Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.

<h4>Background</h4>While ethnic disparities in health and health care are increasing, evidence on how to enhance quality of care and reduce inequalities remains limited. Despite growth in the scope and application of guidelines on "cultural competence," remarkably little is kno...

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Autores principales: Joe Kai, Jackie Beavan, Christina Faull, Lynne Dodson, Paramjit Gill, Angela Beighton
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Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2007
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Acceso en línea:https://doaj.org/article/c8f4d220b6fc4eba80eda5f1d0141cba
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spelling oai:doaj.org-article:c8f4d220b6fc4eba80eda5f1d0141cba2021-11-25T05:36:43ZProfessional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.1549-12771549-167610.1371/journal.pmed.0040323https://doaj.org/article/c8f4d220b6fc4eba80eda5f1d0141cba2007-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.0040323https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>While ethnic disparities in health and health care are increasing, evidence on how to enhance quality of care and reduce inequalities remains limited. Despite growth in the scope and application of guidelines on "cultural competence," remarkably little is known about how practising health professionals experience and perceive their work with patients from diverse ethnic communities. Using cancer care as a clinical context, we aimed to explore this with a range of health professionals to inform interventions to enhance quality of care.<h4>Methods and findings</h4>We conducted a qualitative study involving 18 focus groups with a purposeful sample of 106 health professionals of differing disciplines, in primary and secondary care settings, working with patient populations of varying ethnic diversity in the Midlands of the UK. Data were analysed by constant comparison and we undertook processes for validation of analysis. We found that, as they sought to offer appropriate care, health professionals wrestled with considerable uncertainty and apprehension in responding to the needs of patients of ethnicities different from their own. They emphasised their perceived ignorance about cultural difference and were anxious about being culturally inappropriate, causing affront, or appearing discriminatory or racist. Professionals' ability to think and act flexibly or creatively faltered. Although trying to do their best, professionals' uncertainty was disempowering, creating a disabling hesitancy and inertia in their practice. Most professionals sought and applied a knowledge-based cultural expertise approach to patients, though some identified the risk of engendering stereotypical expectations of patients. Professionals' uncertainty and disempowerment had the potential to perpetuate each other, to the detriment of patient care.<h4>Conclusions</h4>This study suggests potential mechanisms by which health professionals may inadvertently contribute to ethnic disparities in health care. It identifies critical opportunities to empower health professionals to respond more effectively. Interventions should help professionals acknowledge their uncertainty and its potential to create inertia in their practice. A shift away from a cultural expertise model toward a greater focus on each patient as an individual may help.Joe KaiJackie BeavanChristina FaullLynne DodsonParamjit GillAngela BeightonPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 4, Iss 11, p e323 (2007)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
spellingShingle Medicine
R
Joe Kai
Jackie Beavan
Christina Faull
Lynne Dodson
Paramjit Gill
Angela Beighton
Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.
description <h4>Background</h4>While ethnic disparities in health and health care are increasing, evidence on how to enhance quality of care and reduce inequalities remains limited. Despite growth in the scope and application of guidelines on "cultural competence," remarkably little is known about how practising health professionals experience and perceive their work with patients from diverse ethnic communities. Using cancer care as a clinical context, we aimed to explore this with a range of health professionals to inform interventions to enhance quality of care.<h4>Methods and findings</h4>We conducted a qualitative study involving 18 focus groups with a purposeful sample of 106 health professionals of differing disciplines, in primary and secondary care settings, working with patient populations of varying ethnic diversity in the Midlands of the UK. Data were analysed by constant comparison and we undertook processes for validation of analysis. We found that, as they sought to offer appropriate care, health professionals wrestled with considerable uncertainty and apprehension in responding to the needs of patients of ethnicities different from their own. They emphasised their perceived ignorance about cultural difference and were anxious about being culturally inappropriate, causing affront, or appearing discriminatory or racist. Professionals' ability to think and act flexibly or creatively faltered. Although trying to do their best, professionals' uncertainty was disempowering, creating a disabling hesitancy and inertia in their practice. Most professionals sought and applied a knowledge-based cultural expertise approach to patients, though some identified the risk of engendering stereotypical expectations of patients. Professionals' uncertainty and disempowerment had the potential to perpetuate each other, to the detriment of patient care.<h4>Conclusions</h4>This study suggests potential mechanisms by which health professionals may inadvertently contribute to ethnic disparities in health care. It identifies critical opportunities to empower health professionals to respond more effectively. Interventions should help professionals acknowledge their uncertainty and its potential to create inertia in their practice. A shift away from a cultural expertise model toward a greater focus on each patient as an individual may help.
format article
author Joe Kai
Jackie Beavan
Christina Faull
Lynne Dodson
Paramjit Gill
Angela Beighton
author_facet Joe Kai
Jackie Beavan
Christina Faull
Lynne Dodson
Paramjit Gill
Angela Beighton
author_sort Joe Kai
title Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.
title_short Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.
title_full Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.
title_fullStr Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.
title_full_unstemmed Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.
title_sort professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study.
publisher Public Library of Science (PLoS)
publishDate 2007
url https://doaj.org/article/c8f4d220b6fc4eba80eda5f1d0141cba
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