ObjectiveTo examine quality of life and coping strategies among immigrant women living with chronic pain.DesignQualitative content analysis based on in-depth semistructured interviews.SettingA clinic specifically targeting immigrants at a larger university hospital in Copenhagen, Denmark.ParticipantsNon-western female immigrant patients suffering from chronic pain (n=13).Main outcome measuresExperiences of the impact of chronic pain on quality of life.ResultsChronic pain was perceived to have an extensive, adverse effect on all aspects of quality of life, including physical health, mental well-being and social relations. This included the ability to maintain activities of daily living and the ability to work. Chronic pain was further experienced as a cause of emotional distress, depression and altered personalities, which all had great consequences on women's social interactions, causing change and loss of social relations. A variety of coping strategies were used to cope with the pain, manage its consequences, and restore a level of health that would enable women to function and fulfil social roles. Many participants coped with the pain by altering everyday life, keeping daily activities to a minimum and taking pain-killing drugs, offering temporary relief. Seeking healthcare was another coping strategy used as an active means to assert agency and as a temporary distraction from pain. However, accessing healthcare also involved a risk of disagreement and disappointments.ConclusionsChronic pain had a severe negative impact on quality of life and necessitated alterations in everyday life and active health-seeking strategies. Implications for practice imply a need for a more holistic approach to immigrant women with chronic pain, including a family-centred approach. Further research is needed to explore similarities or differences in and between populations with diverse ethnic, socioeconomic and psychosocial backgrounds, and to assess how ethnicity and culture might influence the experiences of chronic pain.

Many researchers and practitioners agree that a specific skillset helps to provide good healthcare to migrant and minority patients. The sciences offer multiple terms for what we are calling ‘diversity competence’. We assume that teaching and developing this competence is a complex, time-consuming task, yet health professionals’ time for further training is limited. Consequently, teaching objectives must be prioritised when creating a short, basic course to foster professionals’ diversity competence. Therefore, we ask: ‘What knowledge, attitudes and skills are most important to enable health professionals to take equally good care of all patients in evermore diverse, modern societies that include migrant and (ethnic) minority patients?’ By means of a modified, two-round Delphi study, 31 clinical and academic migrant health experts from 13 European countries were asked this question. The expert panel reached consensus on many competences, especially regarding attitudes and practical skills. We can provide a competence ranking that will inform teaching initiatives. Furthermore, we have derived a working definition of ‘diversity competence of health professionals’, and discuss the advantages of the informed and conscious use of a ‘diversity’ instead of ‘intercultural’ terminology.

Amendments to the Danish Health Act were introduced in 2018 that stated immigrant patients who have resided in Denmark for more than 3 years have to pay user fees for interpretation in health care. The aim of the study was to explore, how the use of interpreters was affected by the introduction of user fees for interpretation. Results showed a considerable decrease in interpretation services following the introduction of the fee. It is likely to assume that the reduced utilization of interpretation services is highly related to the fee. Further research is needed about the consequences of underutilization of interpretation services.

Background In 2018, an amendment to the Danish Health Care Act was passed making it a requirement for patients not proficient in Danish to pay for interpretation services in health care settings. Thereafter there has been a drastic decline in the use of professional interpreters, especially in general practice. We aimed to investigate the experiences of general practitioners (GPs) in establishing an understanding with these patients in consultations, without the presence of a professional interpreter. Methods The study was qualitative, based on semi-structured interviews with nine purposively selected GPs. Analysis was by interpretative phenomenological analysis. Results The GPs said that after the amendment was passed, the patients chose to almost exclusively use family members or friends as ad hoc interpreters, or they attended consultations with no interpreter present at all. The GPs experienced that the use of family interpreters caused specific problems, due to both their relationship with the patient and their lack of professional interpretation skills. If no mediator was present the GPs perceived the establishment of understanding as extremely challenging. This was particularly the case if patients had chronic conditions, mental or psychosocial problems or if cultural barriers were present. According to the GPs, the challenges were not exclusively restricted to a lack of language translation, but could also involve intertwined cultural barriers or social problems. The impairment in mutual understanding had different consequences, and led to poorer treatment at many levels in health care. The lack of access to a professional interpreter also presented the GP with ethical and legal dilemmas. Conclusions The GPs experienced that the changes in interpretation provision for patients in health care had led to professional interpretation being almost absent from general practice settings for patients subject to the fee. This led to several communication challenges, insufficient understanding in consultations, and poorer treatment of these, often very vulnerable, patients. The situation could, however, also involve the risk of epistemic injustice. The GPs experienced the situation as very unsatisfactory; it both comprised their ability to exercise their professionalism and their ethical obligations and restricted their legal rights.