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Oudbier J, Boerboom T, Peerdeman S, Suurmond J. Which social accountability competencies make a good physician? A qualitative investigation of the patient perspective on social accountability. Med Teach 2024:1-7. [PMID: 38285884 DOI: 10.1080/0142159x.2024.2306842] [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] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Social accountability is an emerging theme in health care education. In previous literature, the perspectives of patients regarding the competencies that they think are required for physicians to demonstrate in this domain are scarce. This study aims to get insight into the competencies in the domain of social accountability that, according to patients, should be demonstrated by physicians. METHODS Online semi-structured interviews with 18 patients in the Netherlands were conducted as part of an exploratory qualitative study. Snowballing and convenience sampling techniques were used to recruit participants. The grounded theory method was used to qualitatively analyze the interviews. RESULTS AND CONCLUSION Patients identified five competencies of a physician in the domain of social accountability: (1) Taking patient's characteristics into account and tailoring care to the individual patient, (2) Taking the broader community into account, (3) Balancing between care for the individual patient versus concern for society, (4) Providing guidance to patients in the navigation within the health system, and (5) Taking climate impact into account. Patients stated that the importance of these competencies are dependent on the specialism. PRACTICE IMPLICATIONS The formulated competencies can be used to better align medical education focussing on social accountability to the expectations of patients.
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Affiliation(s)
- Janique Oudbier
- Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tobias Boerboom
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Saskia Peerdeman
- Neurological Surgery, Amsterdam UMC Location VUmc, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanine Suurmond
- Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Müller F, Veen LM, Galenkamp H, Jim HSL, Lok A, Nieuwkerk PT, Suurmond J, van Laarhoven HWM, Knoop H. Emotional distress in cancer survivors from various ethnic backgrounds: Analysis of the multi-ethnic HELIUS study. Psychooncology 2023; 32:1412-1423. [PMID: 37482911 DOI: 10.1002/pon.6192] [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: 01/18/2023] [Revised: 06/07/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Insight into emotional distress of cancer survivors from ethnic minority groups in Europe is scarce. We aimed to compare distress levels of survivors from ethnic minorities to that of the majority population, determine whether the association between having cancer (yes vs. no) and distress differs among ethnic groups and investigate sociocultural correlates of distress. METHODS Cross-sectional data were derived from HELIUS, a multi-ethnic cohort study conducted in the Netherlands. Of 19,147 participants, 351 were diagnosed with cancer (n = 130 Dutch, n = 75 African Surinamese, n = 53 South-Asian Surinamese, n = 43 Moroccan, n = 28 Turkish, n = 22 Ghanaian). Distress (PHQ-9, MCS-12) and correlates were assessed by self-report. Cancer-related variables were derived from the Netherlands Cancer Registry. RESULTS Survivors were on average 7 years post-diagnosis. Survivors from South-Asian Surinamese, Moroccan, Turkish and Ghanaian origin reported more distress than survivors from Dutch origin (effect sizerange : 0.44-1.17; adjusted models). The association between having cancer or not with distress differed in direction between Dutch and the non-Dutch ethnic groups: Non-Dutch cancer patients tended to have more distress than their cancer-free peers, whereas Dutch cancer patients tended to have less distress than their cancer-free peers. For Moroccan and Turkish patients, the acculturation style of separation/marginalization, compared to integration/assimilation, was associated with higher depressive symptoms. In analyses pooling data from all ethnic minorities, lower health literacy, lower emotional support satisfaction and younger age at the time of migration were associated with higher depressive symptoms. Lower health literacy, fewer emotional support transactions, and more frequent attendance at religious services were associated with worse mental health. CONCLUSION Cancer survivors from ethnic minorities experience more distress than those from the majority population. Culturally sensitive supportive care should be considered.
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Affiliation(s)
- Fabiola Müller
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Linde M Veen
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anja Lok
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep, Amsterdam, the Netherlands
| | - Pythia T Nieuwkerk
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, the Netherlands
| | - Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Hans Knoop
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Expert Center for Chronic Fatigue, Amsterdam, the Netherlands
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Spruijt I, Cronin A, Udeorji F, Nazir M, Shehu S, Poix S, Villanueva A, Jansen N, Huitema I, Suurmond J, Fiekert K. Respected but stigmatized: Healthcare workers caring for COVID-19 patients. PLoS One 2023; 18:e0288609. [PMID: 37478112 PMCID: PMC10361490 DOI: 10.1371/journal.pone.0288609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/02/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) caring for Corona Virus Disease 2019 (COVID-19) patients are at increased risk of being stigmatized, which compromises their individual mental well-being and the quality of care they deliver. Stigma-reduction interventions may (partly) prevent this. However, there is a lack of in-depth understanding of the experiences and underlying causes of COVID-19 stigma among HCWs, which is needed to design such interventions. We conducted in-depth semi-structured interviews to assess COVID-19 stigma among COVID-19 HCWs in Ireland, Nigeria, The Netherlands, Pakistan, and The Philippines. METHODS We used a purposive and snowball sampling to recruit a total of 53 HCWs for online interviews (13 in Ireland; 15 in Nigeria; 6 in The Netherlands; 6 in Pakistan; and 13 in The Philippines (2021). After verbatim transcribing interviews, we used a thematic approach for data analysis. RESULTS In all countries, stigmatization of COVID-19 HCWs is driven by fear of infection and the perception of HCWs being carriers of the disease amplified by them wearing of scrubs and personal protective equipment. There were differences between countries in the way stigma manifested in self- anticipated and experienced stigma like scolding, discrimination, avoidance, (self-) isolation, and exclusion in public, in the community, at work, and in the household. The stigma resulted in feelings of depression, loneliness, isolation, and the desire to quit one's job. DISCUSSION COVID-19 HCWs from all countries experienced all forms of stigmatization related to their work as a COVID-19 frontliner. This affected their mental well-being, which in turn affects job performance and quality of care, there is a high need to develop stigma reduction tools for HCWs.
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Affiliation(s)
- Ineke Spruijt
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Anne Cronin
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | | | - Mamoona Nazir
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Samaila Shehu
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Sebastien Poix
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | | | - Niesje Jansen
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Ineke Huitema
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Jeanine Suurmond
- Department Social Science, Amsterdam Public Health Institute, University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Kathy Fiekert
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
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Baragetti A, Suurmond J, Marques PE, Tavares LP. Editorial: Rising stars in inflammation 2021. Front Immunol 2023; 14:1193694. [PMID: 37207223 PMCID: PMC10189773 DOI: 10.3389/fimmu.2023.1193694] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- A. Baragetti
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", University of Milan, Milan, Italy
- *Correspondence: A. Baragetti,
| | - J. Suurmond
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - P. E. Marques
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - L. P. Tavares
- Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
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Oudbier J, Sperna Weiland NH, Boerboom T, Ravesloot JH, Peerdeman S, Suurmond J. An evidence-based roadmap to integrate planetary health education into the medical curriculum. Med Teach 2022; 45:1-5. [PMID: 36395753 DOI: 10.1080/0142159x.2022.2137015] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The urgency for action on climate change is regarded as the defining issue of our time. Planetary health education prepares future healthcare professionals to promote the health of the planet, including sustainable healthcare. This has potential benefits for the healthcare system, patients, community, and the environment. However, many educators are not confident in explaining and inspiring students and many deans and educational staff report challenges when integrating planetary health into education. The roadmap presented in this paper uses evidence from medical education literature to support medical schools with implementing this type of education. The roadmap can be used as a guide for educators, university leadership, and policy-makers in the design of planetary health education.
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Affiliation(s)
- Janique Oudbier
- Department of Public and Occupational Health, Amsterdam UMC - University of Amsterdam, Amsterdam, Netherlands
- Academic Centre for Dentistry, Amsterdam, Netherlands
| | - Nicolaas H Sperna Weiland
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands
- Centre for Sustainable Healthcare, Amsterdam UMC, Amsterdam, Netherlands
| | - Tobias Boerboom
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Saskia Peerdeman
- Department of Neurological Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam UMC - University of Amsterdam, Amsterdam, Netherlands
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Alkirawan R, Kawous R, Bloemen E, van den Muijsenbergh M, Goosen S, Suurmond J, de Boer F. Perspectives of Syrian refugees on antibiotic use and prescribing in Dutch primary care: a qualitative study. IJMHSC 2022. [DOI: 10.1108/ijmhsc-12-2021-0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose
This study is oriented towards getting insight into the perspectives, knowledge and practices among Syrian refugees regarding antibiotic use and prescribing in Dutch primary care.
Design/methodology/approach
A thematic qualitative study was carried out using semi-structured interviews with 12 Syrian refugees living in the Netherlands. Data analysis consisted of three steps and was oriented towards the development of themes.
Findings
Participants were confronted with restricted access to antibiotics in the Netherlands which was contrary to their experiences in Syria. Some of them continued to self-prescribe antibiotics, while others adhered to the Dutch General Practitioner (GP)’s advice. Especially mothers with young children took up the Dutch GP’s advice. Syrian refugees expressed health beliefs about the healing effects of antibiotics which are related to their past experiences of use and which influenced their current use. Respondents complained about the Dutch health-care system and expressed a preference for the one in Syria.
Research limitations/implications
Syrian refugees vary in their way of dealing with restricted access to antibiotics in Dutch primary care. More in-depth knowledge is required to improve refugee patient–doctor communication about antibiotic use.
Practical implications
The message that antibiotics are not needed may be challenging. Additional communication seems to be necessary to persuade Syrian refugees from self-prescribing antibiotics. Therefore, identifying refugee patient concerns and carefully counseling and communicating it with them is substantial. Developing educational toolkits consisting of various experiences of antibiotic use and ways of dealing with it can equip doctors to more adequately react to migrants’ needs for care.
Social implications
Primary care professionals seem insufficiently equipped to tackle issues related to antibiotic use amongst newly arrived migrants. Therefore, it is important to support professionals in their communication with this patient group about the proper use of antibiotics.
Originality/value
This study shows that more in-depth knowledge is needed about the strategies of newly arrived migrants and their complex reactions to treatment prescriptions with which they are not familiar.
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Koopmanschap I, Martin L, Gitsels - van der Wal JT, Suurmond J. Counselling for prenatal anomaly screening to migrant women in the Netherlands: An interview study of primary care midwives’ perceived barriers with client–midwife communication. Eur J Midwifery 2022; 6:29. [PMID: 35633755 PMCID: PMC9118623 DOI: 10.18332/ejm/147911] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/27/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Large ethnic inequalities exist in the prenatal screening offer, counselling, informed decision-making, and uptake of prenatal anomaly tests. More insight into midwives’ experiences with offering prenatal counselling to migrant women may provide better insight into the origins and consequences of these ethnic inequalities. METHODS We conducted interviews with 12 midwives certified as counsellors for prenatal anomaly screening for women they identified as migrants. Interviews were analyzed using thematic analysis. RESULTS Midwives reported most difficulties in communicating with women of ‘non-western migrant background’, which include first- and second-generation migrants from Africa, Latin-America, Asia, and Turkey. They experienced barriers in communication related to linguistics, health literacy, sociocultural and religious differences, with midwife stereotyping affecting all three aspects of counselling: health education, decision-making support, and the client–midwife relation. Health education was difficult because of language barriers and low health-literacy of clients, decision-making support was hampered by sociocultural and religious midwife–client differences, and client–midwife relations were under pressure due to sociocultural and religious midwife–client differences and midwife stereotyping. CONCLUSIONS Barriers to optimal communication seem to contribute to suboptimal counselling, especially for women of ‘non-western migrant background’. Client–midwife communication thus potentially adds to the ethnic disparities observed in the offer of and informed decision-making about prenatal anomaly screening in the Netherlands. The quality of prenatal counselling for women from all ethnic backgrounds might be improved by addressing linguistic, health literacy, sociocultural and religious barriers in future training and continuing education of prenatal counsellors.
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Affiliation(s)
- Isabel Koopmanschap
- Amsterdam University Medical Center, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Martin
- Department of Midwifery Science, Academy Midwifery Amsterdam and Groningen (AVAG), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Janneke T. Gitsels - van der Wal
- Department of Midwifery Science, Academy Midwifery Amsterdam and Groningen (AVAG), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jeanine Suurmond
- Amsterdam University Medical Center, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
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Abstract
With an increasingly ageing population there will be a rising demand for palliative care, including from older migrants and ethnic minorities. While many (future) physicians are unfamiliar with specific needs of older migrants and ethnic minorities regarding care and communication in palliative care, this may be challenging for them to deal with. Moreover, even many medical teachers also feel unprepared to teach palliative care and culturally sensitive communication to students. In order to support medical teachers, we suggest twelve tips to teach culturally sensitive palliative care to guide the development and implementation of teaching this topic to medical students. Drawn from literature and our own experiences as teachers, these twelve tips provide practical guidance to both teachers and curriculum designers when designing and implementing education about culturally sensitive palliative care.
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Affiliation(s)
- Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Katja Lanting
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Academy of Health (AGZ), Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Xanthe de Voogd
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nursing, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Gudule Boland
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
| | - Maria van den Muijsenbergh
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
- Department of Primary Care and Community Health, Radboud University Nijmegen, Nijmegen, The Netherlands
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Affiliation(s)
- Corrette Ploem
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam
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Schouten BC, Cox A, Duran G, Kerremans K, Banning LK, Lahdidioui A, van den Muijsenbergh M, Schinkel S, Sungur H, Suurmond J, Zendedel R, Krystallidou D. Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach. Patient Educ Couns 2020; 103:S0738-3991(20)30242-1. [PMID: 32423835 DOI: 10.1016/j.pec.2020.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Due to ongoing globalization and migration waves, healthcare providers are increasingly caring for patients from diverse cultural and/or ethnic minority backgrounds. Adequate health communication with migrants and ethnic minorities is often more difficult to establish compared to people belonging to the majority groups of a given society, because of a combination of language and cultural barriers. To address this topic, in December 2018 a symposium was organized-under the auspices of the Amsterdam Center for Health Communication-during which speakers from both academia and professional practice discussed the current state-of-the-art and brought forward innovative solutions to improve intercultural communication in healthcare. Main questions that were discussed during this symposium included: "How can language barriers in intercultural health communication be mitigated?" and "Which innovations can contribute to improving intercultural health communication?" In this paper, we discuss some answers to these questions and propose that in order to enhance intercultural communication and healthcare for migrant and ethnic minority patients, a more holistic approach to studying when, how, and for what purposes (a combination of) communication strategies should be utilized in mitigating both language and cultural barriers to decrease health disparities and improve health care for migrant and ethnic minority patients.
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Affiliation(s)
- Barbara C Schouten
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Antoon Cox
- Interpreting Studies, Antwerp Campus, KU, Leuven, Belgium.
| | - Gözde Duran
- Expertise Centre Dementia for Professionals, University College Windesheim, the Netherlands.
| | - Koen Kerremans
- Department of Linguistics & Literary Studies, Free University Brussels, Belgium.
| | | | - Ali Lahdidioui
- Dutch Association Moroccan Physicians [AMAN], the Netherlands.
| | - Maria van den Muijsenbergh
- Radboud University Medical Centre, Department of Primary and Community Care Health Disparities Group, Nijmegen, the Netherlands; Pharos, Centre of Expertise on Health Disparities, Utrecht, the Netherlands.
| | - Sanne Schinkel
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Hande Sungur
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Jeanine Suurmond
- Department of Social Medicine, Amsterdam University Medical Centre, the Netherlands.
| | - Rena Zendedel
- Department of Languages, Literature and Communication, Utrecht University, the Netherlands.
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Spruijt I, Haile DT, Erkens C, van den Hof S, Goosen S, Ten Kate A, Teshome H, Karels M, Koenders M, Suurmond J. Strategies to reach and motivate migrant communities at high risk for TB to participate in a latent tuberculosis infection screening program: a community-engaged, mixed methods study among Eritreans. BMC Public Health 2020; 20:315. [PMID: 32164637 PMCID: PMC7068882 DOI: 10.1186/s12889-020-8390-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/26/2019] [Accepted: 02/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention. However, there is a lack of insight in effective community-engaged strategies to reach and motivate these migrants to participate in latent TB infection (LTBI) screening and treatment programs. Methods In cocreation with Eritrean key figures and TB staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI programs, in five regions in the Netherlands. We registered participation in LTBI education and screening, and LTBI treatment uptake and completion. We used semi-structured group and individual interviews with Eritrean participants, key figures, and TB staff to identify facilitators and barriers. Results Uptake of LTBI education (13–75%) and consequent screening (10–124%) varied between strategies. LTBI screening uptake > 100% resulted from educated participants motivating others to participate in screening. Two strategies, using face-to-face promotion and targeting smaller groups, were the most successful. The program resulted in high LTBI treatment initiation and completion (both 97%). Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and scepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources. Conclusions Eritrean migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community members, well-connected to and trusted by the community, are engaged in the design and execution of the program.
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Affiliation(s)
- Ineke Spruijt
- KNCV Tuberculosis Foundation, The Hague, The Netherlands. .,Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
| | - Dawit Tesfay Haile
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, The Hague, The Netherlands.,Present Address: National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Simone Goosen
- Netherlands Association of Community Health Services, Utrecht, The Netherlands
| | - Andrea Ten Kate
- Department of Tuberculosis Control, Public Health Service IJsselland, Zwolle, The Netherlands
| | - Hewan Teshome
- Department of Tuberculosis Control, Public Health Service Haaglanden, Den Haag, The Netherlands
| | - Marja Karels
- Department of Tuberculosis Control, Public Health Service Hollands Noorden, Alkmaar, The Netherlands
| | - Marga Koenders
- Department of Tuberculosis Control, Public Health Service Gelderland Zuid, Nijmegen, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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12
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Suurmond J, Bakker A, Van Loey N. Psychological distress in ethnic minority parents of preschool children with burns. Burns 2020; 46:407-415. [DOI: 10.1016/j.burns.2019.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/05/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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13
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Spruijt I, Tesfay Haile D, Suurmond J, van den Hof S, Koenders M, Kouw P, van Noort N, Toumanian S, Cobelens F, Goosen S, Erkens C. Latent tuberculosis screening and treatment among asylum seekers: a mixed-methods study. Eur Respir J 2019; 54:13993003.00861-2019. [DOI: 10.1183/13993003.00861-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/26/2019] [Indexed: 11/05/2022]
Abstract
IntroductionEvidence on conditions for implementation of latent tuberculosis infection (LTBI) screening and treatment among asylum seekers is needed to inform tuberculosis (TB) control policies. We used mixed-methods to evaluate the implementation of an LTBI screening and treatment programme among asylum seekers in the Netherlands.MethodsWe offered voluntary LTBI screening to asylum seekers aged ≥12 years living in asylum seeker centres from countries with a TB incidence >200 per 10 000 population. We calculated LTBI screening and treatment cascade coverage, and assessed associated factors with Poisson regression using robust variance estimators. We interviewed TB care staff (seven group interviews) and Eritrean clients (21 group and 21 individual interviews) to identify programme enhancers and barriers.ResultsWe screened 719 (63% of 1136) clients for LTBI. LTBI was diagnosed among 178 (25%) clients; 149 (84%) initiated LTBI treatment, of whom 129 (87%) completed treatment. In-person TB and LTBI education, the use of professional interpreters, and collaboration with partner organisations were enhancers for LTBI screening uptake. Demand-driven LTBI treatment support by TB nurses enhanced treatment completion. Factors complicating LTBI screening and treatment were having to travel to public health services, language barriers and moving from asylum seeker centres to the community during treatment.ConclusionLTBI screening and treatment of asylum seekers is feasible and effective when high quality of care is provided, including culture-sensitive TB education throughout the care cascade. Additionally, collaboration with partner organisations, such as agencies responsible for reception and support of asylum seekers, should be in place.
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14
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Spruijt I, Erkens C, Suurmond J, Huisman E, Koenders M, Kouw P, Toumanian S, Cobelens F, van den Hof S. Implementation of latent tuberculosis infection screening and treatment among newly arriving immigrants in the Netherlands: A mixed methods pilot evaluation. PLoS One 2019; 14:e0219252. [PMID: 31260502 PMCID: PMC6602457 DOI: 10.1371/journal.pone.0219252] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/19/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION To reach pre-elimination levels of tuberculosis (TB) incidence in the Netherlands, prevention of TB among immigrants through diagnosis and treatment of latent TB infection (LTBI) is needed. We studied the feasibility of a LTBI screening and treatment program among newly arriving immigrants for national implementation. METHODS We used mixed methods to evaluate the implementation of LTBI screening and treatment in five Public Health Services (PHS) among immigrants from countries with a TB incidence >50/100,000 population. We used Poisson regression models with robust variance estimators to assess factors associated with LTBI diagnosis and LTBI treatment initiation and reported reasons for not initiating or completing LTBI treatment. We interviewed five PHS teams using a semi-structured method to identify enhancing and impeding factors for LTBI screening and treatment. RESULTS We screened 566 immigrants; 94 (17%) were diagnosed with LTBI, of whom 49 (52%) initiated and 34 (69%) completed LTBI treatment. LTBI diagnosis was associated with male gender, higher age group, higher TB incidence in the country of origin and lower level of education. Treatment initiation was associated with PHS (ranging from 29% to 86%), lower age group, longer intended duration of stay in the Netherlands, and lower level of education. According to TB physicians, clients and their consulted physicians in the home country lacked awareness about benefits of LTBI treatment. Furthermore, TB physicians questioned the individual and public health benefit of clients who return to their country of origin within the foreseeable future. CONCLUSIONS Doubt of physicians in both host country and country of origin about individual and public health benefits of LTBI screening and treatment of immigrants hampered treatment initiation: the high initiation proportion in one PHS shows that if TB physicians are committed, the LTBI treatment uptake can be higher.
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Affiliation(s)
- Ineke Spruijt
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Huisman
- Department tuberculosis control, Public Health Service Haaglanden, The Hague, The Netherlands
| | - Marga Koenders
- Department tuberculosis control, Public Health Service Gelderland Zuid, Nijmegen, The Netherlands
| | - Peter Kouw
- Department tuberculosis control, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Sophie Toumanian
- Department tuberculosis control, Public Health Service Twente, Enschede, The Netherlands
| | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Lanting K, Dogra N, Hendrickx K, Nathan Y, Sim J, Suurmond J. Culturally Competent in Medical Education - European Medical Teachers' Self-Reported Preparedness and Training Needs to Teach Cultural Competence Topics and to Teach a Diverse Class. MedEdPublish (2016) 2019; 8:98. [PMID: 38089273 PMCID: PMC10712631 DOI: 10.15694/mep.2019.000098.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background Health inequalities related to culture and ethnicity may be reduced by training future health care providers.Medical teachers therefore also need to be culturally competent. The aim of this study was to assess medical teachers' preparedness and their training needs to teach cultural competence topics and to teach a diverse class. Methods A link to an online survey was sent to medical teachers of eleven European institutions. Results were analysed through descriptive analysis and answers to open-ended questions were analysed using qualitative analysis. Results 968 respondents were included. The majority of respondents felt it was important that cultural competence topics should be incorporated into the medical curriculum. Assessment of skills in cultural competence was found important as well. Over 60% of all respondents reported to be somewhat or very prepared to teach cultural competence topics like migrant health and disparities. Most respondents felt somewhat or very prepared to teach a diverse class. A high interest in training was expressed on teaching cultural competence topics, specifically on communication-related topics. Conclusion This study emphasizes the importance of incorporating cultural issues into the medical curriculum and to train medical teachers according to their needs.
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16
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Woudstra AJ, Suurmond J. How narratives influence colorectal cancer screening decision making and uptake: A realist review. Health Expect 2019; 22:327-337. [PMID: 31025444 PMCID: PMC6543268 DOI: 10.1111/hex.12892] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/11/2018] [Revised: 02/19/2019] [Accepted: 03/24/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although narratives have been found to affect decisions about preventive behaviours, including participation in cancer screening, the underlying mechanisms of narratives remain unclear. OBJECTIVE The purpose of this study was to summarize and synthesize existing literature on narrative interventions in the context of colorectal cancer screening. Our main research question was as follows: How, when and for whom do narratives work context of decision making about colorectal cancer screening participation? METHODS We undertook a realist review to collect evidence on narratives in the context of colorectal cancer screening. A search of the literature was performed in Embase, MEDLINE/PubMed, Cinahl and PsycINFO. We included empirical evaluations (qualitative or quantitative) of narrative interventions. In total, 15 studies met the inclusion criteria. A content-based taxonomy of patient narrative types in decision aids formed the basis for our initial programme theory. MAIN RESULT We identified four mechanisms: (a) process narratives that address perceived barriers towards screening lead to improved affective forecasting, (b) experience narratives that demonstrate the screening procedure lead to increased self-efficacy, (c) experience narratives that depict experiences from similar others lead to more engagement and (d) outcome narratives that focus on outcomes of colorectal cancer (CRC) screening decision decrease or increase fear of colorectal cancer. The evidence was limited on which narrative type may facilitate or bias informed decision making in colorectal cancer screening. DISCUSSION AND CONCLUSION The findings indicate the importance of more detailed descriptions of narrative interventions in order to understand how mechanisms may facilitate or bias informed decision making in colorectal cancer screening.
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Affiliation(s)
- Anke Judith Woudstra
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Suurmond J, Dogra N, Carter-Pokras O. Whole institution approaches for diversifying the medical curriculum. BMJ 2019; 364:l1043. [PMID: 30867147 DOI: 10.1136/bmj.l1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jeanine Suurmond
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Nisha Dogra
- Greenwood Institute of Child Health, University of Leicester, Leicester, UK
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Achterbergh L, Suurmond J, Linthorst GE. [Respectful ethnic profiling in the care sector]. Ned Tijdschr Geneeskd 2019; 163:D2716. [PMID: 30875161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Physicians sometimes use ethnicity as part of their clinical reasoning. Using ethnicity can sometimes, however, lead to bias and may lead to discrimination or racial discrimination. In this article we discuss some examples of wrongful medical profiling based on ethnicity, but also show how ethnic profiling can be performed respectfully.
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Affiliation(s)
| | | | - Gabor E Linthorst
- Amsterdam UMC, afd. Inwendige geneeskunde, Endocrinologie en Metabolisme, locatie UvA-AMC
- Contact: G.E. Linthorst
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19
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Kruithof K, Suurmond J, Harting J. Eating together as a social network intervention for people with mild intellectual disabilities: a theory-based evaluation. Int J Qual Stud Health Well-being 2019; 13:1516089. [PMID: 30204061 PMCID: PMC6136387 DOI: 10.1080/17482631.2018.1516089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE People with mild intellectual disabilities (MID) generally live independently among the wider community. This can result in social exclusion and feelings of loneliness. Therefore, social work organizations aim to socially include people with MID through organizing activities in neighbourhoods that should lead to enlarged networks and increased societal participation. The "Communal Table" is such a, group-orientated, intervention that organizes monthly dinners in Amsterdam, the Netherlands. Because little is known about the effectiveness of interventions aiming to bring about social inclusion for people with MID we explored which types of participants were reached and whether and how the intervention brought about the intended outcomes. METHODS We performed a theory-based evaluation, using participatory observations and qualitative interviews (n = 19). The Communal Table attracted a diverse and loyal group of participants. RESULTS We distinguished four types of participants-lonely participants, activist participants, satisfied participants and calculating participants-whose pre-existing networks played a significant role in their individual needs for support and the outcomes of the intervention. Outcomes reported included experiences of conviviality and warmth, temporary relief of underlying problems and an overall positive opinion about the intervention, but network enlargement or increased societal participation were not reported. CONCLUSIONS Our findings suggest that social network interventions for people with MID should be tailored to participants' pre-existing networks and related individual needs to be successful.
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Affiliation(s)
- Kasper Kruithof
- a Department of Public Health , Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
| | - Jeanine Suurmond
- a Department of Public Health , Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
| | - Janneke Harting
- a Department of Public Health , Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
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Sorensen J, Norredam M, Suurmond J, Carter-Pokras O, Garcia-Ramirez M, Krasnik A. Need for ensuring cultural competence in medical programmes of European universities. BMC Med Educ 2019; 19:21. [PMID: 30646910 PMCID: PMC6332889 DOI: 10.1186/s12909-018-1449-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/28/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Europe is becoming more social and cultural diverse as a result of the increasing migration, but the medical doctors are largely unprepared. The medical education programmes and teachers have not evolved in line with development of the population. Culturally competent curricula and teachers are needed, to ensure cultural competence among medical doctors and to tackle inequalities in health between different ethnic groups. The objective of this EU financed study is therefore to provide a snapshot of the role of cultural competence in European medical educational programmes. METHODS A questionnaire was developed in order to uncover strengths and weaknesses regarding cultural competence in the European medical education programmes. The questionnaire consisted of 32 questions. All questions had an evidence box to support the informants' understanding of the questions. The questionnaire was sent by email to the 12 European project partners. 12 completed questionnaires were returned. RESULTS Though over half of the participating medical programmes have incorporated how to handle social determinants of health in the curriculum most are lacking focus on how medical professionals' own norms and implicit attitudes may affect health care provision as well as abilities to work effectively with an interpreter. Almost none of the participating medical programmes evaluate the students on cultural competence learning outcomes. Most medical schools participating in the survey do not offer cultural competence training for teachers, and resources spent on initiatives related to cultural competences are few. Most of the participating medical programmes acknowledge that the training given to the medical students is not adequate for future jobs in the health care service in their respective country regarding cultural competence. CONCLUSIONS Our results indicate that there are major deficiencies in the commitment and practice within the participating educational programs and there are clear potentials for major improvements regarding cultural competence in programmes. Key challenges include making lasting changes to the curriculum and motivating and engaging stakeholders (teachers, management etc.) within the organisation to promote and allocate resources to cultural competence training for teachers.
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Affiliation(s)
- Janne Sorensen
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, 1014 Copenhagen, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, 1014 Copenhagen, Denmark
| | - Jeanine Suurmond
- Academic Medical Center, University of Amsterdam, Department of Public Health, Amsterdam Public Health research institute, P.O. Box 22660, 1100 DE Amsterdam, The Netherlands
| | - Olivia Carter-Pokras
- School of Public Health, University of Maryland, 4200 Valley Drive, Suite 2242G, College Park, MD 20742-2611 USA
| | - Manuel Garcia-Ramirez
- Faculty of Psychology, University of Seville, C/ Camilo José Cela, S/N, 41018 Sevilla, Spain
| | - Allan Krasnik
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, 1014 Copenhagen, Denmark
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21
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Hordijk R, Hendrickx K, Lanting K, MacFarlane A, Muntinga M, Suurmond J. Defining a framework for medical teachers' competencies to teach ethnic and cultural diversity: Results of a European Delphi study. Med Teach 2019; 41:68-74. [PMID: 29490534 DOI: 10.1080/0142159x.2018.1439160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Medical students need to be trained in delivering diversity-responsive health care but unknown is what competencies teachers need. The aim of this study was to devise a framework of competencies for diversity teaching. METHODS An open-ended questionnaire about essential diversity teaching competencies was sent to a panel. This resulted in a list of 74 teaching competencies, which was sent in a second round to the panel for rating. The final framework of competencies was approved by the panel. RESULTS Thirty-four experts participated. The final framework consisted of 10 competencies that were seen as essential for all medical teachers: (1) ability to critically reflect on own values and beliefs; (2) ability to communicate about individuals in a nondiscriminatory, nonstereotyping way; (3) empathy for patients regardless of ethnicity, race or nationality; (4) awareness of intersectionality; (5) awareness of own ethnic and cultural background; (6) knowledge of ethnic and social determinants of physical and mental health of migrants; (7) ability to reflect with students on the social or cultural context of the patient relevant to the medical encounter; (8) awareness that teachers are role models in the way they talk about patients from different ethnic, cultural and social backgrounds; (9) empathy for students of diverse ethnic, cultural and social background; (10) ability to engage, motivate and let all students participate. CONCLUSIONS This framework of teaching competencies can be used in faculty development programs to adequately train all medical teachers.
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Affiliation(s)
- Rowan Hordijk
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | - Kristin Hendrickx
- b Department of Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium
| | - Katja Lanting
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | | | | | - Jeanine Suurmond
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
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Chiarenza A, Horvat L, Lanting K, Suurmond J. A review of training programmes addressing healthcare for migrants and ethnic minorities in Europe. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.353] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - L Horvat
- Consumers as Partners Branch, Melbourne, Australia
| | - K Lanting
- Universiteit van Amsterdam (AMC), Amsterdam, Netherlands
| | - J Suurmond
- Universiteit van Amsterdam (AMC), Amsterdam, Netherlands
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Affiliation(s)
- Jeanine Suurmond
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Marieke Torensma
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
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Suurmond J, Fransen M. 3.2-O6“Big big problem, depression. It has no solution”. Exploration of the perceptions about depression among elderly migrants in the Netherlands. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.090] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Suurmond
- Academic Medical Centre/University of Amsterdam, The Netherlands
| | - M Fransen
- Academic Medical Centre/University of Amsterdam, The Netherlands
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Torensma M, de Voogd X, Suurmond J, Oosterveld-Vlug M, Onwuteaka-Philipsen B, Willems D. 3.11-P9Diversity in palliative care in the Netherlands: development of an instrument to assess diversity responsiveness of research and reform projects. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.131] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Torensma
- Academic Medical Centre Amsterdam, The Netherlands
| | - X de Voogd
- Academic Medical Centre Amsterdam, The Netherlands
| | - J Suurmond
- Academic Medical Centre Amsterdam, The Netherlands
| | | | | | - D Willems
- Academic Medical Centre Amsterdam, The Netherlands
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26
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Lanting K, Marek E, Ridder M, Feiszt Z, Verdonk P, Suurmond J. 4.5-O2Amsterdam Public Health, Global Health program – health professionals’ perception of implicit bias towards minority patients in health care in the Netherlands and Hungary. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.149] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Lanting
- Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - M Ridder
- VU University Medical Center Amsterdam, The Netherlands
| | | | - P Verdonk
- VU University Medical Center Amsterdam, The Netherlands
| | - J Suurmond
- Academic Medical Center, University of Amsterdam, The Netherlands
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De Voogd X, Suurmond J, Onwuteaka-Philipsen B, Willems D, Oosterveld-Vlug M, Torensma M. 6.10-P12Dignity in the last phase of life of non-western patients in the Netherlands, from the perspective of Turkish, Moroccan and Surinamese key informants, patients and relatives. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.217] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- X De Voogd
- Academic Medical Centre (amc), The Netherlands
| | - J Suurmond
- Academic Medical Centre (amc), The Netherlands
| | | | - D Willems
- Academic Medical Centre (amc), The Netherlands
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Suurmond J, Torensma M. 1.2-O4Loneliness among elderly migrants in the Netherlands – a qualitative study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.011] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Suurmond
- Academic Medical Centre/University of Amsterdam, The Netherlands
| | - M Torensma
- Academic Medical Centre/University of Amsterdam, The Netherlands
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Abstract
BACKGROUND Although using professional interpreters is known to improve health outcomes for patients when language barriers are present, care providers often hesitate to use them. Training in how to use interpreters has been effective in increasing students' knowledge and self-efficacy, but little is known about how students apply the competencies gained. We explored students' perspectives on how they dealt with language barriers during their clerkships. METHOD Students in the Netherlands who received training (n = 8) and who did not receive training (n = 8) were interviewed about their experiences during their clerkships with regards to language barriers and the use of professional interpreters. RESULTS Students do not report using interpretation services during clerkships, even when they have been trained. Students report that their supervisors and other staff members provide barriers to the use of interpretation services. CONCLUSIONS Not only students but also staff need training in the use of professional interpretation services, because staff serve as role models for the students. Care providers often hesitate to use [professional interpreters].
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Affiliation(s)
- Laura Lijbers
- Fontys University of Applied Sciences, Tilburg, the Netherlands
| | - Debby Gerritsen
- Department of Interdisciplinary Social Sciences, Faculty of Social and Behavioural Sciences, University of Amsterdam, the Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Academic Medical Centre/University of Amsterdam, the Netherlands
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Suurmond J, Lieveld A, van de Wetering M, Schouten-van Meeteren AYN. Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28370728 DOI: 10.1111/ecc.12680] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
In order to gain more insight on the influence of ethnic diversity in paediatric cancer care, the perspectives of care providers were explored. Semi-structured interviews were conducted among 12 paediatric oncologists and 13 nurses of two different paediatric oncology wards and were analysed using a framework method. We found that care providers described the contact with Turkish and Moroccan parents as more difficult. They offered two reasons for this: (1) language barriers between care provider and parents hindered the exchange of information; (2) cultural barriers between care provider and parents about sharing the diagnosis and palliative perspective hindered communication. Care providers reported different solutions to deal with these barriers, such as using an interpreter and improving their cultural knowledge about their patients. They, however, were not using interpreters sufficiently and were unaware of the importance of eliciting parents' perspectives. Communication techniques to overcome dilemmas between parents and care providers were not used and care providers were unaware of stereotypes and prejudice. Care providers should be offered insight in cultural barriers they are unaware of. Training in cultural competence might be a possibility to overcome manifest barriers.
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Affiliation(s)
- J Suurmond
- Department of Public Health, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - A Lieveld
- OLVG West, Amsterdam, The Netherlands
| | - M van de Wetering
- Department of Pediatric Oncology, Emma Children's Hospital Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - A Y N Schouten-van Meeteren
- Department of Pediatric Oncology, Emma Children's Hospital Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Sorensen J, Norredam M, Dogra N, Essink-Bot ML, Suurmond J, Krasnik A. Enhancing cultural competence in medical education. Int J Med Educ 2017; 8:28-30. [PMID: 28125799 PMCID: PMC5275746 DOI: 10.5116/ijme.587a.0333] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/14/2017] [Indexed: 05/15/2023]
Affiliation(s)
- Janne Sorensen
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Denmark
| | - Nisha Dogra
- Greenwood Institute of Child Health, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Marie-Louise Essink-Bot
- Academic Medical Center, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jeanine Suurmond
- Academic Medical Center, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Allan Krasnik
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Denmark
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Soerensen J, Suurmond J, Lanting K, Krasnik A. Capacity building in Danish Medical Education: towards culturally competent medical teachers. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw164.044] [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: 11/13/2022] Open
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Hudelson P, Dogra N, Hendrickx K, Verdonk P, Essink-Bot ML, Suurmond J. The challenges of integrating cultural competence into undergraduate medical curricula across Europe: experience from the C2ME “Culturally competent in medical education” project. MedEdPublish 2016. [DOI: 10.15694/mep.2016.000010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. Providing high quality care to socially and culturally diverse populations is challenging. Many organizations concerned with quality and equity in health care have called for physician training in cross cultural communication as one strategy for ensuring patient-centered health care for all, but little is known about how to effectively and sustainably integrate such teaching into the medical school curriculum.The C2ME "Culturally Competent in Medical Education" is a European project whose aim was to contribute to the integration of cultural competence teaching in undergraduate medical curricula across Europe. In order to foster exchange among medical schools about cultural competence training, C2ME organized a symposium at the 2014 European Association for Communication in Health Care (EACH) conference. The symposium highlighted the variety of teaching approaches and methods that are used to teach cultural competence as well as the the institutional challenges that make integration of cultural competence into the curricula difficult. There is a need for greater exchange of experiences and best practices among European medical schools to overcome these challenges.
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Abstract
OBJECTIVE Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. SETTING Four large urban hospitals with an ethnic diverse patient population. PARTICIPANTS On hospital admission of ethnic minority patients, 20 cases were purposively sampled in which relatives were observed to play a role in the care process. OUTCOME MEASURES We used documents (patient records) and added eight cases with qualitative interviews with healthcare providers, patients and/or their relatives to investigate the relation between the role of relatives and patient safety. An inductive approach followed by selective coding was used to analyse the data. RESULTS Besides giving social support, family members took on themselves the role of the interpreter, the role of substitutes of the patient and the role of care provider. The taking over of these roles can have positive and negative effects on patient safety. CONCLUSIONS When family members take over various roles during hospitalisation of a relative, this can lead to a safety risk and a safety protection for the patient involved. Although healthcare providers should not hand over their responsibilities to the relatives of patients, optimising collaboration with relatives who are willing to take part in the care process may improve patient safety.
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Affiliation(s)
- Floor van Rosse
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center (VUmc), EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, VU University Medical Center (VUmc), EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Martine de Bruijne
- Department of Public and Occupational Health, VU University Medical Center (VUmc), EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Suurmond J, Woudstra A, Essink-Bot ML. The interpreter as co-interviewer: the role of the interpreter during interviews in cross-language health research. J Health Serv Res Policy 2016; 21:172-7. [PMID: 26888477 DOI: 10.1177/1355819616632020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/17/2022]
Abstract
OBJECTIVE Interviews with ethnic minority patients provide a rich source of data to understand their perspectives of disease and its management. Language barriers are, however, often a problem so interpreters need to be used. We explored the impact of the interpreter on cross-language interviews between researchers and respondents. METHODS Secondary analysis of four interviews between researchers and patients involving professional interpreters. RESULTS Interpreters were actively involved and influenced the interview in several ways: they assumed the interviewer's communicative role, edited information; initiated information-seeking, took over control of the interview, and took over the respondent's role. While the interpreter supported the interviewer, they posed risks to the quality of the interview. CONCLUSION Researchers need to be aware of the influence of interpreters. Researchers should instruct interpreters carefully about their roles though they may benefit from interpreters' strategies to support them.
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Affiliation(s)
- Jeanine Suurmond
- Project Coordinator European projects, Department of Public Health, Academic Medical Centre/University of Amsterdam, the Netherlands
| | - Anke Woudstra
- Researcher, Department of Public Health, Academic Medical Centre/University of Amsterdam, the Netherlands
| | - Marie-Louise Essink-Bot
- Principal Investigator, Department of Public Health, Academic Medical Centre/University of Amsterdam, the Netherlands
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Suurmond J, Dorjée AL, Knol EF, Huizinga TWJ, Toes REM. Differential TLR-induced cytokine production by human mast cells is amplified by FcɛRI triggering. Clin Exp Allergy 2015; 45:788-96. [PMID: 25665021 DOI: 10.1111/cea.12509] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 11/29/2014] [Revised: 01/12/2015] [Accepted: 02/04/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mast cells are mainly present in strategic locations, where they may have a role in defence against parasites and bacteria. These pathogens can be recognized by mast cells via Toll-like receptors (TLR). Allergic symptoms are often increased in the presence of pathogens at the site of allergen exposure, but it is unknown which cytokines can mediate such an effect. OBJECTIVE To study whether an interaction between IgE- and TLR-mediated activation of human mast cells can contribute to exacerbated inflammatory responses. METHODS Peripheral blood-derived mast cells were stimulated with TLR ligands, in the presence or absence of anti-IgE triggering, after which degranulation was measured using flow cytometry and cytokine production was evaluated by multiplex assays, and ELISA. For evaluation of allergen-specific responses, mast cells were sensitized with serum of allergic individuals or controls, after which they were stimulated using allergens in combination with TLR ligands. RESULTS Simultaneous triggering of mast cells via IgE and TLR ligands greatly enhanced cytokine production but not IgE-induced degranulation. Different TLR ligands specifically enhanced the differential production of cytokines in conjunction with FcεRI triggering. Importantly, only TLR-4 and TLR-6 were able to induce robust production of IL-13, an important molecule in allergic reactions. CONCLUSIONS & CLINICAL RELEVANCE These results indicate that the simultaneous presence of pathogen- or danger-associated signals and FcεRI triggering via specific IgE can significantly modify mast cell-mediated allergic reactions via synergistic production of cytokines and inflammatory mediators and provide an explanation of augmented allergic symptoms during infection.
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Affiliation(s)
- J Suurmond
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Woudstra AJ, Dekker E, Essink-Bot ML, Suurmond J. Knowledge, attitudes and beliefs regarding colorectal cancer screening among ethnic minority groups in the Netherlands - a qualitative study. Health Expect 2015; 19:1312-1323. [PMID: 26576015 PMCID: PMC5139054 DOI: 10.1111/hex.12428] [Citation(s) in RCA: 23] [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] [Accepted: 10/14/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Research has shown that ethnic minority groups are less likely to participate in colorectal cancer (CRC) screening than the majority population and hence less likely to be diagnosed at an early stage when treatment is potentially more successful. OBJECTIVE To explore knowledge, attitudes and beliefs regarding CRC and CRC screening among ethnic minority groups in the Netherlands. DESIGN We conducted qualitative interviews with 30 first-generation immigrants born in Turkey, Morocco and Surinam. We based the topic guide on the health belief model. Framework analysis was used to analyse our data. RESULTS Although knowledge of CRC and CRC screening was limited, all respondents felt susceptible to CRC. CRC screening was perceived to mainly benefit those individuals with poor health and symptoms. Although most respondents had a positive attitude towards CRC screening, knowledge about its potential harms was limited and self-efficacy to participate was low. Adult children acted as important mediators in providing access to information. The language barrier and low literacy formed serious barriers to informed participation in CRC screening. CONCLUSION To ensure that all eligible individuals, including ethnic minority groups, have equal opportunities to informed participation in screening, targeted communication strategies should be developed, such as oral and visual channels, and face-to-face communication in the mother tongue. This will help ethnic minority groups to make an informed decision about participation in CRC screening.
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Affiliation(s)
- Anke J Woudstra
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Rivellese F, Suurmond J, Habets K, Dorjée A, de Paulis A, Marone G, Pitzalis C, Huizinga T, Toes R. THU0024 Human Mast Cells Stimulated with IL-33 and Immune Complexes Down-Regulate Monocyte Activation in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3541] [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: 11/03/2022]
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Ikram UZ, Essink-Bot ML, Suurmond J. How we developed an effective e-learning module for medical students on using professional interpreters. Med Teach 2015; 37:422-7. [PMID: 25109296 DOI: 10.3109/0142159x.2014.939579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Language barriers may lead to poorer healthcare services for patients who do not speak the same language as their care provider. Despite the benefits of professional interpreters, care providers tend to underuse professional interpretation. Evidence suggests that students who received training on language barriers and interpreter use are more likely to utilize interpretation services. AIMS We developed an e-learning module for medical students on using professional interpreters during the medical interview, and evaluated its effects on students' knowledge and self-efficacy. METHODS In the e-learning module, three patient-physician-interpreter video vignettes were presented, with three different types of interpreters: a family member, an untrained bilingual staff member, and a professional interpreter. The students answered two questions about each vignette, followed by feedback which compared their responses with expert information. In total, 281 fourth-year medical students took the e-learning module during the academic year 2012-2013. We assessed their knowledge and self-efficacy in interpreter use pre- and post-test on 1 (lowest)-10 (highest) scale, and analysed the differences in mean scores using paired t-tests. RESULTS Upon completing the e-learning module, students reported higher self-efficacy in using professional interpretation. The mean knowledge score on the pre-test was 5.5 (95% confidence interval 5.3-5.8), but on the post-test this increased to 8.4 (95% CI 8.2-8.6). The difference was highly significant (p < 0.001). For self-efficacy, the mean score on the pre-test was 4.9 (95% CI 4.7-5.1), and on the post-test 7.0 (95% CI 6.8-7.1); p < 0.001. CONCLUSION This e-learning module improved students' knowledge and self-efficacy in using professional interpreters during the medical interview. Using such tools in medical curricula might encourage future doctors to use professional interpretation services to overcome language barriers, thereby potentially contributing to equitable healthcare services for a linguistically diverse patient population.
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Suurmond J, Rosenmöller DL, El Mesbahi H, Lamkaddem M, Essink-Bot ML. Barriers in access to home care services among ethnic minority and Dutch elderly--a qualitative study. Int J Nurs Stud 2015; 54:23-35. [PMID: 25776734 DOI: 10.1016/j.ijnurstu.2015.02.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 08/28/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ethnic minority elderly have a high prevalence of functional limitations and chronic conditions compared to Dutch elderly. However, their use of home care services is low compared to Dutch elderly. OBJECTIVES Explore the barriers to access to home care services for Turkish, Moroccan Surinamese and ethnic Dutch elderly. DESIGN Qualitative semi-structured group interviews and individual interviews. SETTING The Netherlands. PARTICIPANTS Seven group interviews (n=50) followed by individual interviews (n=5) were conducted, in the preferred language of the participants. METHODS Results were ordered and reported according to a framework of access to health care services. This framework describes five dimensions of accessibility to generate access to health care services, from the perspective of the users: ability to perceive health needs, ability to seek health care, ability to reach, ability to pay and ability to engage. RESULTS This study shows that while barriers are common among all groups, several specific barriers in access to home care services exist for ethnic minority elderly. Language and communication barriers as well as limited networks and a preference for informal care seem to mutually enforce each other, resulting in many barriers during the navigation process to home care. CONCLUSION In order to provide equal access to home care for all who need it, the language and communication barriers should be tackled by home care services and home care nurses.
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Affiliation(s)
- Jeanine Suurmond
- Department of Public Health, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Doenja L Rosenmöller
- Department of Public Health, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Hakima El Mesbahi
- Department of Public Health, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Majda Lamkaddem
- Department of Public Health, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Suurmond J, Seeleman C, Essink-Bot ML. Analyzing Fallacies in Argumentation to Enhance Effectiveness of Educational Interventions: The Case of Care Providers' Arguments Against Using Professional Interpretation. J Contin Educ Health Prof 2015; 35:249-254. [PMID: 26953855 DOI: 10.1097/ceh.0000000000000003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Although research has shown that professional interpreters improve health care to patients who do not speak the same language as their care provider, care providers underuse professional interpretation services. To get more insight into the reasons of care providers to underuse professional interpreters, we studied fallacies in their arguments. Fallacies in reasoning may explain why care providers avoid changing their behavior even if they are aware of evidence in favor of such behavior. METHODS We did a secondary analysis of interviews about immigrant patients with care providers collected in two studies on in-hospital pediatric care. Interviews (N = 37) were held in 2009, in the Netherlands. Interviews were analyzed using a contextual approach to fallacious argumentation: a method that can identify fallacies as "wrong" arguments compared with the context in they are made. RESULTS We identified six main fallacies that care providers used to argue that they prefer not to use a professional interpreter while having free access to professional interpreters: 1) There are also some negative side effects to using professional interpreters, 2) there is no language problem, 3) it is such an enormous hassle to organize it, 4) I am a good doctor, 5) my medical information is not complex, and 6) patients do not want it. DISCUSSION Familiarizing care providers with these fallacies can raise their awareness of the wrong arguments to defend their underuse of professional interpreters and can be made part of their training.
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Affiliation(s)
- Jeanine Suurmond
- Drs. Suurmond, Seeleman, and Essink-Bot: Department of Public Health, Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
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Seeleman C, Hermans J, Lamkaddem M, Suurmond J, Stronks K, Essink-Bot ML. A students' survey of cultural competence as a basis for identifying gaps in the medical curriculum. BMC Med Educ 2014; 14:216. [PMID: 25305069 PMCID: PMC4287427 DOI: 10.1186/1472-6920-14-216] [Citation(s) in RCA: 20] [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: 05/02/2014] [Accepted: 10/03/2014] [Indexed: 05/15/2023]
Abstract
BACKGROUND Assessing the cultural competence of medical students that have completed the curriculum provides indications on the effectiveness of cultural competence training in that curriculum. However, existing measures for cultural competence mostly rely on self-perceived cultural competence. This paper describes the outcomes of an assessment of knowledge, reflection ability and self-reported culturally competent consultation behaviour, the relation between these assessments and self-perceived cultural competence, and the applicability of the results in the light of developing a cultural competence educational programme. METHODS 392 medical students, Youth Health Care (YHC) Physician Residents and their Physician Supervisors were invited to complete a web-based questionnaire that assessed three domains of cultural competence: 1) general knowledge of ethnic minority care provision and interpretation services; 2) reflection ability; and 3) culturally competent consultation behaviour. Additionally, respondents graded their overall self-perceived cultural competence on a 1-10 scale. RESULTS 86 medical students, 56 YHC Residents and 35 YHC Supervisors completed the questionnaire (overall response rate 41%; n= 177). On average, respondents scored low on general knowledge (mean 46% of maximum score) and knowledge of interpretation services (mean 55%) and much higher on reflection ability (80%). The respondents' reports of their consultation behaviour reflected moderately adequate behaviour in exploring patients' perspectives (mean 64%) and in interaction with low health literate patients (mean 60%) while the score on exploring patients' social contexts was on average low (46%). YHC respondents scored higher than medical students on knowledge of interpretation services, exploring patients' perspectives and exploring social contexts. The associations between self-perceived cultural competence and assessed knowledge, reflection ability and consultation behaviour were weak. CONCLUSION Assessing the cultural competence of medical students and physicians identified gaps in knowledge and culturally competent behaviour. Such data can be used to guide improvement efforts to the diversity content of educational curricula. Based on this study, improvements should focus on increasing knowledge and improving diversity-sensitive consultation behaviour and less on reflection skills. The weak association between overall self-perceived cultural competence and assessed knowledge, reflection ability and consultation behaviour supports the hypothesis that measures of sell-perceived competence are insufficient to assess actual cultural competence.
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Affiliation(s)
- Conny Seeleman
- />Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DE Amsterdam, The Netherlands
| | - Jessie Hermans
- />Netherlands School of Public and Occupational Health, Utrecht, The Netherlands
| | - Majda Lamkaddem
- />Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DE Amsterdam, The Netherlands
| | - Jeanine Suurmond
- />Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DE Amsterdam, The Netherlands
| | - Karien Stronks
- />Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DE Amsterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- />Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DE Amsterdam, The Netherlands
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Suurmond J, Rivellese F, Dorjée AL, Bakker AM, Rombouts YJPC, Rispens T, Wolbink G, Zaldumbide A, Hoeben RC, Huizinga TWJ, Toes REM. Toll-like receptor triggering augments activation of human mast cells by anti-citrullinated protein antibodies. Ann Rheum Dis 2014; 74:1915-23. [PMID: 24818634 DOI: 10.1136/annrheumdis-2014-205562] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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: 03/12/2014] [Accepted: 04/17/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Mast cells may play a role in rheumatoid arthritis (RA), but activation of human mast cells in autoimmune settings has been little studied. Toll-like receptors (TLR) and Fcγ receptors (FcγR) are important receptors for cellular activation in the joint, but expression and stimulation of these receptors in human mast cells or the functional interplay between these pathways is poorly understood. Here, we analysed triggering of human mast cells via these receptors in the context of anti-citrullinated protein antibody-positive (ACPA+) RA. METHODS RNA and protein expression of TLRs and FcγR was quantified using PCR and flow cytometry, respectively. Mast cells were stimulated with TLR ligands (including HSP70) combined with IgG immune complexes and IgG-ACPA. RESULTS Human mast cells expressed TLRs and produced cytokines in response to TLR ligands. Both cultured and synovial mast cells expressed FcγRIIA, and triggering of this receptor by IgG immune complexes synergised with activation by TLR ligands, leading to two- to fivefold increased cytokine levels. Mast cells produced cytokines in response to ACPA immune complexes in a citrulline-specific manner, which synergised in the presence of HSP70. CONCLUSIONS Our data show that synovial mast cells express FcγRIIA and that mast cells can be activated by IgG-ACPA and TLR ligands. Importantly, combined stimulation via TLRs and immune complexes leads to synergy in cytokine production. These findings suggest mast cells are important targets for TLR ligands and immune complexes, and that combined activation of mast cells via these pathways greatly enhances inflammation in synovial tissue of RA patients.
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Affiliation(s)
- J Suurmond
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Rivellese
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - A L Dorjée
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - A M Bakker
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y J P C Rombouts
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - T Rispens
- Sanquin Research and Landsteiner Laboratorium, Academic Medical Center, Amsterdam, The Netherlands
| | - G Wolbink
- Sanquin Research and Landsteiner Laboratorium, Academic Medical Center, Amsterdam, The Netherlands
| | - A Zaldumbide
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - R C Hoeben
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - T W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Suurmond J, Rupp I, Seeleman C, Goosen S, Stronks K. The first contacts between healthcare providers and newly-arrived asylum seekers: a qualitative study about which issues need to be addressed. Public Health 2013; 127:668-73. [DOI: 10.1016/j.puhe.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/06/2012] [Accepted: 04/08/2013] [Indexed: 11/24/2022]
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de Bruijne MC, van Rosse F, Uiters E, Droomers M, Suurmond J, Stronks K, Essink-Bot ML. Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study. Eur J Public Health 2013; 23:964-71. [PMID: 23388242 PMCID: PMC3840803 DOI: 10.1093/eurpub/ckt005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Studies in the USA have shown ethnic inequalities in quality of hospital care, but in Europe, this has never been analysed. We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands. Methods: We analysed unplanned readmissions and excess length of stay (LOS) across ethnic groups in a large population of hospitalized patients over an 11-year period by linking information from the national hospital discharge register, the Dutch population register and socio-economic data. Data were analysed with stepwise logistic regression. Results: Ethnic differences were most pronounced in older patients: all non-Western ethnic groups > 45 years had an increased risk for excess LOS compared with ethnic Dutch patients, with odds ratios (ORs) (adjusted for case mix) varying from 1.05 [95% confidence intervals (95% CI) 1.02–1.08] for other non-Western patients to 1.14 (95% CI 1.07–1.22) for Moroccan patients. The risk for unplanned readmission in patients >45 years was increased for Turkish (OR 1.24, 95% CI 1.18–1.30) and Surinamese patients (OR 1.11, 95% CI 1.07–1.16). These differences were explained partially, although not substantially, by differences in socio-economic status. Conclusion: We found significant ethnic variations in unplanned readmissions and excess LOS. These differences may be interpretable as shortcomings in the quality of hospital care delivered to ethnic minority patients, but exclusion of alternative explanations (such as differences in patient- and community-level factors, which are outside hospitals’ control) requires further research. To quantify potential ethnic inequities in hospital care in Europe, we need empirical prospective cohort studies with solid quality outcomes such as adverse event rates.
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Affiliation(s)
- Martine C de Bruijne
- 1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Suurmond J, Bakker AM, Knol EF, Huizinga TWJ, Toes REM, Schuerwegh AJM. Toll-like receptor triggering can synergise with ige-mediated activation in ACPA+RA. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201230.7] [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: 11/03/2022]
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Suurmond J, Dorjee AL, Boon MR, Knol EF, Huizinga TWJ, Toes REM, Schuerwegh AJM. Mast cells are the main IL-17 producing cells in synovium of anti-citrullinated protein antibody-positive and -negative rheumatoid arthritis and osteoarthritis patients. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.148973.4] [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: 11/04/2022]
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Suurmond J, Schuerwegh AJM, Toes REM. Anti-citrullinated protein antibodies in rheumatoid arthritis: a functional role for mast cells and basophils? Ann Rheum Dis 2011; 70 Suppl 1:i55-8. [DOI: 10.1136/ard.2010.138032] [Citation(s) in RCA: 9] [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: 11/03/2022]
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Suurmond J, Uiters E, de Bruijne MC, Stronks K, Essink-Bot ML. Negative health care experiences of immigrant patients: a qualitative study. BMC Health Serv Res 2011; 11:10. [PMID: 21235738 PMCID: PMC3029223 DOI: 10.1186/1472-6963-11-10] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 01/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Negative events are abusive, potentially dangerous or life-threatening health care events, as perceived by the patient. Patients' perceptions of negative events are regarded as a potentially important source of information about the quality of health care. We explored negative events in hospital care as perceived by immigrant patients. METHODS Semi-structured individual and group interviews were conducted with respondents about negative experiences of health care. Interviews were transcribed and analyzed using a framework method. A total of 22 respondents representing 7 non-Dutch ethnic origins were interviewed; each respondent reported a negative event in hospital care or treatment. RESULTS Respondents reported negative events in relation to: 1) inadequate information exchange with care providers; 2) different expectations between respondents and care providers about medical procedures; 3) experienced prejudicial behavior on the part of care providers. CONCLUSIONS We identified three key situations in which negative events were experienced by immigrant patients. Exploring negative events from the immigrant patient perspective offers important information to help improve health care. Our results indicate that care providers need to be trained in adequately exchanging information with the immigrant patient and finding out specific patient needs and perspectives on illness and treatment.
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Affiliation(s)
- Jeanine Suurmond
- Academic Medical Centre/University of Amsterdam, Department of Social Medicine, Amsterdam, The Netherlands.
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Suurmond J, Seeleman C, Rupp I, Goosen S, Stronks K. Cultural competence among nurse practitioners working with asylum seekers. Nurse Educ Today 2010; 30:821-826. [PMID: 20416993 DOI: 10.1016/j.nedt.2010.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 02/17/2010] [Accepted: 03/10/2010] [Indexed: 05/28/2023]
Abstract
Asylum seekers often have complex medical needs. Little is known about the cultural competences health care providers should have in their contact with asylum seekers in order to meet their needs. Cultural competence is generally defined as a combination of knowledge about certain cultural groups, as well as attitudes towards and skills for dealing with cultural diversity. Given asylum seekers' specific care needs, it may be asked whether this set of general competences is adequate for the medical contact with asylum seekers. We explored the cultural competences that nurse practitioners working with asylum seekers thought were important. A purposive sample of 89 nurse practitioners in the Netherlands completed a questionnaire. In addition, six group interviews with nurse practitioners were also conducted. A framework analysis was used to analyse the data of the questionnaires and the interviews. From the analysis, several specific competences emerged, which were required for the medical contact with asylum seekers: knowledge of the political situation in the country of origin; knowledge with regard to diseases common in the country of origin; knowledge of the effects of refugeehood on health; awareness of the juridical context in the host country; ability to deal with asylum seekers' traumatic experiences; and skills to explain the host country's health care system. Apart from these cultural competences specific for the situation of asylum seekers, general cultural competences were also seen as important, such as the ability to use interpretation services. We conclude that insight into these cultural competences may help to develop related education and training for health care providers working with asylum seekers.
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Affiliation(s)
- Jeanine Suurmond
- Academic Medical Centre, University of Amsterdam, Dept. of Public Health, P.O. Box 22660, 1100 DD Amsterdam, Netherlands.
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