poorer general health were most frequently associated with discrimination. Participants who experienced discrimination from friends were three times more likely to report mental health problems (AOR=3.0, CI95=1.5-6.0). CONCLUSIONS There are significant associations between the domains in which discrimination takes place and the health and wellbeing of people who inject drugs. Our findings highlighted the importance of assessing the social domains of discrimination in relation to mental health. Further research needs to assess not just whether a group or individual is discriminated against, but rather how they are likely to perceive this discrimination and how this experience can affect their life as a whole.
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Affiliation(s)
- Camila Couto E Cruz
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia.
| | - Caroline Salom
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia
| | - Cameron Parsell
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia
| | - Paul Dietze
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Lucinda Burns
- University of New South Wales, National Drug and Alcohol Research Centre (NDARC), 22-32 King St, Randwick, NSW 2031, Australia
| | - Rosa Alati
- University of Queensland, Institute for Social Science Research, 80 Meiers Road, Indooroopilly, QLD 4068, Australia
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Abstract
UNLABELLED One in four births in the UK is to foreign-born women. In 2016, the figure was 28.2%, the highest figure on record, with maternal and perinatal mortality also disproportionately higher for some immigrant women. Our objective was to examine issues of access and experience of maternity care by immigrant women based on a systematic review and narrative synthesis of empirical research. REVIEW METHODS A research librarian designed the search strategies (retrieving literature published from 1990 to end June 2017). We retrieved 45 954 citations and used a screening tool to identify relevance. We searched for grey literature reported in databases/websites. We contacted stakeholders with expertise to identify additional research. RESULTS We identified 40 studies for inclusion: 22 qualitative, 8 quantitative and 10 mixed methods. Immigrant women, particularly asylum-seekers, often booked and accessed antenatal care later than the recommended first 10 weeks. Primary factors included limited English language proficiency, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Maternity care experiences were both positive and negative. Women with positive perceptions described healthcare professionals as caring, confidential and openly communicative in meeting their medical, emotional, psychological and social needs. Those with negative views perceived health professionals as rude, discriminatory and insensitive to their cultural and social needs. These women therefore avoided continuously utilising maternity care.We found few interventions focused on improving maternity care, and the effectiveness of existing interventions have not been scientifically evaluated. CONCLUSIONS The experiences of immigrant women in accessing and using maternity care services were both positive and negative. Further education and training of health professionals in meeting the challenges of a super-diverse population may enhance quality of care, and the perceptions and experiences of maternity care by immigrant women.
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Affiliation(s)
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | | | - Jeanette Eldridge
- Research and Learning Services, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- School of Health Sciences, University of Nottingham, Nottingham, UK
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34
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Chaouni SB, Smetcoren AS, De Donder L. Caring for migrant older Moroccans with dementia in Belgium as a complex and dynamic transnational network of informal and professional care: A qualitative study. Int J Nurs Stud 2020; 101:103413. [PMID: 31678839 DOI: 10.1016/j.ijnurstu.2019.103413] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Due to its labour migration history, Belgium is confronted with an increasingly older population of people of Moroccan background who have been diagnosed with dementia. These migrants came to the country during the labour migration wave of the nineteen-sixties and seventies to work in mines and other industries and they are now ageing. Yet little is known about how dementia care is provided to this older population. OBJECTIVES This study explores how dementia care is provided to these Moroccan older people with dementia, and what challenges do caregivers face in providing care. METHODS A qualitative study including 31 informal caregivers of older Moroccan migrants with dementia and professional caregivers in the field of dementia care in several Belgian cities was conducted. After an initial focus group including 6 informal and professional caregivers, individual in-depth interviews were held with 12 informal caregivers of Moroccan decent and 13 professional caregivers. In order to be included in the study, informal caregivers had to have a recent experience in caring for an older family member with dementia. The professional caregivers had to be active in the field of dementia care (General Practitioners, nurses, psychologists,…) and have experience with older migrants with dementia. RESULTS Analyses of the collected data reveal that current dementia care is a challenging, complex and dynamic search process. This process is shaped by (1) multiple factors reflecting the changing care needs of the care recipient during the course of the dementia, (2) the individual (transnational) recourses of the informal caregivers and the (3) current (lack of) accessibility of professional dementia care (driven by the absence of an accessible migration-, culture- and religion-sensitive professional care). The limited professional service-use is predominantly compensated through the search for transnational external helpers. The limited migration, cultural and religious sensitivity of current dementia care is often overlooked by professional caregivers. CONCLUSION The study provides a better understanding of the complex reality of dementia care for older migrants in which these different aspects intersect. This understanding enable health professionals and policy makers to develop a better suited care for older migrants with dementia.
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Abstract
Large variations of inequalities in rates of mental health disorders and access to mental health care exist within and between countries. Globally, disparities range from countries where there is little provision to those where, despite the availability of evidence-based mental health care, service access and outcomes are mediated by social factors such as socio-economic status, race/ethnicity, and culture. This is salient because increasingly diverse populations are inevitably created with globalization. We posit that in multicultural contexts, effective therapeutic engagement requires therapists who are competent and confident to work with diversity and difference, utilizing insights into their own as well as their clients' internal and external worlds. Although there are many reasons why psychotherapies can be insensitive and harmful, for example, the inherent power imbalance in therapeutic relationships, a lack of awareness of cultural and ethnic variation and needs are among them. Acquisition of 'cultural competence' and increasing availability of culturally-adapted interventions should, in theory, enable practitioners to work with a range of individuals with whom they might have little in common. However, whilst cultural adaptation appears promising, there are concerns regarding its viability as a strategy for tackling disparities in access to psychological care. Evidence for cultural competency is patchy at best. We show how and why delivering effective psychotherapy in the twenty-first century requires a paradigm shift from current approaches to truly integrated models, developed in collaboration with recipients of care. Coproducing interventions, training, and means of evaluating them with clients necessitates taking into consideration social contexts, alternative conceptualizations of mental health and disorders and difficulties, and what constitutes appropriate helpful interventions for psychological distress. PRACTITIONER POINTS: Upskilling therapists to work with diversity and difference is essential for effective delivery of psychological treatments. Increasing the availability of culturally-adapted interventions together with therapists who are sufficiently competent and confident to deliver them should enable practitioners to work with a range of individuals with whom they might have little in common. Coproducing culturally appropriate means of responding to mental health difficulties, staff training and development, and service evaluation methods with clients necessitates taking into consideration social contexts, alternative explanatory models of mental health and 'illness', and what constitutes helpful interventions for psychological distress.
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Affiliation(s)
- Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, UK.,Research & Innovation, Greater Manchester Mental Health NHS Trust, UK
| | - Henna Lemetyinen
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, UK
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36
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Aveyard H, Bradbury-Jones C. An analysis of current practices in undertaking literature reviews in nursing: findings from a focused mapping review and synthesis. BMC Med Res Methodol 2019; 19:105. [PMID: 31096917 PMCID: PMC6524227 DOI: 10.1186/s12874-019-0751-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this paper we discuss the emergence of many different methods for doing a literature review. Referring back to the early days, when there were essentially two types of review; a Cochrane systematic review and a narrative review, we identify how the term systematic review is now widely used to describe a variety of review types and how the number of available methods for doing a literature review has increased dramatically. This led us to undertake a review of current practice of those doing a literature review and the terms used to describe them. METHOD We undertook a focused mapping review and synthesis. Literature reviews; defined as papers with the terms review or synthesis in the title, published in five nursing journals between January 2017-June 2018 were identified. We recorded the type of review and how these were undertaken. RESULTS We identified more than 35 terms used to describe a literature review. Some terms reflected established methods for doing a review whilst others could not be traced to established methods and/or the description of method in the paper was limited. We also found inconsistency in how the terms were used. CONCLUSION We have identified a proliferation of terms used to describe doing a literature review; although it is not clear how many distinct methods are being used. Our review indicates a move from an era when the term narrative review was used to describe all 'non Cochrane' reviews; to a time of expansion when alternative systematic approaches were developed to enhance rigour of such narrative reviews; to the current situation in which these approaches have proliferated to the extent so that the academic discipline of doing a literature review has become muddled and confusing. We argue that an 'era of consolidation' is needed in which those undertaking reviews are explicit about the method used and ensure that their processes can be traced back to a well described, original primary source.
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Affiliation(s)
- Helen Aveyard
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straw's Lane, Oxford, OX3 0FL, England, UK.
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37
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Schilgen B, Handtke O, Nienhaus A, Mösko M. Work-related barriers and resources of migrant and autochthonous homecare nurses in Germany: A qualitative comparative study. Appl Nurs Res 2019; 46:57-66. [DOI: 10.1016/j.apnr.2019.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 01/01/2023]
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Griffiths P, Norman I. The impact of "Brexit" on nursing and health services: Editorial debate. Int J Nurs Stud 2019; 77:A1-A2. [PMID: 29254582 DOI: 10.1016/j.ijnurstu.2017.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/26/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Ian Norman
- Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
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Mourão S, Bernardes SF. What determines immigrant caregivers' adherence to health recommendations from child primary care services? A grounded theory approach. Prim Health Care Res Dev 2019; 20:e31. [PMID: 32799992 DOI: 10.1017/S1463423619000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim To investigate the diversity and specificity of the determinants of immigrant caregivers’ adherence to child primary care (CPC) health recommendations. Background Immigrant caregiver’s adherence to CPC health recommendations is of utmost importance to minimize their children’s health-related vulnerabilities. Some research has been conducted on the determinants of immigrants’ access to health services, but much less is known about the determinants of their adherence to health professionals’ recommendations once they get there, especially in a primary health care context. This study contributes to bridge these gaps. Methods Interviews and focus groups were conducted, with immigrant and non-immigrant caregivers living in Portugal (n=35), from heterogeneous socioeconomic backgrounds. Focus group and individual interview scripts were developed to explore caregivers’ understanding and use of CPC services and, particularly, their adherence to CPC recommendations. A socio-demographic questionnaire was also administered. Qualitative data were analyzed using a grounded theory methodology. Findings ‘Adherence to CPC health recommendations’ is a core and multidimensional concept. Several determinants were identified at individual, interpersonal, organizational and structural levels. Some determinants were highlighted both by immigrant and non-immigrant caregivers: valuing children’s health, usefulness of recommendations, perceived health-care professionals’ competence, central role of vaccination in CPC and caregivers’ socio-economic conditions. Other determinants were specifically mentioned by immigrant caregivers: expectations about traditional versus pharmacological treatments, cultural mismatches in children’s care practices, perceived quality of Portuguese CPC services versus CPC from countries of origin. These results provide innovative theoretical and empirical contributions to the field of primary health care and, particularly, to immigrant caregivers’ adherence behaviors. Implications for research on treatment adherence in primary care contexts, the development of interventions that promote caregivers’ adherence to CPC health recommendations and for child protection will be discussed.
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Nielsen DS, Korsholm KM, Mottelson I, Sodemann M. Cultural Competences Gained Through an Education Program as Ethnic Patient Coordinator: A Qualitative Study. J Transcult Nurs 2019; 30:394-402. [PMID: 30688159 DOI: 10.1177/1043659618823923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Studies have shown that health care professionals lack cultural knowledge and cultural competences in the care of patients with a minority background. The aim of this study was to explore whether a cultural teaching program, the so-called ethnic patient coordinator program, had an impact on health professionals' self-perceived clinical competences in the encounter with the minority patient. METHODOLOGY The study was designed as a qualitative study using participant observation and semistructured interviews with a practice-led research approach. In total, 30 health professionals participated in the program. RESULTS/DISCUSSION The coordinators described that they had learned to focus systematically on reducing language barriers and to overcome prejudices. Their new competences not only had a direct influence on patient-related practical skills but also affected the practice culture and their colleagues' approach to vulnerable patients with a minority background. Conclusion/Implication: The presence of an ethnic patient coordinator team may give rise to a more migrant-friendly and culturally competent hospital.
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Affiliation(s)
- Dorthe S Nielsen
- 1 Center for Global Health, University of Southern Denmark, Odense, Denmark.,2 Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark.,3 Migrant Health Clinic, Odense University Hospital, Odense, Denmark
| | - Karen M Korsholm
- 3 Migrant Health Clinic, Odense University Hospital, Odense, Denmark
| | - Ida Mottelson
- 1 Center for Global Health, University of Southern Denmark, Odense, Denmark
| | - Morten Sodemann
- 1 Center for Global Health, University of Southern Denmark, Odense, Denmark.,3 Migrant Health Clinic, Odense University Hospital, Odense, Denmark
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Markkula N, Cabieses B, Lehti V, Uphoff E, Astorga S, Stutzin F. Use of health services among international migrant children - a systematic review. Global Health 2018; 14:52. [PMID: 29769091 PMCID: PMC5956827 DOI: 10.1186/s12992-018-0370-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/06/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Migrant children have specific health needs, and may face difficulties in accessing health care, but not enough is known about their health service use. This study aims to describe patterns of use of health services of international migrant children and differences to respective native populations. METHODS Electronic databases PubMed and Web of Science, references of identified publications, and websites of relevant international agencies were searched. We included observational studies published between 2006 and 2016 that reported use of formal health services by migrant children (0-18 years), including first and second generation migrants. Data on study characteristics, study theme, main outcome and study quality were extracted. RESULTS One hundred seven full texts were included in the review. Of the studies that reported comparable outcomes, half (50%) indicated less use of healthcare by migrants compared with non-migrants; 25% reported no difference, 18% reported greater use, and 7% did not report this outcome. There was variation by theme, so that the proportion of conclusions "less use" was most common in the categories "general access to care", "primary care" and "oral health", whereas in the use of emergency rooms or hospitalisations, the most common conclusion was "greater use". CONCLUSIONS Migrant children appear to use different types of healthcare services less than native populations, with the exception of emergency and hospital services. SYSTEMATIC REVIEW REGISTRATION PROSPERO systematic review registration number: CRD42016039876 .
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Affiliation(s)
- Niina Markkula
- Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12461, Las Condes, Santiago Chile
| | - Baltica Cabieses
- Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12461, Las Condes, Santiago Chile
- Department of Health Sciences, University of York, York, England
| | - Venla Lehti
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eleonora Uphoff
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sofia Astorga
- Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12461, Las Condes, Santiago Chile
| | - Francisca Stutzin
- Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Las Condes 12461, Las Condes, Santiago Chile
- Centre for Interdisciplinary and Intercultural Inquiry, Health Humanities, University College London, London, UK
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Borde T. Kommunikation und Sprache: Herausforderungen und Chancen einer diversitätsgerechten Gesundheitsversorgung. Gynäkologische Endokrinologie 2018; 16:3-9. [DOI: 10.1007/s10304-017-0167-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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