Illness and treatment perceptions of Ethiopian immigrants and their doctors in Israel.

Abstract

OBJECTIVES: Patient-provider misunderstandings arising from disparate medical and cultural concepts can impede health care among immigrant populations. This study assessed the extent of disagreement and identified the salient problems of communication between Israeli doctors and Ethiopian immigrant patients. METHODS: Semistructured interviews were conducted with 59 Ethiopian immigrants. Self-reports of health status and effectiveness of treatment were compared with evaluations by the primary care physician and supplemented by qualitative data from descriptions of illness, observations of medical visits, informant interviews, and participant observations conducted by the anthropologist. RESULTS: Health status and effectiveness of treatment were rated significantly higher by the doctor than by the patients. Low doctor-patient agreement occurred mainly for illnesses with stress-related or culture-specific associations. Qualitative data suggested that more long-term immigrants may alter their expectations of treatment but continue to experience symptoms that are culturally, but not biomedically, meaningful. CONCLUSIONS: Misunderstandings between immigrant patients and their doctors emerge from the biomedical system's limitations in addressing stress-related illnesses and from culture-based discrepancies in concepts of illness and healing. Including trained translators in medical teams can reduce medical misunderstandings and increase patient satisfaction among immigrant populations.

Do Healthy People Worry? Modern Health Worries, Subjective Health Complaints, Perceived Health, and Health Care Utilization

“…However, the cultures within which the MHW scale has demonstrated consistent findings are relatively similar to one another. Several studies have suggested that some cultures do not interpret health within the same contextual framework as most westernized cultures [35,36]. Inclusion of individuals from diverse cultures that may interpret and respond to symptoms differently would be informative.…”

Suboptimal Pneumococcal Pneumonia Vaccination Rates Among Patients at Risk in a Managed Care Organization in Israel

“…Direct contact with the patients, with or without a survey, appears to be necessary, particularly among more insular immigrant populations from the developing world, such as the Ethiopians in this study, who must cope with the complexities of modern Western medical care that are nonexistent in their country of origin. 20 In addition to telephone contact, case mangers may need to assume responsibility for pneumococcal vaccination of highrisk patients. Since many of these patients receive chronic care in non-MCO facilities, there will be challenges in coordinating care among a multitude of providers, making intervention by the case manager particularly important.…”

Conceptions of health: A cross-cultural comparison.

“…Some authors have argued that relational difficulties during cross-cultural medical encounters result from cultural differences between doctors and their minority patients, especially with respect to their perceptions of health, illness, and treatment plans (Cass et al, 2002;Pachter, 1994;Pavlish et al, 2010;Reiff, Zakut, & Weingarten, 1999;Schouten & Meeuwesen, 2006). For instance, past studies have shown that, due to divergent health perspectives, cultural minority patients often report not feeling understood by their doctors (Hilfinder Messias, 2002;Pavlish et al, 2010;Reiff et al, 1999).…”

“…For instance, past studies have shown that, due to divergent health perspectives, cultural minority patients often report not feeling understood by their doctors (Hilfinder Messias, 2002;Pavlish et al, 2010;Reiff et al, 1999). Other studies have demonstrated that cultural differences in the views of doctors and patients can result in misunderstandings (Armstrong & Swartzman, 2001;Laffrey, 1986a;Pavlish et al, 2010;Tripp-Reimer, 1984) and lead to patients' lack of trust in their doctors (Pavlish et al, 2010;Rubenstein et al, 1992;Schlomann & Schmitke, 2007).…”

“…These differences in the health conceptions of health professionals and patients can have serious implications for the doctor-patient working alliance (Jovchelovitch & Gervais, 1999). In a study conducted with Ethiopian immigrants, Reiff et al (1999) found disparities in the meaning of illness and in treatment beliefs of doctors and patients. While patients talked about their illness in a more holistic way, sometimes referring to culture-specific complaints, doctors focused almost exclusively on the biomedically meaningful complaints.…”