Professionals' and Intercultural Mediators' Perspectives on Communication With Ukrainian Refugees in the Czech Healthcare System.

INTRODUCTION: A growing body of research is examining how healthcare systems are responding to the increasing numbers of migrants and the resulting superdiversity of patients. The aim of this article is to identify and explain communication barriers in the provision of healthcare to Ukrainian war refugees in the Czech Republic from the perspectives of healthcare professionals and intercultural mediators. METHODS: The exploratory case study is based on a qualitative analysis of semi-structured interviews with frontline health professionals: 20 with doctors and 10 with nurses. The second source of data is two focus groups aimed at capturing communication problems from the perspective of intercultural mediators who accompany refugees to health facilities. The interview transcripts and FGs were analysed using six-stage thematic coding. RESULTS: The survey identified five main themes related to barriers to communication: (1) language barriers and interpreting, (2) cultural barriers, (3) differing expectations of health and the healthcare systems in the Czech Republic and Ukraine, (4) prejudices and negative attitudes and unethical behaviour towards refugees and migrants and (5) lack of awareness of patient rights. CONCLUSIONS: The arrival of large numbers of migrants has highlighted deficiencies in the system that may affect other vulnerable groups and the general population. These include the lack of general communication skills and legal awareness among many health professionals, which are barriers to the development of patient-centred care. The involvement of intercultural mediators fundamentally improves communication between health professionals and (not only) migrant patients. Nevertheless, it is necessary to legally anchor and define the position of intercultural mediators within the healthcare system. PATIENT OR PUBLIC CONTRIBUTION: Collaboration with intercultural mediators who interpreted the extensive experiences of Ukrainian refugee patients and also have personal experience as migrant or migrant-origin patients contributed to shaping research questions, facilitating study participation and enriching evidence interpretation. Researchers with multicultural backgrounds and experience with working with people from refugee backgrounds were involved in the study design and analysis.

Physicians' experiences of intercultural differences in communication with Ukrainian refugees during the Russian-Ukrainian armed conflict.

The aim of the study was to identify and explore barriers to communication between refugees from Ukraine and physicians providing health care, the perspective of physicians was embraced. The focus of the work reflects on the arrival of many forced migrants from Ukraine in 2022. Further, it focuses on the pressure that the presence of migrants' places on the Czech healthcare system, especially in doctor-migrant patient communication. The objectives of this study are also motivated by existing international evidence that misunderstandings and poor-quality communication can lead to lower patient satisfaction and adherence, and consequently poorer healthcare outcomes. The research was carried out in the form of qualitative research, 16 in-depth semi-structured interviews were conducted with physicians providing health care to Ukrainian refugees. Informants were selected using a purposive sampling method to obtain as diverse a sample as possible. The resulting data were analysed by applying thematic coding. The results showed that four main areas of intercultural barriers play a key role in the relationship between physicians and Ukrainian patients. These are: (1) language, (2) differences in healthcare systems, (3) different attitudes towards health and illness and (4) prejudice. The major source of misunderstanding was the difference between the Czech and Ukrainian healthcare systems, which leads to a different position of the patient in the healthcare system. The conclusions prove that intercultural barriers play a significant role in the provision of health care to Ukrainian refugees but can be addressed to a large extent. The current situation in Czechia and the increasing diversity in society call for the need to acquire intercultural competencies in undergraduate and continuing medical education. Similarly, the adoption of measures that promote culturally competent health care is needed.