Yvan Leanza

A Systematic Review of Patients' Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity.

Communication difficulties persist between patients and physicians. In order to improve care, patients’ experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients’ experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients’ experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients’ experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients’ evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all patients seemed to face additional cultural challenges. Findings provide a foundation for the development of tailored interventions to patients’ preferences, thus ensuring more satisfactory experiences. Health care providers should be sensitive to specific factors (cultural and micro-cultural) during all medical encounters.

Working with Interpreters

Interpreting in medical and especially in psychiatric and psychotherapy settings is an ethical imperative. In mental health, clinical assessment and intervention require that the interpreter have specific skills and sensitivity to work with a patient-centered approach. This chapter provides an orientation to working with mental health interpreters, with a review of relevant research literature and theoretical models followed by guidelines and practical recommendations relevant to cultural consultation. Key principles are presented on how to work with interpreters in various contexts (e.g. CBT, psychodynamic, family therapy). Case vignettes from the CCS are provided throughout the text to illustrate the main points. In cultural consultation, issues of roles, neutrality and the interpreter’s identity (age, gender, ethnicity, religion, political orientation) should be carefully considered. In addition to the individual characteristics of interpreters, it is essential that organizational efforts are made to adapt institutional policies to patients’ linguistic and cultural diversity. Institutional change depends on recognizing interpreters’ skills and contributions to clinical work and encouraging practitioners to work with trained interpreters rather than untrained or ad hoc interpreters, especially family members. Quality assurance standards must formally require the routine use of interpreters in mental health and there must be mechanisms in place to monitor and enforce these standards.

Integration of interpreters in mental health interventions with children and adolescents: The need for a framework

Few empirical studies have detailed the specificities of working with interpreters in mental healthcare for children. The integration of interpreters in clinical teams in child mental healthcare was explored in two clinics, in Montreal and Paris. Four focus groups were conducted with interpreters and clinicians. Participants described the development of the working alliance between interpreters and clinicians, the delineation of interpreters’ roles, and the effects of translation on the people in the interaction. Integrating interpreters in a clinical team is a slow process in which clinicians and interpreters need to reflect upon a common framework. An effective framework favours trust, mutual understanding, and valorization of the contribution of each to the therapeutic task. The interpreter’s presence and activities seem to have some therapeutic value.

Risk, disaster and crisis reduction : mobilizing, collecting and sharing information

Preface.- Risk and Information: for a new Conceptual Framework.- A Contemporary Look at Risks: Risks are Plural and Transcalar.- Information as a Process.- Definitions, Classifications and Models.- Reviewing Risk Categories.- Integrated Risk Management.- Temporal Risk Models.- Contextualising the Stages of Risk and the Various Types of Expertise.- The Information Flow.- Proposing a new Conceptual Framework.- The Translation Process.- The Holds.- The Trajectories.- The Research.- Case Studies.- Methodology.- Field Research.- Disseminating Information and Risk Management in Madagascar.- Risk Management in Madagascar.- The Institutional Structures of Crisis Management.- The Focal Point in Madagascar: the BNGRC.- The Roles and Responsibilities of the Actors.- The Terminology and the Categories of Alert Used.- Prevention, Alleviation, Preparation, Intervention.- Vulnerability.- The Warning.- Permeable Categories.- Definitions and Approaches to Risks.- The Circulation of Risk Information in Madagascar.- The Information Circulation Profiles.- Vertical Communication.- Horizontal Communication.- Actor Profiles.- The Socio-Technical Intermediaries.- Batteries.- Fuel.- Books, Forms and Reports.- Figures.- Conclusion.- Continuity between Categories and Reference Points for Action.- Structure Linking the Levels of Information.- Connexity and Contiguity.- Using and Communicating Information Practices Adopted by Tow Organisations in Cameroon.- Introduction.- The National Context with Regard to Health and Environmental Problems.- Objectives of the Research carried out in Cameroon.- Presentation of two NGOs, Local Contexts and Populations.- Research Methods.- The Doctors Working with Prosenat.- Definition of Risk and of Prevention.- Sources of Information and Professional Training Routes.- Communicating Knowledge.- Circulation of Information.- The Prosenat Traditional Therapists.- Definition of Risk and of Prevention.- Training and Sources of Information.- Communicating Knowledge.- Circulation of Information.- The Members of Wesde.- The Definition of Risk and Prevention.- Training and Sources of Information.- Communicating Knowledge.- Sources of Knowledge and Stages of its Transmission by Wesde.- Synthesis and Reflections.- Professional Definitions of Risk and Prevention.- A Restricting Factor: the Funding Structure for the Transmission of Knowledge.- Professional Training Routes: Gaps in the Transmission of Knowledge.- The Consequences of the Lack of Recognition for Traditional Medicine by the State.- Translation and Transmission of the Information.- Conclusions.- Conclusion.

Risk and Information: For a New Conceptual Framework

Dissemination of information is more complex, less linear and more heterogeneous than dominant scientific models propose. These models suggest that information is conveyed from a transmitter to a precise receiver by means of known socio-technical intermediaries. By closely observing how, in three distinct situations (Chaps. 2, 3 and 4), risk and crisis information is collected, processed, disseminated and used, this book will delve into the numerous processes by which information travels. The underlying hypothesis of this book is that these processes represent an important condition for the information to reach the receiver. This chapter describes the theoretical framework which is composed of four theoretical statements. The first statement relates to crises and risk situations and the need to integrate temporality and spatiality into the understanding of risks. The second concerns the importance of taking account of the contextualised facts and varied levels of knowledge inherent in all risk and crisis situations. The third shows how information should be seen as a process and a succession of interpretations. Finally, the fourth stage sets out the milestones for a new conceptual framework for the circulation of information.

Centralising Information: Predicting and Managing the Risk of Pandemics at the WHO

In order to analyse the centralisation of information, the research team went to the SHOC Room of the World Health Organization (WHO) in Geneva, a critical hub through which passes all information destined to managing worldwide epidemic risks. The description of the WHO’s surveillance device for epidemic diseases has brought to our attention the fact that an information becomes ‘alive’ only if seized, translated and transmitted to the next level, which in turn, undertakes the same process, and so on, thus creating a succession of ‘captures’. Furthermore, the socio-technical intermediaries, which are constantly being perfected by technological advancements, have allowed to broaden, in response to the SARS crisis, the notion of risk and to display the emergence of a novel spatiality on the scene of world affairs. This broadening also tampers with temporality. The WHO must now not only come to terms with the ‘during’, but must also invest in the analysis of all potentially sensitise information, such as rumours.

Communicating Information and Risk Management in Madagascar

Field libraries, a WHO initiative, were introduced in developing countries as of 2004 and aim to fill the gap regarding the lack of information about vulnerability to natural disasters. The monitoring of the constitution and the reception of such a library in Madagascar, an island systematically hit by cyclones and other disastrous elements, have permitted the analysis of information dissemination processes during a crisis situation. In 2007, the period of data collection, two tropical cyclones hit the country, leading to approximately 150 deaths, 200,000 disaster victims and substantial flooding. The current study offers a comprehensive overview of the actors involved in the management of crises and introduces a table depicting actors’ actions with regard to risk. Our analysis has allowed to underline many means of information dissemination (some more vertical, others more horizontal) and to depict individuals’ profiles during crisis management situations: the coordinator, the producer, the transmitters, the forwarder and the operators. Moreover, in order for information to circulate, some socio-technical intermediaries are crucial (e.g. batteries, fuel, written reports, numbers and statistics). Finally, in spatio-temporal terms, it was uncovered that risk and crisis prevention in Madagascar is still widely conceptualised in terms of proximity, although prevention is strongly encouraged to take into account connexity, as illustrated by the SMS mass sending system inaugurated in 2010, which alerts populations of imminent disasters.