Influence of national culture on the social construction of health care quality

Abstract

The purpose of this study is to examine how national culture influences the social constructions of health care quality in the Kuwaiti primary care. Kuwait has a well- developed primary care system, offering a wide range of services in practices distributed throughout the nation, throughout the day, and on a walk-in basis. Despite its extended hours, relative comprehensiveness and affordability, the primary care service in Kuwait appears to be poorly received by the public. This study employed a qualitative research methodology to investigate how the elements of the Kuwaiti national culture shape the social constructions of health care quality. The study proposal was reviewed by the research ethics committees of the University of Surrey and KIMS, and a favourable ethical opinion was obtained. Participant information sheet were given to potential participants and consent obtained before data collection. Semi-structured interviews were conducted with 42 participants from various stakeholder groups. Data analysis identified three themes that represent the experiences of the various stakeholders’ relating to their social constructions of health care quality in primary care: (1) meanings of health, (2) attitudes towards primary care service, and (3) access to primary care. Within the identified themes, a number of sub-themes were identified, including: (a) the meaning of health, (b) responsibility for one’s health, (c) tensions in doctor-patient communication, (d) doctors feeling ‘undervalued’, (e) gender issues, (f) cultural suitability of primary care, (g) primary care work environment, (h) disproportionate distribution, (i) waiting times, and (j) institutional discrimination. The study found that the high-power distance element of national culture impacts the social constructions of health care quality. Perceptions of power differentials across social groups seem to contribute considerably to the social construction of health care quality. The contribution of this study is towards the body of knowledge on the cultural competence of health care provision in high-power distance cultures.