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1.
Patient Educ Couns ; 102(6): 1217-1221, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30661729

RESUMEN

In 2017, EACH celebrated its change of name from European Association for Communication in Healthcare to EACH: International Association for Communication in Healthcare. This paper aims to present the developments and achievements of EACH over the past five years with a focus on its mission in promoting and advancing the field of communication in healthcare. Specifically, the paper focuses on how EACH, first, promotes research in the field of health communication, second, provides support, resources and sharing for healthcare communication teachers and, third, aims at influencing policy through dissemination of evidence. This paper also explores future challenges and directions for EACH to further strengthen its impact by designing activities in knowledge transfer and knowledge dissemination, engaging with patients and truly benefitting from their expertise, fostering active participation and networking among its members, targeting interventions to the needs of different countries around the world and refining knowledge-sharing and cooperation both within the membership of EACH and outside the association to as wide an audience as possible. Scholars, educators and practitioners active in the field of healthcare communication are invited to comment on this paper and to actively contribute towards the goals of EACH.

2.
J Cancer Educ ; 2018 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-30128954

RESUMEN

Feedback is a key factor in acquiring breaking bad news (BBN) communication skills and its' acceptance depends on the perceived credibility of the provider. Our aim was to investigate students' opinions on the provided feedback by different educators (surgeons, psychologists, and simulated patient (SP)) during BBN skills training. We developed a questionnaire investigating provided feedback by the surgeon, psychologist, and SP (yes or no statements), regarding (1) perceived safety of the atmosphere, (2) perceived positive feedback, (3) perceived specific feedback, and (4) perceived usefulness for improvement during BBN skills training. Five hundred twenty students returned the questionnaire after BBN skills training. Most students rated the feedback as positive, specific, and useful. Also, the atmosphere was considered safe. Feedback ratings of the SP were the same as for the surgeon and valued higher than for the psychologist. An unsafe atmosphere, or not receiving positive, specific, or useful feedback was mostly related to the psychologist's feedback. Feedback on BBN skills training by surgeons and SPs is rated equally helpful by students and is regarded specific, useful, and positive. When designing a BBN training, it is worth to consider involving SP's as well as clinicians.

3.
Health Expect ; 21(1): 159-170, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28841753

RESUMEN

BACKGROUND: The material practices which researchers use in research partnerships may enable or constrain the nature of engagement with stakeholder groups. Participatory learning and action (PLA) research approaches show promise, but there has been no detailed analysis of stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis. OBJECTIVES: To explore stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis. DESIGN: The EU RESTORE implementation science project employed a participatory approach to investigate and support the implementation of guidelines and training initiatives (GTIs) to enhance communication in cross-cultural primary care consultations. We developed a purposeful sample of 78 stakeholders (migrants, general practice staff, community interpreters, service providers, service planners) from primary care settings in Austria, England, Greece, Ireland and The Netherlands. We used speed evaluations and participatory evaluations to explore their experiences of two PLA techniques-Commentary Charts and Direct Ranking-which were intended to generate data for co-analysis by stakeholders about the GTIs under analysis. We evaluated 16 RESTORE researchers' experiences using interviews. We conducted thematic and content analysis of all evaluation data. RESULTS: PLA Commentary Charts and Direct Ranking techniques, with their visual, verbal and tangible nature and inherent analytical capabilities, were found to be powerful tools for involving stakeholders in a collaborative analysis of GTIs. Stakeholders had few negative experiences and numerous multifaceted positive experiences of meaningful engagement, which resonated with researchers' accounts. CONCLUSION: PLA techniques and approaches are valuable as material practices in health research partnerships.

4.
Med Educ ; 51(11): 1103-1117, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28762538

RESUMEN

CONTEXT: Patient-centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient-centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is systematic. This calls for adequate measurement instruments. OBJECTIVES: The aim of this study was to provide a systematic review of existing instruments that measure patient centredness in doctor-patient communication and can be used to provide direct feedback. METHODS: A systematic review was conducted using an extensive validated search strategy for measurement instruments in PubMed, EMBASE, PsycINFO and CINAHL. The databases were searched from their inception to 1 July 2016. Articles describing the development or evaluation of the measurement properties of instruments that measure patient centredness (by applying three or more of the six dimensions of a published definition of patient centredness) in doctor-patient communication and that can be used for the provision of direct feedback were included. The methodological quality of measurement properties was evaluated using the COSMIN checklist. RESULTS: Thirteen articles describing 14 instruments measuring patient centredness in doctor-patient communication were identified. These studies cover a wide range of settings and patient populations, and vary in the dimensions of patient centredness applied and in methodological quality on aspects of reliability and validity. CONCLUSIONS: This review gives a comprehensive overview of all instruments available for the measurement of patient centredness in doctor-patient communication that can be used for the provision of direct feedback and are described in the literature. Despite the widely felt need for valid and reliable instruments for the measurement of patient-centred communication, most of the instruments currently available have not been thoroughly investigated. Therefore, we recommend further research into and enhancement of existing instruments in terms of validity and reliability, along with enhancement of their generalisability, responsiveness and aspects of interpretability in different contexts (real patients, simulated patients, doctors in different specialties, etc.). Comprehensibility and feasibility should also be taken into account.


Asunto(s)
Comunicación , Relaciones Médico-Paciente , Encuestas y Cuestionarios , Humanos , Atención Dirigida al Paciente
6.
Patient Educ Couns ; 100(9): 1758-1761, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28438364

RESUMEN

OBJECTIVE: This article reports experiences and challenges encountered in a cross-cultural training project in Moldova that was undertaken by tEACH, the teaching subcommittee of EACH: International Association for Communication in Healthcare, in cooperation with local and international stakeholders. As part of a major health policy reform, the aim was to equip a group of trainers with the skills to train Moldovan professionals in skills for primary mental health care, including communication skills. METHODS: The project consisted of 3 weeks of training using mainly experiential teaching methods to allow participants to practice content and methods, including interactive lecturing, roleplay, feedback and video. RESULTS: A majority of the participants reported that they acquired key facilitation skills. They valued the opportunity to practice and receive feedback. However, some reported that there was too much focus on communication skills, which was thought to be less relevant in a Moldovan context. Furthermore our learner-centered approach was occasionally experienced as a lack of structure CONCLUSION: The tEACH expertise plays an important role in supporting trainers in cross-cultural contexts with effective communication skills methods. PRACTICE IMPLICATIONS: Teaching in a cross-cultural context is only successful through continuous dialogue with stakeholders and demands attention to cultural differences.


Asunto(s)
Comunicación , Comparación Transcultural , Personal de Salud/educación , Derivación y Consulta , Enseñanza , Retroalimentación , Humanos , Salud Mental , Servicios de Salud Mental , Moldavia
7.
Eur J Gen Pract ; 23(1): 128-134, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28388310

RESUMEN

BACKGROUND: Migration in Europe is increasing at an unprecedented rate. There is an urgent need to develop 'migrant-sensitive healthcare systems'. However, there are many barriers to healthcare for migrants. Despite Greece's recent, significant experiences of inward migration during a period of economic austerity, little is known about Greek primary care service providers' experiences of delivering care to migrants. OBJECTIVES: To identify service providers' views on the barriers to migrant healthcare. METHODS: Qualitative study involving six participatory learning and action (PLA) focus group sessions with nine service providers. Data generation was informed by normalization process theory (NPT). Thematic analysis was applied to identify barriers to efficient migrant healthcare. RESULTS: Three main provider and system-related barriers emerged: (a) emphasis on major challenges in healthcare provision, (b) low perceived control and effectiveness to support migrant healthcare, and (c) attention to impoverished local population. CONCLUSION: The study identified major provider and system-related barriers in the provision of primary healthcare to migrants. It is important for the healthcare system in Greece to provide appropriate supports for communication in cross-cultural consultations for its diversifying population.


Asunto(s)
Actitud del Personal de Salud , Prestación de Atención de Salud/economía , Emigrantes e Inmigrantes , Medicina General , Atención Primaria de Salud , Adolescente , Adulto , Barreras de Comunicación , Competencia Cultural , Prestación de Atención de Salud/legislación & jurisprudencia , Emigrantes e Inmigrantes/legislación & jurisprudencia , Femenino , Grupos Focales , Grecia/etnología , Disparidades en Atención de Salud , Humanos , Lenguaje , Masculino , Pacientes no Asegurados/etnología , Persona de Mediana Edad , Pobreza/etnología , Atención Primaria de Salud/economía , Investigación Cualitativa , Cambio Social , Adulto Joven
8.
BMJ Open ; 6(7): e010822, 2016 07 22.
Artículo en Inglés | MEDLINE | ID: mdl-27449890

RESUMEN

OBJECTIVES: Guidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings. SETTING: As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands. PARTICIPANTS: A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners). PRIMARY AND SECONDARY OUTCOME MEASURES: We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs. RESULTS: The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project. CONCLUSIONS: This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants.


Asunto(s)
Comunicación , Asistencia Sanitaria Culturalmente Competente , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/métodos , Migrantes , Adolescente , Austria , Inglaterra , Femenino , Grupos Focales , Grecia , Investigación sobre Servicios de Salud/métodos , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Países Bajos , Atención Primaria de Salud/estadística & datos numéricos , Investigación Cualitativa , Adulto Joven
9.
J Med Internet Res ; 18(7): e206, 2016 07 29.
Artículo en Inglés | MEDLINE | ID: mdl-27473173

RESUMEN

BACKGROUND: The complex nature of the medical dialogue and the often emotional context in cancer care present challenges to health care professionals (HCPs) and patients. Patients are increasingly expected to be informed participants and to be able to make conscious decisions, which they often find very difficult. In an attempt to support patients with malignant lymphoma in clinical communication, we developed a stand-alone, Web-based intervention called "PatientTIME." The development of PatientTIME was based on a participatory intervention mapping framework. Its primary aim is to boost patients' self-efficacy in patient-professional communication (ie, their confidence when interacting with their HCP). Patients can use this intervention before their hospital visit to prepare for their clinical consultation. PatientTIME is fully automated and use is patient-initiated. OBJECTIVE: The aim of this study was to evaluate if and in what way patients benefit from PatientTIME and if it enhances their confidence in clinical communication. METHODS: The intervention was evaluated in a closed randomized controlled trial with continuous recruitment (using online and offline methods to reach potential participants) and data collection. In accordance with the Medical Research Council guidance, we started with a process evaluation. Subsequently, an outcome evaluation was performed focusing on the patients' perceived confidence in communication with their HCP, measured with the validated PEPPI questionnaire at baseline and at 3 months after participation. Process and outcome data were obtained through Web-based questionnaires, log files (automatically generated files mapping the interactions between program and users), and a logbook (comprising a record of actions and interactions kept by the researchers). Participants were not blinded. A total of 146 patients registered online, of whom 97 gave their informed consent and were assigned at random to the control group (N=34) or 1 of the 2 intervention groups (N=63). Ultimately 87/97 (90%) of these patients actually participated in the study, producing 87 datasets for analysis. RESULTS: More than half of the intervention group patients reported that the intervention helped them prepare for a clinical consultation; it created awareness about the importance of communication and reinforced their existing communication skills. In the postvisit test, the control group showed a small, nonsignificant improvement in perceived communication efficacy. The intervention group showed a significant improvement in perceived efficacy. However, the interaction effect was not significant, indicating that the improvement solely as a result of the intervention may not be significant. CONCLUSIONS: A considerable number of patients reported that PatientTIME did provide support. We found a trend indicating that in the long run, patients with access to PatientTIME scored better on the perceived efficacy scale than patients without access. However, at this stage we cannot conclude that PatientTIME improves patients' confidence when interacting with HCPs. CLINICALTRIAL: Netherlands National Trial Register (NTR): 3779; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3779 (archived by WebCite at http://www.webcitation.org/6iztxJ5Nt).


Asunto(s)
Comunicación , Internet , Linfoma , Relaciones Profesional-Paciente , Autoeficacia , Adulto , Anciano , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Países Bajos , Evaluación de Procesos y Resultados (Atención de Salud) , Encuestas y Cuestionarios
10.
Patient Educ Couns ; 99(9): 1441-5, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27473637

RESUMEN

This paper is based on the keynote lecture given at the ICCH conference in New Orleans in October 2015. With as background the observation that even though research and teaching of communication have been receiving attention for some time now, patients still encounter many problems when they visit clinicians because of health problems, it subsequently touches upon research on integration of communication with correct medical content, person centered communication and the role of placebo on outcomes. For teaching it emphasizes methods working best to teach clinical communication skills and lead to behavior changes in professionals: experiential teaching methods but taking care of a balance with cognitive methods. It then discusses the challenge of transfer to clinical practice and what is needed to overcome these challenges: learning from reflecting on undesired outcomes in clinical practice, feedback from clinicians who are open to communication and support learners with effective feedback in that specific context. It adds suggestions about where linking more between research, teaching and clinical practice could help moving communication in health care forward and builds the case for involving policymakers and members of hospital boards to help manage the necessary climate change in clinical settings.


Asunto(s)
Competencia Clínica , Comunicación , Investigación , Enseñanza , Humanos , Relaciones Médico-Paciente
12.
Health Policy ; 120(5): 495-508, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27080344

RESUMEN

There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed.


Asunto(s)
Política de Salud , Accesibilidad a los Servicios de Salud , Migrantes , Europa (Continente) , Humanos , Atención Primaria de Salud/estadística & datos numéricos , Investigación Cualitativa , Calidad de la Atención de Salud
13.
Ann Hematol ; 95(7): 1177-83, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27091348

RESUMEN

Many patients with haematological malignancies experience barriers in clinical communication. Reaching effective communication is of great importance as it has been linked to a range of improved patient outcomes such as satisfaction, compliance to treatment, perceived quality of life and physical and mental health. To get a better understanding how communication in haematological consultations can be improved, the current study focussed on patients' preferences and perceived performances regarding the communicative behaviour of their health care professional. Secondly, the mediation of an online communication tool for patients was analysed. Within a controlled pre- post-test design, 78 datasets of clinical consultations could be analysed. Patients considered both affective and instrumental communication aspects important. The affective communication behaviour of the health care professional met the patients' pre-visit preferences well. In the information exchange, more variability and discrepancies were found. Overall, the online intervention did not seem to influence the patients' perceived communication performance of their health care professional much. To further improve the communication during clinical consultations, health care professionals should inquire about patients' expectations, especially during the exchange of information and advices. At the same time, patients should be supported to express their preferences at the start of the consultation. The study was registered in the Netherlands Trial Register, number 3779.


Asunto(s)
Comunicación , Personal de Salud/normas , Enfermedades Hematológicas/epidemiología , Prioridad del Paciente , Rol Profesional , Relaciones Profesional-Paciente , Femenino , Estudios de Seguimiento , Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/terapia , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Derivación y Consulta/normas , Encuestas y Cuestionarios
14.
Eur J Gen Pract ; 22(2): 119-25, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26966968

RESUMEN

BACKGROUND: Mental health problems are highly prevalent amongst undocumented migrants (UMs), and often part of their consultations with general practitioners (GPs). Little empirical data are available of how GPs and UMs engage around mental health in Greece, a country with a lack of balance between primary and secondary care and limited healthcare provisions for UMs. OBJECTIVES: To acquire insight in the barriers and levers in the provision of mental healthcare for UMs by GPs in Greece. METHODS: This was a qualitative study using semi-structured interviews with 12 GPs in Crete, Greece with clinical expertise in the care of UMs. All interviews were audio-taped and transcribed verbatim and were analysed using thematic content analysis. RESULTS: Greek GPs recognized many mental health problems in UMs and identified the barriers that prevented them from discussing these problems and delivering appropriate care: growing societal resistance towards UMs, budget cuts in healthcare, administrative obstacles and lack of support from the healthcare system. To overcome these barriers, Greek GPs provided UMs with free access to care and psychotropic drugs free of charge, and referred to other primary care professionals rather than to mental healthcare institutions. CONCLUSION: Greek GPs experienced substantial barriers in the provision of mental healthcare to UMs and political, economic and organizational factors played a major role.


Asunto(s)
Médicos Generales/organización & administración , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Migrantes , Femenino , Médicos Generales/economía , Grecia/epidemiología , Accesibilidad a los Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Trastornos Mentales/economía , Trastornos Mentales/epidemiología , Servicios de Salud Mental/economía , Política , Psicotrópicos/economía , Psicotrópicos/provisión & distribución , Derivación y Consulta
15.
BMC Health Serv Res ; 16: 25, 2016 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-26792057

RESUMEN

BACKGROUND: Communication problems occur in general practice consultations when migrants and general practitioners do not share a common language and culture. Migrants' perspectives have rarely been included in the development of guidelines designed to ameliorate this. Considered 'hard-to-reach' on the basis of inaccessibility, language discordance and cultural difference, migrants have been consistently excluded from participation in primary healthcare research. The purpose of this qualitative study was to address this gap. METHODS: The study was conducted in the Republic of Ireland, 2009 - 2011. We developed a multi-lingual community-university research team that included seven established migrants from local communities. They completed training in Participatory Learning & Action (PLA) - a qualitative research methodology. Then, as trained service-user peer researchers (SUPERs) they used their access routes, language skills, cultural knowledge and innovative PLA techniques to recruit and engage in research with fifty-one hard-to-reach migrant service-users (MSUs). RESULTS & DISCUSSION: In terms of access, university researchers successfully accessed SUPERs, who, in turn, successfully accessed, recruited and retained MSUs in the study. In terms of meaningful engagement, SUPERs facilitated a complex PLA research process in a language-concordant manner, enabling inclusion and active participation by MSUs. This ensured that MSUs' perspectives were included in the development of a guideline for improving communication between healthcare providers and MSUs in Ireland. SUPERs evaluated their experiences of capacity-building, training, research fieldwork and dissemination as positively meaningful for them. MSUs evaluated their experiences of engagement in PLA fieldwork and research as positively meaningful for them. CONCLUSIONS: Given the need to build primary healthcare 'from the ground up', the perspectives of diverse groups, especially the hard-to-reach, must become a normative part of primary healthcare research. PLA is a powerful, practical 'fit-for-purpose' methodology for achieving this: enabling hard-to-reach groups to engage meaningfully and contribute with ease to academic research. PLA has significant potential to become a 'standard' or generic approach in building community-based primary health care. Community-university partnerships have a significant role to play in this, with capacity to radically influence the shape of healthcare research, expanding the research agenda to incorporate the views and needs of hard-to-reach and vulnerable populations.


Asunto(s)
Investigación sobre Servicios de Salud/métodos , Atención Primaria de Salud , Migrantes , Poblaciones Vulnerables/etnología , Adulto , Comunicación , Servicios de Salud Comunitaria , Femenino , Medicina General , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/normas , Investigación Cualitativa , Derivación y Consulta , Investigadores , Características de la Residencia
16.
BMJ Open ; 5(9): e007092, 2015 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-26391628

RESUMEN

OBJECTIVE: The aim of this research was to involve migrants and other key stakeholders in a participatory dialogue to develop a guideline for enhancing communication in cross-cultural general practice consultations. In this paper, we focus on findings about the use of formal versus informal interpreters because dialogues about these issues emerged as central to the identification of recommendations for best practice. DESIGN: This qualitative case study involved a Participatory Learning and Action (PLA) research methodology. PARTICIPANTS: The sample comprised 80 stakeholders: 51 from migrant communities; 15 general practitioners (GPs) and general practice staff; 7 established migrants as peer researchers; 5 formal, trained interpreters; and 2 service planners from the national health authority. SETTING: Galway, Ireland. RESULTS: There was 100% consensus across stakeholder groups that while informal interpreters have uses for migrants and general practice staff, they are not considered acceptable as best practice. There was also 100% consensus that formal interpreters who are trained and working as per a professional code of practice are acceptable as best practice. CONCLUSIONS: Policymakers and service planners need to work in partnership with service providers and migrants to progress the implementation of professional, trained interpreters as a routine way of working in general practice.


Asunto(s)
Barreras de Comunicación , Investigación Participativa Basada en la Comunidad , Asistencia Sanitaria Culturalmente Competente/métodos , Medicina General , Lenguaje , Guías de Práctica Clínica como Asunto , Migrantes , Adulto , Anciano , Asistencia Sanitaria Culturalmente Competente/normas , Femenino , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Traducción
17.
Scand J Prim Health Care ; 33(2): 82-90, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25961462

RESUMEN

OBJECTIVE: To explore the views and experiences of general practitioners (GPs) in relation to recognition, recording, and treatment of mental health problems of undocumented migrants (UMs), and to gain insight in the reasons for under-registration of mental health problems in the electronic medical records. DESIGN: Qualitative study design with semi-structured interviews using a topic guide. SUBJECTS AND SETTING: Sixteen GPs in the Netherlands with clinical expertise in the care of UMs. RESULTS: GPs recognized many mental health problems in UMs. Barriers that prevented them from recording these problems and from delivering appropriate care were their low consultation rates, physical presentation of mental health problems, high number of other problems, the UM's lack of trust towards health care professionals, and cultural differences in health beliefs and language barriers. Referrals to mental health care organizations were often seen as problematic by GPs. To overcome these barriers, GPs provided personalized care as far as possible, referred to other primary care professionals such as social workers or mental health care nurses in their practice, and were a little less restrictive in prescribing psychotropics than guidelines recommended. CONCLUSIONS: GPs experienced a variety of barriers in engaging with UMs when identifying or suspecting mental health problems. This explains why there is a gap between the high recognition of mental health problems and the low recording of these problems in general practice files. It is recommended that GPs address mental health problems more actively, strive for continuity of care in order to gain trust of the UMs, and look for opportunities to provide mental care that is accessible and acceptable for UMs.


Asunto(s)
Prestación de Atención de Salud , Emigración e Inmigración , Médicos Generales , Trastornos Mentales/terapia , Servicios de Salud Mental , Pautas de la Práctica en Medicina , Migrantes , Adulto , Actitud del Personal de Salud , Medicina Familiar y Comunitaria , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Países Bajos , Atención Primaria de Salud , Investigación Cualitativa , Derivación y Consulta
18.
Fam Pract ; 32(4): 420-5, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25917169

RESUMEN

BACKGROUND: Guidelines and training initiatives (G/TIs) available to support communication in cross-cultural primary health care consultations are not routinely used. We need to understand more about levers and barriers to their implementation and identify G/TIs likely to be successfully implemented in practice. OBJECTIVE: To report a mapping process used to identify G/TIs and to prospectively appraise their implementability, using Normalization Process Theory (NPT). METHODS: RESTORE is a 4-year EU FP-7 project. We used purposeful and network sampling to identify experts in statutory and non-statutory agencies across Austria, England, Greece, Ireland, Scotland and the Netherlands who recommended G/TI data from the grey literature. In addition, a peer review of literature was conducted in each country. Resulting data were collated using a standardized Protocol Mapping Document. G/TIs were identified for inclusion by (i) initial elimination of incomplete G/TI material; (ii) application of filtering criteria; and (iii) application of NPT. RESULTS: 20 G/TIs met selection criteria: 8 guidelines and 12 training initiatives. Most G/TIs were identified in the Netherlands (n = 7), followed by Ireland (n = 6) and England (n = 5). Fewer were identified in Scotland (n = 2), and none in Greece or Austria. The majority (n = 13) were generated without the inclusion of migrant service users. All 20 were prospectively appraised for potential implementability by applying NPT. CONCLUSIONS: NPT is useful as a means of prospectively testing G/TIs for implementability. Results indicate a need to initiate meaningful engagement of migrants in the development of G/TIs. A European-based professional standard for development and assessment of cross-cultural communication resources is advised.


Asunto(s)
Comunicación , Comparación Transcultural , Asistencia Sanitaria Culturalmente Competente/métodos , Guías de Práctica Clínica como Asunto/normas , Atención Primaria de Salud/normas , Austria , Inglaterra , Grecia , Humanos , Irlanda , Países Bajos , Investigación Cualitativa , Derivación y Consulta , Escocia , Migrantes
19.
BMJ Open ; 4(11): e005738, 2014 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-25416057

RESUMEN

OBJECTIVE: To explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems. DESIGN: Qualitative study using semistructured interviews and thematic analysis. PARTICIPANTS: 15 UMs in The Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached. SETTING: 4 cities in The Netherlands. RESULTS: UMs consider mental health problems to be directly related to their precarious living conditions. For support, they refer to friends and religion first, the general practitioner (GP) is their last resort. Barriers for seeking help include taboo on mental health problems, lack of knowledge of and trust in GPs competencies regarding mental health and general barriers in accessing healthcare as an UM (lack of knowledge of the right to access healthcare, fear of prosecution, financial constraints and practical difficulties). Once access has been gained, satisfaction with care is high. This is primarily due to the attitude of the GPs and the effectiveness of the treatment. Reasons for dissatisfaction with GP care are an experienced lack of time, lack of personal attention and absence of physical examination. Expectations of the GP vary, medication for mental health problems is not necessarily seen as a good practice. CONCLUSIONS: UMs often see their precarious living conditions as an important determinant of their mental health; they do not easily seek help for mental health problems and various barriers hamper access to healthcare for them. Rather than for medication, UMs are looking for encouragement and support from their GP. We recommend that barriers experienced in seeking professional care are tackled at an institutional level as well as at the level of GP.


Asunto(s)
Medicina General/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Trastornos Mentales/psicología , Aceptación de la Atención de Salud/psicología , Atención Primaria de Salud/estadística & datos numéricos , Migrantes/psicología , Adulto , Anciano , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Aceptación de la Atención de Salud/estadística & datos numéricos , Investigación Cualitativa , Migrantes/estadística & datos numéricos , Adulto Joven
20.
JMIR Res Protoc ; 3(4): e59, 2014 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-25379679

RESUMEN

BACKGROUND: An important and challenging part of living with cancer relates to the repeated visits to the hospital. Since how patients cope between these post-diagnostic visits depends partly on the information and support received from their physician during the visits, it is important to make the most of them. Recent findings reinforce the importance of training not only the health care professionals in communication skills, but providing patients with support in communication as well. Delivering such supportive interventions online can have potential benefits in terms of accessibility, cost-effectiveness, and ability to tailor information to personal needs. However, problems with attrition (dropout, non-usage) during the test phase and poor uptake after implementation are frequently reported. The marginal level of engagement of the patient as end user seems to play a role in this. Therefore, recent research suggests integrating theory-based development methods with methods that promote involvement of the patient at an early stage. This paper describes a participatory protocol, used to let patients guide a theory-informed development process. OBJECTIVE: The objective of this project was to apply a bottom-up inspired procedure to develop a patient-centered intervention with corresponding evaluation and implementation plan. METHODS: The applied development protocol was based on the intervention mapping framework, combined with patient participatory methods that were inspired by the participation ladder and user-centred design methods. RESULTS: The applied protocol led to a self-directed online communication intervention aimed at helping patients gain control during their communications with health care professionals. It also led to an evaluation plan and an implementation plan. The protocol enabled the continuous involvement of patient research partners and the partial involvement of patient service users, which led to valuable insights and improvements. CONCLUSIONS: The applied protocol realized patient participation on different levels throughout the entire project. Early involvement, involvement on different levels, and flexibility in terms of planning and setup seem to be preconditions to creating a bottom-up inspired development procedure with (seriously ill) patients. Further research is necessary to find out if a more patient-centered approach improves the implementation and uptake of eHealth interventions. TRIAL REGISTRATION: Netherlands National Trial Register ID number: NTR3779; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3779 (Archived by WebCite at http://www.webcitation.org/6TdfALKxV).

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