Abstract
BackgroundIn a context of increasing ethnic diversity, culturally competent strategies have been recommended to improve care quality and access to health care for ethnic minorities and migrants; their implementation by health professionals, however, has remained patchy. Most programs of cultural competence assume that health professionals accept that they have a responsibility to adapt to migrants, but this assumption has often remained at the level of theory. In this paper, we surveyed health professionals’ views on their responsibility to adapt.MethodsFive hundred-and-sixty-nine health professionals from twenty-four inpatient and outpatient health services were selected according to their geographic location. All health care professionals were requested to complete a questionnaire about who should adapt to ethnic diversity: health professionals or patients. After a factorial analysis to identify the underlying responsibility dimensions, we performed a multilevel regression model in order to investigate individual and service covariates of responsibility attribution.ResultsThree dimensions emerged from the factor analysis: responsibility for the adaptation of communication, responsibility for the adaptation to the negotiation of values, and responsibility for the adaptation to health beliefs. Our results showed that the sense of responsibility for the adaptation of health care depended on the nature of the adaptation required: when the adaptation directly concerned communication with the patient, health professionals declared that they should be the ones to adapt; in relation to cultural preferences, however, the responsibility felt on the patient’s shoulders. Most respondents were unclear in relation to adaptation to health beliefs. Regression indicated that being Belgian, not being a physician, and working in a primary-care service were associated with placing the burden of responsibility on the patient.ConclusionsHealth care professionals do not consider it to be their responsibility to adapt to ethnic diversity. If health professionals do not feel a responsibility to adapt, they are less likely to be involved in culturally competent health care.
Highlights
In a context of increasing ethnic diversity, culturally competent strategies have been recommended to improve care quality and access to health care for ethnic minorities and migrants; their implementation by health professionals, has remained patchy
The results imply that attitudes to responsibility for the adaptation of health care depend on the nature of the adaptation required: when the adaptation directly concerned communication with the patient, health professionals declared they are the ones to adapt, but for cultural preferences the responsibility seems to fall on patients’ shoulders
How can we explain that responsibility falls on health care providers for instrumental communication, whereas it falls on patients for the negotiation of values? Four elements may contribute to our understanding of the attribution of responsibility: the legal framework, the training of health professionals, the organisational culture, and the adaptation to communication as a prerequisite to other adaptation issues
Summary
In a context of increasing ethnic diversity, culturally competent strategies have been recommended to improve care quality and access to health care for ethnic minorities and migrants; their implementation by health professionals, has remained patchy. Health professionals are required to adapt to specific demands by migrant patients in order to lower linguistic or cultural barriers that prevent these groups from accessing adequate care [2,3] This adaptation requirement is reinforced by international and national and intercultural mediators in health facilities, the development of culturally-specific health services or ethnically sensitive health promotion campaigns, etc. The organisation of health services and health systems varies from one country to another, migrants and ethnic minorities still have lower levels of access to health promotion facilities and health prevention [18,19] They experience worse health outcomes in acute [20] and chronic conditions, such as type 2 diabetes mellitus [21] and asthma [22]. This leads to temporary or permanent complications, increasing the burden of diseases among these vulnerable groups: e.g. higher rates of amputations due to inadequate management of type 2 diabetes mellitus have been reported among ethnic minorities [23]
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