Wednesday, November 28, 2007

Chalk another one up for "environment"

What contributes to the disparities in health between ethnic groups in the US: genetic or environmental differences between groups? ... well, both probably, but we have a long way to go in identifying all the specific genetic and environmental variants that contribute to these disparities, and to understand the relative contribution of each, for specific diseases and for specific groups. The paper below, newly published in PLoS Medicine gives us insight into another potential environmental contributor to health disparities between majority and minority groups in England. Doctors are more likely to be of a different ethnicity than their minority patients, and this can create problems in communication and optimal health care delivery to ethnic minorities

Professional Uncertainty and Disempowerment Responding to Ethnic Diversity in Health Care: A Qualitative Study

Joe Kai, Jackie Beavan, Christina Faull, Lynne Dodson, Paramjit Gill, Angela Beighton

PLoS Medicine 4(11): e323
Background 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.

Methods and Findings 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.

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.

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