Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study

E Teunissen,E Van Weel-Baumgarten,A Macfarlane,M Van Den Muijsenbergh,T De Brún,C O’Donnell,C Van Weel,K Gravenhorst,A Saridaki,C Dowrick,F Van Den Driessen Mareeuw,C Lionis,F S Mair,M Papadakaki,M O’Reilly-De Brún,W Spiegel,N Burns

doi:10.1186/s12939-017-0525-y

Abstract

BackgroundCross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice.MethodsWe undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers’ fieldwork reports, were coded and thematically analysed by each team using NPT.ResultsIn all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants’ needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP’s diagnoses and GPs reported a clearer understanding of migrants’ symptoms.ConclusionsMigrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.

Highlights

Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care
With migration on the rise globally, problems with crosscultural communication are increasingly common in primary care, leaving migrants vulnerable to sub-standard care [4,5,6] and healthcare providers unsatisfied with the quality of care they deliver [7,8,9]
One of the reasons being the fact that these guidelines and training initiatives (G/TIs) are often not well tailored to daily practice, and stakeholders

Summary

Introduction

Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Recent research provides evidence of the value of participatory methodologies to engage migrants and indicates the positive impact of their involvement on the development of guidelines to improve communication in cross-cultural consultations [14, 24]. Taken together, this shows that it is imperative to involve migrants in the implementation and evaluation of available G/TIs in primary care to improve communication in cross-cultural consultations.

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Conclusion