Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

Abstract

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions.

Compassionate care provision: an immense need during the refugee crisis: lessons learned from a European capacity-building project

“…When providing care to migrants, the specific stress factors associated with migration and fleeing from one's home, along with the short-and long-term impact on the incidence of mental disorders and timing for detection thereof ought to be considered. Additionally, longer stay, of migrants and refugees in one or multiple host countries ought to be considered along with the conditions under which they live and/or are moved across settings and/or countries [26,27].…”

REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings (RESTORE): study protocol

“…We are also aware that the challenging and fast-changing economic climate in Europe is another potential threat [53]. We will monitor these issues carefully, and compare and contrast the emerging findings in our different settings so that we can determine shared and differential levers and barriers to normalization of the selected interventions.…”

“…Taken together, RESTORE countries: host a diverse range of migrants from around the world; have different histories of inward migration in terms of colonial ties and migration rates; and have different capabilities and resources in primary care to respond to the complex health and social care needs of migrants [53]. …”

Participatory implementation research in the field of migrant health: Sustainable changes and ripple effects over time

“…19,[21][22][23] The EU-funded project RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings; summarized in Table 3) combined NPT and PLA to investigate and support implementation of guidelines and training initiatives to improve communication in primary care with migrants who are not fluent in the language of their host country. 7,11,12,24,25 There was evidence of positive changes to attitudes, knowledge and behaviour in practice settings 12 (see Table 3).…”