Consultations between Immigrant Patients, Their Interpreters, and Their General Practitioners: Are They Real Meetings or Just Encounters? A Qualitative Study in Primary Health Care
Objective. In Sweden, about 19% of residents have a foreign background. Previous studies reported immigrant patients experience communication difficulties despite the presence of interpreters during consultations. The objective of this study was to gain insights into the participants’ perceptions and reflections of the triangular meeting by means of in-depth interviews with immigrant patients, interpreters, and general practitioners (GPs). Method. A total of 29 participants—10 patients, 9 interpreters, and 10 GPs—participated in face-to-face interviews. Content analysis was used to process the interview material. Results. Six themes were generated and arranged under two subject areas: the interpretation process (the means of interpreting and means of informing) and the meeting itself (individual tailored approaches, consultation time, the patient’s feelings, and the role of family members). Conclusion. This paper highlights feelings including frustration and insecurity when interpretation and relationships are suboptimal. Strategies for immigrant patients, interpreters, and GPs for getting a successful consultation may be needed. To transform the triangular meeting from an encounter to a real meeting, our results indicate a need for professional interpreters, for GPs to use a patient-tailored approach, and sufficient consultation time. Practice Implications. Use of professional interpreters is recommended, as is developing cultural competence. 1. Introduction All patients have the right to equal access to health care that meets their individual needs. The Swedish Health and Medical Services Act (1982:763) states that the objective of health care is good health and care on equal terms for the whole population. Section？？2 (b) states that the patient should be given individually tailored information on 1. His state of health 2. The methods of examination, care, and treatment that exist. Between the end of the Second World War and the 1960s, Sweden had a large influx of labour immigrants. Since the 1980s, immigration has been dominated by refugees and/or individuals with family members in Sweden. Sweden is a multicultural society, with 19% of its population in 2011 having a foreign background [1]. An assessment of primary care services conducted in London by Campbell et al. [2] showed that younger patients and nonwhite ethnic minority patients rated the care they received less positively than older patients and ethnic majority patients. A Swedish study by Hjern et al. [3] found that immigrants from Chile, Turkey, and Iran have a less satisfactory
J. L. Campbell, J. Ramsay, and J. Green, “Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care,” Quality in Health Care, vol. 10, no. 2, pp. 90–95, 2001.
[3]
A. Hjern, B. Haglund, G. Persson, and M. Roen, “Is there equity in access to health services for ethnic minorities in Sweden?” European Journal of Public Health, vol. 11, no. 2, pp. 147–152, 2001.
[4]
J. C. M. van Wieringen, J. A. M. Harmsen, and M. A. Bruijnzeels, “Intercultural communication in general practice,” European Journal of Public Health, vol. 12, no. 1, pp. 63–68, 2002.
[5]
A. Wearn, F. Goodyear-Smith, H. Everts, and P. Huggard, “Frequency and effects of non-English consultations in New Zealand general practice,” New Zealand Medical Journal, vol. 120, no. 1264, article U2771, 2007.
[6]
B. C. Schouten and L. Meeuwesen, “Cultural differences in medical communication: a review of the literature,” Patient Education and Counseling, vol. 64, no. 1–3, pp. 21–34, 2006.
[7]
C. Wachtler, A. Brorsson, and M. Troein, “Meeting and treating cultural difference in primary care: a qualitative interview study,” Family Practice, vol. 23, no. 6, pp. 111–115, 2006.
[8]
A. Pilnick, J. Hindmarsh, and V. T. Gill, “Beyond ‘doctor and patient’: developments in the study of healthcare interactions,” Sociology of Health and Illness, vol. 31, no. 6, pp. 787–802, 2009.
[9]
L. Meeuwesen, F. Tromp, B. C. Schouten, and J. A. M. Harmsen, “Cultural differences in managing information during medical interaction: how does the physician get a clue?” Patient Education and Counseling, vol. 67, no. 1-2, pp. 183–190, 2007.
[10]
B. C. Schouten, L. Meeuwesen, F. Tromp, and H. A. M. Harmsen, “Cultural diversity in patient participation: the influence of patients' characteristics and doctors' communicative behaviour,” Patient Education and Counseling, vol. 67, no. 1-2, pp. 214–223, 2007.
[11]
E. Wiking, N. Saleh-Stattin, S. E. Johansson, and J. Sundquist, “A description of some aspects of the triangular meeting between immigrant patients, their interpreters and GPs in primary health care in Stockholm, Sweden,” Family Practice, vol. 26, no. 5, pp. 377–383, 2009.
[12]
Oxford Dictionaries, April 2010, http://oxforddictionaries.com/definition/english/meeting.
[13]
U. H. Graneheim and B. Lundman, “Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness,” Nurse Education Today, vol. 24, no. 2, pp. 105–112, 2004.
[14]
D. W. Baker, R. Hayes, and J. P. Fortier, “Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients,” Medical Care, vol. 36, pp. 1461–1470, 1998.
[15]
E. Hadziabdic, K. Heikkil？, B. Albin, and K. Hjelm, “Migrants’ perceptions of using interpreters in health care,” International Nursing Review, vol. 56, pp. 461–469, 2009.
[16]
G. Flores, “The impact of medical interpreter services on the quality of health care: a systematic review,” Medical Care Research and Review, vol. 62, no. 3, pp. 255–299, 2005.
[17]
E. Rosenberg, Y. Leanza, and R. Seller, “Doctor-patient communication in primary care with an interpreter: physician perceptions of professional and family interpreters,” Patient Education and Counseling, vol. 67, no. 3, pp. 286–292, 2007.
[18]
G. Flores, M. B. Laws, S. J. Mayo et al., “Errors in medical interpretation and their potential clinical consequences in pediatric encounters,” Pediatrics, vol. 111, no. 1, pp. 6–14, 2003.
[19]
L. Meeuwesen, S. Twilt, J. D. ten Thije, and H. Harmsen, “‘Ne diyor?’ (what does she say?): informal interpreting in general practice,” Patient Education and Counseling, vol. 81, no. 2, pp. 198–203, 2010.
[20]
E. Hadziabdic, B. Albin, K. Heikkil？, and K. Hjelm, “Healthcare staffs perceptions of using interpreters: a qualitative study,” Primary Health Care Research & Development, vol. 11, pp. 260–270, 2010.
[21]
N. Fatahi, B. Mattsson, J. Hasanpoor, and C. Skott, “Interpreters' experiences of general practitioner-patient encounters,” Scandinavian Journal of Primary Health Care, vol. 23, no. 3, pp. 159–163, 2005.
[22]
R. Rivadeneyra, V. Elderkin-Thompson, R. C. Silver, and H. Waitzkin, “Patient centeredness in medical encounters requiring an interpreter,” American Journal of Medicine, vol. 108, no. 6, pp. 470–474, 2000.
[23]
M. Stewart, “Towards a global definition of patient centred care: the patient should be the judge of patient centred care,” British Medical Journal, vol. 322, no. 7284, pp. 444–445, 2001.
[24]
S. A. Lewin, Z. C. Skea, V. Entwistle, M. Zwarenstein, and J. Dick, “Interventions for providers to promote a patient-centred approach in clinical consultations,” Cochrane Database of Systematic Reviews, no. 4, Article ID CD003267, 2001.
[25]
P. Kinnersley, N. Stott, T. J. Peters, and I. Harvey, “The patient-centredness of consultations and outcome in primary care,” British Journal of General Practice, vol. 49, no. 446, pp. 711–716, 1999.
[26]
J. A. M. Harmsen, R. M. D. Bernsen, M. A. Bruijnzeels, and L. Meeuwesen, “Patients' evaluation of quality of care in general practice: what are the cultural and linguistic barriers?” Patient Education and Counseling, vol. 72, no. 1, pp. 155–162, 2008.
[27]
S. Saha, M. C. Beach, and L. A. Cooper, “Patient centeredness, cultural competence and healthcare quality,” Journal of the National Medical Association, vol. 100, no. 11, pp. 1275–1285, 2008.
[28]
“If you don’t understand what I mean…‘Interpreting in health and social care’,” in International Handbook of Good Practice. European Handbook of Good Practice. European TRICC Project ‘Training in Intercultural and Bilingual Competencies in Health and Social Care’, L. Meeuwesen and S. Twilt, Eds., Centre for Social Policy and Intervention Studies, Utrecht, UK, 2011.
[29]
I. Kapborg and C. Berter？, “Using an interpreter in qualitative interviews: does it threaten validity?” Nursing Inquiry, vol. 9, no. 1, pp. 52–56, 2002.
[30]
I. T. Coyne, “Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries?” Journal of Advanced Nursing, vol. 26, no. 3, pp. 623–630, 1997.
[31]
M. Q. Patton, Qualitative Research and Evaluation Methods, Sage, London, UK, 2002.
[32]
C. A. Chew-Graham, C. R. May, and M. S. Perry, “Qualitative research and the problem of judgement: lessons from interviewing fellow professionals,” Family Practice, vol. 19, no. 3, pp. 285–289, 2002.
[33]
L. Coar and J. Sim, “Interviewing one's peers: methodological issues in a study of health professionals,” Scandinavian Journal of Primary Health Care, vol. 24, no. 4, pp. 251–256, 2006.
