Noura A. Abouammoh

3.5 Summary

While there are many studies that have considered immigrant patients’ and local physicians’ experiences of the cross-cultural medical encounter, there are a limited number of studies that have looked at the reverse scenario, where IMGs care for local patients. These studies reveal challenges that considerably affect the quality of care provision. Although it has been noted that the majority of these studies did not actually use the term “cultural competence”, this concept clearly exists, as cross-cultural medical communication is the central idea examined in these studies.

It has been shown that the quality of interpersonal level of care in SA is suboptimal. Additionally, there is a lack of studies investigating IMGs’ experiences of caring for local patients in SA, despite researchers’ acknowledgment of the existence of cultural challenges in providing appropriate health care by international health workers and despite the existence of evidence that prove that cultural competence training has positive effect on physicians’ attitude and patients’ satisfaction.

Chapter 4

Scope of the study

4. Introduction

This chapter outlines the study rationale, based on key points identified from the literature review and on the specific situation of the Saudi MOH which is working to improve primary health care services, while the quality of care was shown to be suboptimal, particularly for chronic disease management including health education and interpersonal communication. Exploring IMGs’ experiences in caring for local patients is under-researched. The previously identified challenges and facilitators experienced by IMGs in caring for local patients in different parts of the world may differ from those that could be identified in SA due to its different cultural and social structure. This chapter discusses the rationale for exploring IMGs’ experiences in caring for T2DM patients and the experiences of the latter in receiving care from IMGs, in SA. It then articulates the research aims and objectives.

4.1 Study Rationale

One of the main goals of the Saudi MOH is to decrease the load on hospitals and focus on promoting health and preventing diseases through primary health care services. The MOH in SA is giving particular attention to developing primary health care provision, and is spending huge amounts of money to this end. This is evident from the dramatic increase in the number of PHCCs. This had led to more availability of GP positions, which cannot be filled by Saudi physicians. As a result, the country has had to rely on IMGs to satisfy the increasing demand for primary health care provision.

Meanwhile, the literature, presented in the previous chapter, provides evidence that IMGs are faced with culturally-related challenges that negatively affect the quality of care with which they provide local patients. In line with this evidence, a systematic review examining the quality of primary health care in Saudi Arabia by Al-Ahmadi and Martin (2005) showed poor quality of care at the interpersonal level, which is mainly provided by IMGs in SA. The search in the literature showed no attempt to further examine the exact reasons behind this poor interpersonal level of care; however, the authors acknowledged that this could be attributed to cultural differences between most IMGs and patients.

The previous chapter identified the fact that IMGs’ challenges in interacting with local patients are underexplored. There is not enough evidence concerning IMGs’ experiences of interaction with local patients, nor is there any great understanding of these experiences. Furthermore, researching the literature highlighted the lack of studies comparing the accounts of IMGs and local patients to present a comprehensive picture of the situation. A close look at how IMG-local patient interaction affects patients’ perception of physicians’ advice, which needs to be culturally sensitive, has not been carried out yet.

It was discovered in the previous chapter that cultural competence interventions have proved their effectiveness in improving the quality of care, through improved patient satisfaction and physicians’ confidence in terms of being able to provide patients from different cultural backgrounds with care. However, the relationship between IMGs and patients is more complex than the one that exists between local physicians and immigrant patients, due to the dominance of patients and the vulnerability of IMGs. Thus an in-depth qualitative approach to exploring IMGs’ and patients’ experiences seems important.

IMGs’ and local patients’ experiences in caring for T2DM were included in the current study to highlight these experiences, as it is an example of a situation where competent physician-patient communication is essential because physicians are required to explain the diagnosis, its consequences, its medications, their use and side effects. T2DM is an important public health issue; patients with T2DM require long-term follow-up and need to be educated by GPs. What is more, this disease is highly prevalent in SA and requires lifestyle changes, which are culturally defined. IMGs are relied on heavily to provide diabetes care, and they are expected to provide culturally sensitive lifestyle advice to local patients in order to help them to control their condition. However, the MOH has not yet fully grasped the challenges IMGs face as they endeavour to provide high quality care.

Given that the MOH in SA aims to strengthen its primary health care system, and that SA is one of the countries with a majority of IMGs (Arabic and non-Arabic speakers) little is known about IMGs’ and their patients’ experiences. This study aimed to examine the issue of cultural competence by exploring IMGs and patients’ experiences in the cross-cultural medical encounter.

Exploring the challenges faced by IMGs in caring for patients with T2DM could lead to recommendations to reduce these challenges and ease the interaction process between physicians and patients in cross-cultural clinical settings in order to provide T2DM patients with high quality care.