"Ne diyor?" (What does she say?): informal interpreting in general practice.

OBJECTIVE: The aim of this study was to offer a comparative analysis of informal interpreters during medical consultations with both good and poor mutual understanding between general practitioners (GPs) and patients. METHODS: Sixteen video-registered medical interviews of Turkish immigrant patients were analysed. Stretches of discourse of eight interviews with good mutual understanding between patient and doctor were compared to eight interviews with poor mutual understanding. The discourse analysis focused on: (1) miscommunication and its causes; (2) changes in the translation; (3) side-talk activities. RESULTS: In the cases of 'poor mutual understanding', the instances of miscommunication far exceeded those in the 'good mutual understanding' group. Style of self-presentation, content omissions and side-talk activities seemed to hinder good mutual understanding. CONCLUSION: Alongside the evidence about problems with informal interpreting, sometimes the use of family interpreters can facilitate medical communication. PRACTICE IMPLICATIONS: Recommendations are given in order to increase physicians' awareness of the complex process of interpreting, as well as to empower informal interpreters and patients to effectively deal with this communicative triad.

GPs' interactional styles in consultations with Dutch and ethnic minority patients.

The aim of this study was to examine interactional styles of general practitioners (GPs) in consultations with Dutch patients as compared to ethnic minority patients, from the perspective of level of mutual understanding between patient and GP. Data of 103 transcripts of video-registered medical interviews were analyzed to assess GPs' communication styles in terms of involvement, detachment, shared decision-making and patient-centeredness. Surveys were used to collect data on patients' characteristics and mutual understanding. Results show that overall, GPs communicate less adequately with ethnic minority patients than with Dutch patients; they involve them less in decision-making and check their understanding of what has been discussed less often. Intercultural consultations are thus markedly distinguishable from intracultural consultations by a lack of adequate communicative behavior by GPs. As every patient has a moral and legal right to make informed decisions, it is concluded that GPs should check more often whether their ethnic minority patients have understood what has been said during the medical consultation.

Parent-adolescent communication about sexuality: the role of adolescents' beliefs, subjective norm and perceived behavioral control.

OBJECTIVE: To examine to what extent adolescents' beliefs, subjective norm and perceived behavioral control predict the amount of parent-adolescent communication about sexuality. In addition, the role of adolescents' gender, ethnic background, religiosity and educational level on these relationships was assessed as well. METHODS: Data were collected from 481 students of four high schools in The Netherlands. A questionnaire assessed adolescents' beliefs, subjective norm, perceived behavioral control, and self-reported parent-adolescent communication about sexuality. Linear regression analyses were performed to identify predictors of parent-adolescent communication. To assess differences between subgroups, chi(2)-analyses, t-tests and analyses of variance were conducted. RESULTS: Being female and having positive beliefs about talking with parents about sexuality were positively related to amount of parent-adolescent communication. In addition, adolescents' perceived behavioral control and subjective norm were significant predictors as well. CONCLUSION: Adolescents' beliefs, subjective norm and perceived behavioral control, are all significant predictors of frequency of parent-adolescent sex communication, with beliefs being the most important. In addition, adolescents' gender predicted a significant amount as well. PRACTICE IMPLICATIONS: Interventions aimed to increase the amount of parent-adolescent communication should primarily target their efforts to changing adolescents' underlying beliefs about discussing sexuality with their parents. Our results furthermore suggest that it is important to take into consideration gender variations in these beliefs, by designing separate interventions for different groups of adolescents.

The effect of educational intervention on intercultural communication: results of a randomised controlled trial.

BACKGROUND: Due to worldwide migration to Western countries, physicians are increasingly encountering patients with different ethnic backgrounds. Communication problems can arise as a result of differences in cultural backgrounds and poor language proficiency. AIMS: To assess the effectiveness of an educational intervention on intercultural communication aimed to decrease inequalities in care provided between Western and non-Western patients. DESIGN OF STUDY: A randomised controlled trial with randomisation at the GP level and outcome measurements at the patient level. SETTING: General practice in Rotterdam. METHOD: Thirty-eight Dutch GPs in the Rotterdam region, with at least 25% of inhabitants of non-Western origin, and 2407 visiting patients were invited to participate in the study. A total of 986 consultations were finally included. The GPs were educated about cultural differences and trained in intercultural communication. Patients received a videotaped instruction focusing on how to communicate with their GP in a direct way. The primary outcome measure was mutual understanding and the secondary outcomes were patient's satisfaction and perceived quality of care. The intervention effect was assessed for all patients together, for the 'Western' and 'non-Western' patients, and for patients with different cultural backgrounds separately. RESULTS: An intervention effect was seen 6 months after the intervention, as improvement in mutual understanding (and some improvement in perceived quality of care) in consultations with 'non-Western' patients. CONCLUSIONS: A double intervention on intercultural communication given to both physician and patient decreases the gap in quality of care between 'Western' and 'non-Western' patients.