Objectives. To explore and compare beliefs about healthcare and treatment of four ethnic groups attending a Melbourne emergency department (ED), and the corresponding perceptions held by emergency clinicians.
Method. Prospective survey of ED doctors and patients from Greek, Italian, Vietnamese and Anglo-Saxon backgrounds.
Results. Vietnamese patients were least likely to believe their ethnic group received the best available care but less likely to believe in the existence of ethnic healthcare disparities. They were most likely to have an ethnically concordant GP and preferred most strongly to raise sensitive issues with an ethnically concordant doctor. Anglo-Saxon patients placed less importance on family support and older Anglo-Saxons were less likely than other groups to turn to God for comfort. Doctors perceived the existence of ethnic healthcare disparity, which was not perceived by the ethnic groups themselves. They underestimated the extent of patient-perceived disease control, external supports for coping, or use of complementary practitioners. Doctors overestimated patient perceived importance of doctor-patient ethnic concordance for Anglo-Saxons but underestimated the importance this has for Vietnamese patients. They also underestimated importance of cliniciandemonstrated cultural understanding.
Conclusions. Beliefs about healthcare and treatment differ across the four major ethnic groups attending a Melbourne ED. Doctors' misperceptions of patients' beliefs suggest that cultural competence amongst ED doctors could be improved.
What is known about the topic? Among English speaking countries, Australian society is one of the more ethnically diverse. Australia's increasingly multicultural landscape has been accompanied by minority health inequity, as seen in the States and UK. Internationally, several systems for improving ethnic health have been proposed, most notably the development of cultural competency. Like other settings, optimal healthcare delivery in emergency department (ED) settings demands a patient-centred, culturally competent approach. However, attaining this may be threatened by the time pressure of the clinical exchange and communication barriers, particularly for non-English speaking patients. For this reason, it is important to better understand the healthcare beliefs of ED patients and the corresponding perceptions held by doctors.
What does this paper add? This study explored differences in beliefs regarding healthcare and treatment of the four major ethnic groups attending a Melbourne ED, and assessed the degree of cultural understanding amongst ED doctors towards these groups. We report several differences in the beliefs of the four patient groups and several misperceptions held by doctors.
What are the implications for practitioners? Currently available cultural competency training programs for healthcare professionals are either inadequate or inaccessible. Further educational programs are necessary to improve cultural competence amongst practitioners. Strategies to improve ED clinicians' understanding of health beliefs and how they impact on the patient-centred care approach may be required.
Additional keywords: attitude to health, culture, emergency medicine, healthcare surveys, patient-centred care.
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. …