Ontology based intercultural patient practitioner assistive communications from qualitative gap analysis

Abstract

Purpose – There is an increasing interest in using information and communication technologies to support health services. But the adoption and development of even basic ICT communications services in many health services is limited, leaving enormous gaps in the broad understanding of its role in health care delivery. The purpose of this paper is to address a specific (intercultural) area of healthcare communications consumer disadvantage; and it examines the potential for ICT exploitation through the lens of a conceptual framework. The opportunity to pursue a new solutions pathway has been amplified in recent times through the development of computer-based ontologies and the resultant knowledge from ontologist activity and consequential research publishing. Design/methodology/approach – A specific intercultural area of patient disadvantage arises from variations in meaning and understanding of patient and clinician words, phrases and non-verbal expression. Collection and localization of data concepts, their attributes and individual instances were gathered from an Aboriginal trainee nurse focus group and from a qualitative gap analysis (QGA) of 130 criteria-selected sources of literature. These concepts, their relationships and semantic interpretations populate the computer ontology. The ontology mapping involves two domains, namely, Aboriginal English (AE) and Type II diabetes care guidelines. This is preparatory to development of the Patient Practitioner Assistive Communications (PPAC) system for Aboriginal rural and remote patient primary care. Findings – The combined QGA and focus group output reported has served to illustrate the call for three important drivers of change. First, there is no evidence to contradict the hypothesis that patient-practitioner interview encounters for many Australian Aboriginal patients and wellbeing outcomes are unsatisfactory at best. Second, there is a potent need for cultural competence knowledge and practice uptake on the part of health care providers; and third, the key contributory component to determine success or failures within healthcare for ethnic minorities is communication. Communication, however, can only be of value in health care if in practice it supports shared cognition; and mutual cognition is rarely achievable when biopsychosocial and other cultural worldview differences go unchallenged. Research limitations/implications – There has been no direct engagement with remote Aboriginal communities in this work to date. The authors have initially been able to rely upon a cohort of both Indigenous and non-Indigenous people with relevant cultural expertise and extended family relationships. Among these advisers are health care practitioners, academics, trainers, Aboriginal education researchers and workshop attendees. It must therefore be acknowledged that as is the case with the QGA, the majority of the concept data is from third parties. The authors have also discovered that urban influences and cultural sensitivities tend to reduce the extent of, and opportunity to, witness AE usage, thereby limiting the ability to capture more examples of code-switching. Although the PPAC system concept is qualitatively well developed, pending future work planned for rural and remote community engagement the authors presently regard the work as mostly allied to a hypothesis on ontology-driven communications. The concept data population of the AE home talk/health talk ontology has not yet reached a quantitative critical mass to justify application design model engineering and real-world testing. Originality/value – Computer ontologies avail us of the opportunity to use assistive communications technology applications as a dynamic support system to elevate the pragmatic experience of health care consultations for both patients and practitioners. The human-machine interactive development and use of such applications is required just to keep pace with increasing demand for healthcare and the growing health knowledge transfer environment. In an age when the worldwide web, communications devices and social media avail us of opportunities to confront the barriers described the authors have begun the first construction of a merged schema for two domains that already have a seemingly intractable negative connection. Through the ontology discipline of building syntactically and semantically robust and accessible concepts; explicit conceptual relationships; and annotative context-oriented guidance; the authors are working towards addressing health literacy and wellbeing outcome deficiencies of benefit to the broader communities of disadvantage patients.

Healing Conversations: Developing a Practical Framework for Clinical Communication Between Aboriginal Communities and Healthcare Practitioners

“…A closer look at the integration of culture into communication provides an insight into the appropriate application of culture in the clinical context. Whilst many definitions of culture exist, the onus is on the health practitioner to acknowledge that in regard to health, culture can influence communication, beliefs about disease and wellness in addition to values that guide health-related behaviour [21,22]. In reviewing the literature one definition states culture to be "an accumulated pattern of values, beliefs, and behaviors shared by an identifiable group of people with a common history and verbal and nonverbal symbol systems" [23] (p16) and another the 'integrated pattern of human behaviour which includes, but is not limited to, communications languages, beliefs, values, practices, customs, rituals, roles, relationships and expected behaviours of a racial, ethnic, religious, social or political group" [13] (p253).…”

“…The relevance of high and low-context theories to Aboriginal health is supported in research that indicates relationship building and feelings of trust between Aboriginal peoples and health practitioners extends beyond what is spoken in the clinical encounter, to how welcoming the environment is and how safe people feel in their identity [22,34,35]. The importance of body language when working with Aboriginal communities also supports the significance of non-verbal techniques in clinical encounters [22,36]. This can be relevant when looking at healthcare delivery if services are designed to cater for…”

“…Time is needed to build trust and allow stories to be shared [21]. Effective use of time requires a balance of practitioner and patient needs being addressed [22]. In addition to the availability and use of time, perceptions of time within Given the diversity of Aboriginal communities and cultures within Australia, exploring the utility of a model within a small number of settings will guide planning for a more broadly applicable tool that can be contextualised to local community needs.…”

“…This can involve reflections on approach to asking questions and accommodation of a shared dialogue [65]. Yarning has been raised as an effective communication style that is characterised by its informal, conversation qualities [22,66]. Such approaches may work toward addressing power imbalances and making people feel more able to contribute to the communication dialogue.…”

“…A potential for communication conflict may arise when discussing topics that may be seen by community as inappropriate with particular genders due to local customs and practices. [22,73]. Understanding potential gender impacts will vary according to the local context, and having set strategies to manage this can ensure more effective communication encounters in the clinical environment.…”