Physician behaviours that optimize patient‐centred care: Focus groups with migrant women

Abstract

Background No prior research studied how to implement patient‐centred care (PCC) for migrant women, who face inequities in health‐care quality. This study explored migrant women's views about what constitutes PCC and how to achieve it. Design We conducted a qualitative study involving three focus groups with migrant women living in Toronto, Canada, recruited from English language classes at a community settlement agency, used constant comparative technique to inductively analyse transcripts and interpreted themes against a published PCC framework. Participants Twenty‐three migrant women aged 25‐78 from 10 countries participated. Results Women articulated 28 physician behaviours important to them across six PCC domains: foster a healing relationship, exchange information, address concerns, manage uncertainty, share decisions and enable self‐care. They emphasized the PCC domain of exchanging information, which included 13 (46.4%) of 28 behaviours: listen to reason for visit, ask questions, provided detailed explanations, communicate clearly, ensure privacy and provide additional information. Women said that instead of practising these behaviours, physicians rushed through discussions, and ignored or dismissed their concerns and questions. As a result, women said that physicians may not fully understand their problem, and they may refrain from stating important details or avoid seeking care. Conclusions This research characterized the lack of PCC experienced by migrant women and revealed specific physician behaviours to optimize PCC for migrant women. Research is needed to develop and evaluate the impact of strategies targeted at migrant women, physicians and health‐care systems to support PCC for migrant women.

Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines

“…These enablers can be mapped to the principle of “essential characteristics of the clinician”, the enabler “clinician-patient communication” and the activity dimensions of “Patient information” and “patient involvement in care”. These dimensions have also been identified in qualitative research with women, ten of these studies originated from countries where FGM is practised [ 134 ].…”

Medical student exposure to women’s health concepts and practices: a content analysis of curriculum at Canadian medical schools

“…Medical education must expand to include a range of healthcare conditions, and beyond the lifespan context to consider not only healthcare conditions, but also issues and challenges that affect women’s health and health care. Considerable research has established wide-spread gendered inequities in access to and quality of care [ 7 – 19 , 23 , 24 ], further exacerbated by social determinants of health such as race, ethnicity, culture, education and employment, and other research shows that women’s healthcare concerns and questions are often dismissed [ 20 – 22 ]. One way to address these problems is to ensure that future generations of physicians are aware of these issues and understand what can be done at the individual, organizational and system levels to prevent and mitigate such inequities.…”

“…Another 1225 Canadian women said that truncated discussion of health issues was a frequent problem [ 20 ]. We recently interviewed Canadian women of varied age, ethnicity, province, urban or rural dwelling and health issue, who said that clinicians often ignored or dismissed their concerns or questions, resulting in confusion, frustration, anxiety, and dissatisfaction, and probable future avoidance of raising issues or seeking care [ 21 , 22 ]. Findings are similar elsewhere in both developed and developing countries.…”

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“…Immigrant women are also hard-to-reach due to low help-seeking arising from mistrust of healthcare providers and poor healthcare experiences [ 12 ]. We conducted focus groups with 23 immigrant women aged 25 to 78 from 10 countries who said that physicians rushed through discussions, did not address their questions, and did not make time for lifestyle counseling, which they desired as a means of preventing illness [ 13 ].…”

“…PA promotion is particularly crucial for groups at high risk of chronic diseases who experience disparities in PA participation. This includes immigrant women who face a plethora of barriers to PA [ 9 – 13 ]. We lack knowledge of how best to promote awareness of the importance of PA to immigrant women, but research suggests that community-based culturally-safe approaches are needed.…”