Communication in refugee and migrant mental healthcare: A systematic rapid review on the needs, barriers and strategies of seekers and providers of mental health services.

BACKGROUND: Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present. METHODS: We undertook a rapid systematic review of the literature (01/01/2011 - 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively. RESULTS: 58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems. CONCLUSIONS: Language barriers impede TCNs' access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services.

Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach.

Due to ongoing globalization and migration waves, healthcare providers are increasingly caring for patients from diverse cultural and/or ethnic minority backgrounds. Adequate health communication with migrants and ethnic minorities is often more difficult to establish compared to people belonging to the majority groups of a given society, because of a combination of language and cultural barriers. To address this topic, in December 2018 a symposium was organized-under the auspices of the Amsterdam Center for Health Communication-during which speakers from both academia and professional practice discussed the current state-of-the-art and brought forward innovative solutions to improve intercultural communication in healthcare. Main questions that were discussed during this symposium included: "How can language barriers in intercultural health communication be mitigated?" and "Which innovations can contribute to improving intercultural health communication?" In this paper, we discuss some answers to these questions and propose that in order to enhance intercultural communication and healthcare for migrant and ethnic minority patients, a more holistic approach to studying when, how, and for what purposes (a combination of) communication strategies should be utilized in mitigating both language and cultural barriers to decrease health disparities and improve health care for migrant and ethnic minority patients.

Turkish migrant GP patients' expression of emotional cues and concerns in encounters with and without informal interpreters.

OBJECTIVE: The aim of this study was to compare patients' expressions of emotional cues and concerns, and GPs' responses during consultations with and without informal interpreters. Furthermore, informal interpreters' expression of emotional cues and concerns and their responses were examined too. METHODS: Twenty-two audiotaped medical encounters with Turkish migrant patients, eleven with and eleven without an informal interpreter, were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (VR-CoDES-P). RESULTS: In encounters with informal interpreters, patients expressed less emotional concerns than in encounters without informal interpreters. Only half of all patients' cues is being translated by the informal interpreter to the GP. Furthermore, 20% of all cues in encounters with informal interpreters is being expressed by the interpreter, independent of patients' expression of emotions. CONCLUSION: The presence of an informal interpreter decreases the amount of patients' expression of emotional concerns and cues. Furthermore, a substantial amount of cues is being expressed by the informal interpreter, corroborating the often-made observation that they are active participants in triadic medical encounters. PRACTICE IMPLICATIONS: GPs should be trained in communication strategies that enable elicitation of migrant patients' emotions, in particular in encounters with informal interpreters.

Are GP patients' needs being met? Unfulfilled information needs among native-Dutch and Turkish-Dutch patients.

OBJECTIVE: This study aims to assess unfulfilled information needs of native-Dutch and Turkish-Dutch general practitioner (GP) patients in the Netherlands. In addition, the relation between perceived and recorded information provision by GPs is studied. METHODS: Unfulfilled information needs of native-Dutch (N=117) and Turkish-Dutch patients (N=74) were assessed through pre- and post-consultation questionnaires. Audiotapes of GP consultations were made to code GPs' information provision. RESULTS: Turkish-Dutch patients experience more unfulfilled information needs than native-Dutch patients, in particular those who identify equally with Dutch and Turkish culture. Overall, perceived information provision is hardly related to recorded information provision. CONCLUSION: GPs insufficiently provide Turkish-Dutch patients and, to a lesser extent, native-Dutch patients as well, the information they need. PRACTICE IMPLICATIONS: GPs should be trained in giving adequate, tailored information to patients with various ethnic and cultural backgrounds.

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.

Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior.

OBJECTIVE: This study examined the influence of the following variables on patients' information-seeking and participating behavior during emergency treatment: patients' preferences for information and participation, patients' coping style, patients' socio-demographic variables, and dentists' communicative behavior. METHODS: The sample consisted of 83 patients receiving emergency care from 13 different dentists. Consultations were videotaped in order to assess dentists' and patients' behavior. Dentists' communicative behavior was coded by means of the Communication in Dental Settings Scale (CDSS); scores for patients' behavior included the number and nature of questions asked during the consultation, attempts to offer diagnoses, and whether or not patients made the decision to undergo treatment themselves. At home, patients filled out a questionnaire that included scales to measure their preference for information and participation and other background variables. RESULTS: Results showed that patients' desire for information and participation, together with other variables, was not reflected in their overt behavior. Furthermore, dentists' communicative behavior was unrelated to patients' information-seeking and participating behavior. CONCLUSIONS: Scores on the CDSS show that still there is a discrepancy between the legal prerequisites of information-giving and emergency dental practice. Therefore, dentists' information-giving behavior should be improved in order to enhance the patients' right to make informed decisions.