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Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers

OBJECTIVES: In many high-income countries, structural, legal, social and political barriers to adequate healthcare interfere with the ability of health professionals to respond to the healthcare needs of a fluctuating and superdiverse population of asylum seekers. However, the relationship between i...

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Autores principales: Jahn, Rosa, Biddle, Louise, Ziegler, Sandra, Nöst, Stefan, Bozorgmehr, Kayvan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693650/
https://www.ncbi.nlm.nih.gov/pubmed/36424105
http://dx.doi.org/10.1136/bmjopen-2022-063012
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author Jahn, Rosa
Biddle, Louise
Ziegler, Sandra
Nöst, Stefan
Bozorgmehr, Kayvan
author_facet Jahn, Rosa
Biddle, Louise
Ziegler, Sandra
Nöst, Stefan
Bozorgmehr, Kayvan
author_sort Jahn, Rosa
collection PubMed
description OBJECTIVES: In many high-income countries, structural, legal, social and political barriers to adequate healthcare interfere with the ability of health professionals to respond to the healthcare needs of a fluctuating and superdiverse population of asylum seekers. However, the relationship between individual, interpersonal and structural factors is not well understood. We explore the views and experiences of physicians working with asylum seekers in Germany and aim to identify how these may impact the provision of medical care. METHODS: A secondary analysis of 16 semistructured interviews conducted in two qualitative studies was performed. These explored the delivery of medical care to asylum seekers in Germany. In order to examine physicians’ views towards their work with asylum seekers, we analysed evaluative judgements on interpersonal relationships, workplace factors, the external environment, the physician’s own self and individual medical conduct. Analysis was conducted by identifying cross-cutting themes through thematic analysis and mapping these onto a framework matrix. RESULTS: Physicians perceive the provision of medical care to asylum seekers as ‘different’. This ‘difference’ is conceptualised at three levels: patients’ perceived cultural attributes, the workplace or contextual level. Evaluative judgements on patients perceived as ‘other’ and the difference of the space of care provision were found to impede appropriate care, while physicians emphasising contextual factors reported more responsive medical practices. CONCLUSIONS: Concepts of difference at patient level resemble processes of ‘othering’ asylum seekers as a ‘different patient group’, while differences in rules, norms and practices in settings of medical care to asylum seekers create heterotopic spaces. Both appear to endanger the doctor–patient relationship and responsiveness of care, while an understanding of differences attributed to context seemed to foster a more caring approach. Training in contextual competence, sufficient physical and human resources and encouraging support between physicians working with asylum-seeking patients could counteract these processes.
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spelling pubmed-96936502022-11-26 Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers Jahn, Rosa Biddle, Louise Ziegler, Sandra Nöst, Stefan Bozorgmehr, Kayvan BMJ Open Public Health OBJECTIVES: In many high-income countries, structural, legal, social and political barriers to adequate healthcare interfere with the ability of health professionals to respond to the healthcare needs of a fluctuating and superdiverse population of asylum seekers. However, the relationship between individual, interpersonal and structural factors is not well understood. We explore the views and experiences of physicians working with asylum seekers in Germany and aim to identify how these may impact the provision of medical care. METHODS: A secondary analysis of 16 semistructured interviews conducted in two qualitative studies was performed. These explored the delivery of medical care to asylum seekers in Germany. In order to examine physicians’ views towards their work with asylum seekers, we analysed evaluative judgements on interpersonal relationships, workplace factors, the external environment, the physician’s own self and individual medical conduct. Analysis was conducted by identifying cross-cutting themes through thematic analysis and mapping these onto a framework matrix. RESULTS: Physicians perceive the provision of medical care to asylum seekers as ‘different’. This ‘difference’ is conceptualised at three levels: patients’ perceived cultural attributes, the workplace or contextual level. Evaluative judgements on patients perceived as ‘other’ and the difference of the space of care provision were found to impede appropriate care, while physicians emphasising contextual factors reported more responsive medical practices. CONCLUSIONS: Concepts of difference at patient level resemble processes of ‘othering’ asylum seekers as a ‘different patient group’, while differences in rules, norms and practices in settings of medical care to asylum seekers create heterotopic spaces. Both appear to endanger the doctor–patient relationship and responsiveness of care, while an understanding of differences attributed to context seemed to foster a more caring approach. Training in contextual competence, sufficient physical and human resources and encouraging support between physicians working with asylum-seeking patients could counteract these processes. BMJ Publishing Group 2022-11-24 /pmc/articles/PMC9693650/ /pubmed/36424105 http://dx.doi.org/10.1136/bmjopen-2022-063012 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Public Health
Jahn, Rosa
Biddle, Louise
Ziegler, Sandra
Nöst, Stefan
Bozorgmehr, Kayvan
Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers
title Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers
title_full Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers
title_fullStr Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers
title_full_unstemmed Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers
title_short Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers
title_sort conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693650/
https://www.ncbi.nlm.nih.gov/pubmed/36424105
http://dx.doi.org/10.1136/bmjopen-2022-063012
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