he Language Barrier in Primary Care Perspectives of …在初级保健方面的语言障碍….ppt

The Language Barrier in Primary Care: Perspectives of Refugees and Asylum Seekers Department of General Practice Health Services Research Seminar December 13th 2005 Anne MacFarlane, Department of General Practice, NUI, Galway Unprecedented Patterns of Migration Anne MacFarlane, Department of General Practice, HSR Seminar December, 13th 2005 Research about Refugee and Asylum Seeker Health nLanguage differences, communication difficulties qRefugees, asylum seekers, services providers (primary and secondary care) qUse of interpreters nFormal interpreters (telephone/face to face interpreting) nInformal interpreters (Friends and relatives) Anne MacFarlane, Department of General Practice, HSR Seminar December, 13th 2005 Communication Matters nGeneral Practice and nursing qBiopsychosocial model of health qParticipation of patients nPatient agenda nPatient narratives nShared decision making Anne MacFarlane, Department of General Practice, HSR Seminar December, 13th 2005 CARe Communication with Asylum Seekers and Refugees nConduct an in-depth exploration of the impact of language as a barrier in primary care qDocument experiences of refugees, asylum seekers acknowledging local expertise qFocus on concrete actions arising out of data collection qEqual relationship between the researcher and the researched qDoing research with people rather than on them Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 PLA in action qInter-agency Partners nHSE WA Health Promotion, Public Health nCommunity Representation qGalway Refugee Support Group Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 PLA in action qCore group for the research nCroatian woman, Ukrainian man, two Russian women and Nigerian woman qResearch planning project name and logo, project materials qPLA training to facilitate peer researcher model for data collection and data analysis Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Methods: Sampling and Recruitment nPurposeful sampling qEthnicity (Serb-Croat and Russian speaking communities) qGender (men and women) n26 participants q16 women and 10 men n10 asylum seekers, n6 refugees, n10 with residency on the basis of having Irish born children Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Methods: Data Collection Topic Guide nResearch question q“Tell me about peoples experiences of language differences and communication difficulties with GPs” nExperiences of making appointments nArriving at the surgery, place of consultation nBeing in the consultation nWhat happens afterwards qExperiences with public health nurses and pharmacists Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Methods: Technique nEmic card sort qQualitative data qInsider perspective nResearcher elicits stories nInterviews them nStory broken down onto cards nCards sorted thematically by participant Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Methods: Emic Card Sort nStory about daughter acting as an interpreter qdaughter interprets qdaughter interpreter absent from school qdaughter interpreter explains everything nSorted with cards about friend acting as interpreter Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Methods: Co-analysis of Card Sorts nRecording forms translated nSharing of data nManual analysis nFramework analysis Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Overview of Thematic Framework GPs he felt humiliated and degraded. Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Relevance of being a foreigner? nD4 describes her GPs manner in their consultations as “superficially pleasant, polite, well-mannered” but holds a strong perception that he is indifferent. nan absence of true medical interest in her and engagement with her n There is no open racist attitude but, she does wonder whether this underlies his behaviour and manner? Communication is embedded in social relationsthere are significant racial and cultural dimensions at play Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Competencies nB1 had a small child with bad cough nrepeat visits to her GP, asked for analysis and tests but the GP would not arrange them nA Response rate 76%; nQualitative Interviews (GPs) qn=12 Anne MacFarlane, Department of General Practice, HSR Seminar, December 13th 2005 Overview of Results nUse of interpreters 90% nRelative or friend 70% nFormal interpreter by telephone 19% nFormal interpreter face to face 7% nPreference for informal interpreter36% nPreference for formal interpreter41% nManaged wit