Primary care professionals’ perspectives on communication with recent migrants: a qualitative study

Problem

Increasing numbers of diverse migrants are arriving in the UK, some of them encountering a primary care service for the first time in their lives. Communication barriers can contribute to misunderstandings and an unsatisfactory patient experience especially where migrants and clinical staff are language discordant. However, little is known about primary care professionals’ (PCPs) perspectives on communicating with migrant patients.

Approach

This study was guided by a qualitative pragmatic approach. We interviewed 16 PCPs (GPs, nurses and practice managers) and conducted 2 rounds of thematic analysis. The first (led by ZT) focused on barriers and facilitators to good care; the second (led by AL) focused on the nature and context of communication and social interaction between PCPs and migrant patients.

Findings

Four major themes emerged around the topic of communication:1) PCPs and patients sharing a language was perceived to improve rapport and understanding. This worked best in large practices with a team approach; in small practices it could result in increased workload for bilingual staff and difficulties in maintaining professional boundaries. Some practices purposively employed ‘bridging’ staff (e.g. link worker, bilingual receptionist).2) Where there was no common language, interpreted consultations, while not ideal, were overall seen as satisfactory; a good interpreter could contribute to identification of mental health issues such as anxiety and depression. However, sometimes there was no time to call an interpreter (emergencies/ registration) and workarounds were used (family member, phrase book, Google Translate).3) There was potential for miscommunication related to patients’ level of English, health literacy and vocabulary to describe medical matters or parts of the body; wider assumptions and expectations around health and health care (e.g. when medical intervention is appropriate) could also be divergent. Some PCPs recognised this and put in ‘back stops’ (e.g. asking for clarification, arranging another consultation) to make sure errors were picked up. 4) PCPs found that there were sometimes disjoints in cultural understandings both in PCPs encountering different health beliefs and patients engaging with the NHS as a ‘culture’ in itself. Sometimes consultations did not ‘flow’ as patients came from areas where social conventions were different. Examples were whether family members should be present at the consultation, how to introduce a health problem (and how many); and when touch was acceptable and reassuring.

Consequences

It is important that dynamics around communication are understood to provide appropriate services to a highly diverse population. We will share our findings with CCGs and other stakeholders working in migrant health; we are also aiming to conduct further research to aid the development of resources to aid PCPs in effectively communicating with migrant patients.