Academic journal article Australian Health Review

Exploring Beliefs of the Four Major Ethnic Groups in Melbourne regarding Healthcare and Treatment

Academic journal article Australian Health Review

Exploring Beliefs of the Four Major Ethnic Groups in Melbourne regarding Healthcare and Treatment

Article excerpt

Introduction

Cultural background may shape health outcomes by influencing perceptions of illness, attitudes towards healthcare providers, and most importantly, patient behaviour.1 Similarly, clinicians' own cultural beliefs may influence service provision to patients from other cultures.2 A mismatch between clinician and patient beliefs may result in suboptimal health outcomes.3,4 A clear understanding of a patient's health-related cultural beliefs is therefore integral to a patient-centred approach to healthcare. A patientcentred approach involves physician-patient communication and interaction at a personal level to produce individualised care, adapted to the unique needs and expectations of the patient.5

The diversity of Australia's cultural mix dictates that clinicians interact with patients with varying cultural values and beliefs. In other westernised countries, increasing multiculturalism has been accompanied by health inequity for some minorities.6-8 Although literature regarding disparities in health and health access for ethnic groups in Australia have emerged,9-15 guidelines for overcoming such disparities are lacking. Internationally, several systems for improving ethnic health have been proposed, most notably the development of cultural competency. This has been defined as, 'Aset of congruent behaviours, attitudes and policies that come together in a system, agency, or among professionals enabling them to work effectively in cross-cultural situations'.16

Although early incarnations of this concept encouraged stereotyping, 'cultural competence' as understood today, involves understanding patients' unique social and cultural contexts while appreciating patient individuality, congruent with patient-centeredness. When cultural competence is achieved, patient-centred orientation is maintained, fostering a patientprovider partnership and effective communication, with particular attention to language and literacy.17

Recently, cultural competence and patient-centeredness have been promoted as central to improving patient care.18-20 NHMRC21 guidelines on cultural competence published in 2005 describe four dimensions for action: systemic, organisational, professional and individual. In particular, professional action involves the development of toolkits to improve cultural competency of healthcare professionals. Despite this, specific modules on cultural competency, patient-centred care and the relationship of both are lacking in the core curriculum of Australian medical schools. Little locally relevant data are available regarding the extent of hospital cultural proficiency training programs, and no data exist regarding the culturally specific health-related beliefs of patients or the preconceptions of doctors. Further, some available American studies examining culturally specific expectations have omitted examination of clinicians' preconceived notions of various ethnic groups.22,23 An understanding of practitioners' preconceived attitudes to ethnic groups and their health-related beliefs and behaviour is essential since patients' reactions to doctors may further contribute to healthcare disparities.6

This issue of ethnic disparities in healthcare provision is particularly relevant for the emergency department (ED) where a high proportion of patients do not speak English as a first language or are not Australian-born. Although ethnic disparities in the provision of emergency care in Australia are, as yet, undocumented, international literature suggests that such disparities do exist.24-29 It is beyond the scope and intent of this study to assess the standard of care delivered to ethnic patients, specifically in the ED. A body of data has, however, emerged which clearly demonstrates ethnic groups in Australia have a greater burden of disease as compared with Anglo-Australians.9,30,31 The ED context is characterised by time pressure, high demands on clinicians' attention and cognition, and incomplete information. …

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