Search

Introduction: Although the United States has been central in bringing cultural competency into the discussion of high-quality care, health systems all over the world are faced with the effects of global immigration and the widening disparities gap between socioeconomic classes. Lausanne University Hospital is one of five Swiss academic medical centers chosen to develop programs addressing cultural competency. Here we focus on our medical training as a model for other international settings looking to build curricula based on best practices, but tailored to their local context. Setting and Participants: At Lausanne University Hospital, diversity is part of clinical practice. Just over a third of the patient population is non-Swiss, and include undocumented and recently arrived refugees. The center serves other high-risk and vulnerable populations. The strategies presented here focus on medical learners at the Lausanne center. Program results and historical overview: Primary cultural competency topics are social determinants of health, cultural groups in the local community, stereotypes, and unintended biases. Early sessions begin with medical anthropology material which raise consciousness of the learner's own potential biases. Medical education evolves to a more case-based medical training- focusing on the social determinants of health through clinical vignettes linked to disparities (mental health, HIV). Our narrative describes the inception of such teaching topics and its evolution over time given national health mandates and Switzerland's environmental context. Discussion: We describe one of the few official cultural competency medical curricula in Europe. We present the theoretical framework and pedagogical models that have been most applicable to our endeavor since its inception in 2005, educational content, developmental approach, and assessments. In summary, we provide a "roadmap" for international health-education systems developing cultural competency medical training, at various learner levels, in the context of their local setting.

BackgroundAs the diversity of the European population evolves, measuring providers' skillfulness in cross-cultural care and understanding what contextual factors may influence this is increasingly necessary. Given limited information about differences in cultural competency by provider role, we compared cross-cultural skillfulness between physicians and nurses working at a Swiss university hospital.MethodsA survey on cross-cultural care was mailed in November 2010 to front-line providers in Lausanne, Switzerland. This questionnaire included some questions from the previously validated Cross-Cultural Care Survey. We compared physicians' and nurses' mean composite scores and proportion of "3-good/4-very good" responses, for nine perceived skillfulness items (4-point Likert-scale) using the validated tool. We used linear regression to examine how provider role (physician vs. nurse) was associated with composite skillfulness scores, adjusting for demographics (gender, non-French dominant language), workplace (time at institution, work-unit "sensitized" to cultural-care), reported cultural-competence training, and cross-cultural care problem-awareness.ResultsOf 885 questionnaires, 368 (41.2%) returned the survey: 124 (33.6%) physicians and 244 (66.4%) nurses, reflecting institutional distribution of providers. Physicians had better mean composite scores for perceived skillfulness than nurses (2.7 vs. 2.5, p < 0.005), and significantly higher proportion of "good/very good" responses for 4/9 items. After adjusting for explanatory variables, physicians remained more likely to have higher skillfulness (β = 0.13, p = 0.05). Among all, higher skillfulness was associated with perception/awareness of problems in the following areas: inadequate cross-cultural training (β = 0.14, p = 0.01) and lack of practical experience caring for diverse populations (β = 0.11, p = 0.04). In stratified analyses among physicians alone, having French as a dominant language (β = -0.34, p < 0.005) was negatively correlated with skillfulness.ConclusionsOverall, there is much room for cultural competency improvement among providers. These results support the need for cross-cultural skills training with an inter-professional focus on nurses, education that attunes provider awareness to the local issues in cross-cultural care, and increased diversity efforts in the work force, particularly among physicians.

BackgroundGrowing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients' health-care needs and financial resources.ObjectivesIdentify a screening question to, indirectly, rule out patients' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians' attitudes toward deprivation.DesignMulticenter cross-sectional survey.ParticipantsForty-seven general practitioners working in the French-speaking part of Switzerland enrolled a random sample of patients attending their private practices.Main measuresPatients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels.Key resultsOverall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4-12.1) reported a member of their household to have forgone health care during the 12 previous months. The question "Did you have difficulties paying your household bills during the last 12 months" performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R(2) = 0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times.ConclusionGeneral practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.

Due to the Syrian civil war, millions of Syrians have fled the country since 2011. Several issues have inhibited their successful resettlement, but few studies have examined the development of the healthcare needs of Syrian forced migrants in Europe. This study examined Syrian forced migrants' healthcare needs in Switzerland, and whether migration type and family functioning affect their mental health. Our sample included 108 individuals from 14 families from the usual asylum process and 19 from the Swiss Resettlement Program (SRP). Each family member was surveyed thrice in 1 year. Several participants reported symptoms of major depressive and post-traumatic stress disorder. However, their general mental health was similar to that of the Western populations. Swiss Resettlement Program participants reported higher overall mental health scores than non-SRP participants, while the two groups showed different progression over time. Children and fathers reported similar levels of mental health, whereas mothers' mental health scores worsened over time. Family functioning was important for mental health in both groups. Overall, considering the structural and family contexts is important when studying forced migrants' mental health. [ABSTRACT FROM AUTHOR]