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Acute respiratory infections (ARI) are responsible for one quarter to one third of all deaths in infants and young children, with most deaths being attributed to pneumonia. At present, few measures exist to prevent pneumonia. However, most pneumonia deaths can be averted by treatment with an appropriate antibiotic. The effectiveness of this strategy depends on families' ability to recognize the signs of pneumonia, and to promptly seek care from a trained health practitioner. In order for health workers to communicate effectively with families about how to care for children with ARI, what signs to watch for, and when to come back for care, they need to know how families perceive and respond to respiratory infections. The WHO ARI Programme has recently developed a research protocol for conducting ethnographic studies of community perceptions and practices related to ARI. The purpose of this protocol is describe communities' explanatory models for ARI, identify cultural and other factors that facilitate or constrain appropriate home care and careseeking for children with ARI, and make recommendations to national ARI programmes about how to develop effective communication activities. This paper reports on two studies conducted in Bolivia using the WHO/ARI Focused Ethnographic Study (FES) protocol, and describes the way in which the data were utilized by the national ARI programme. Key words - acute respiratory infection, child health, Bolivia, pneumonia, preventive programmes

This paper discusses results from a study of the household management of childhood diarrhea in a poor, urban neighborhood of Managua, Nicaragua, carried out between February 1987 and April 1988. Eight key informants and a random sample of 109 mothers were interviewed. Appropriate use of ORS was not found to be a common feature of the household management of diarrhea despite health education efforts to change mothers' beliefs and practices, and the provision of oral rehydration solution (ORS) packets by state health facilities, pharmacies and informal drug vendors. Although mothers knew about dehydration and ORS, their explanatory models for diarrhea, as well as actual practices, reflected heavy reliance on self-prescribed pharmaceuticals and home remedies, while ORS use was associated with clinic attendance. These findings point to the difficulties inherent in changing people's explanatory models for illness and illness management, and the importance of understanding the context in which treatment options are assessed and utilized.

Abstract Background Physicians working with multicultural populations need to know how to elicit the patient's understanding of the illness; determine the patient's sociocultural context and identify any issues that might affect care; communicate effectively across patient-provider social and cultural differences; and collaborate effectively with an interpreter. Skills self-assessment can contribute to identifying training needs and monitoring skills development in these areas. Methods As part of a larger study exploring the knowledge, attitudes and practices of Geneva physicians and medical students regarding the care of immigrant patients, we asked respondents to self-rate their ability to perform a range of common yet challenging intercultural communication tasks. Results Overall, respondents rated themselves less competent at intercultural tasks than at basic medical skills and less competent at specific intercultural communication skills than at general intercultural skills. Qualified doctors (as opposed to students), those with greater interest in caring for immigrants, and those who rarely encountered difficulties with immigrants rated themselves significantly more competent for all clinical tasks. Having a higher percentage of immigrant patients and previous cultural competence training predicted greater self-rated intercultural communication skills. Conclusion Our self-assessment results suggest that students and physicians should be provided with the opportunity to practice intercultural skills with immigrant patients as part of their cultural competence training. To strengthen the validity of self-assessment measures, they should ideally be combined with more objective methods to assess actual skills.

Abstract Background Use of available interpreter services by hospital clincial staff is often suboptimal, despite evidence that trained interpreters contribute to quality of care and patient safety. Examination of intra-hospital variations in attitudes and practices regarding interpreter use can contribute to identifying factors that facilitate good practice. The purpose of this study was to describe attitudes, practices and preferences regarding communication with limited French proficiency (LFP) patients, examine how these vary across professions and departments within the hospital, and identify factors associated with good practices. Methods A self-administered questionnaire was mailed to random samples of 700 doctors, 700 nurses and 93 social workers at the Geneva University Hospitals, Switzerland. Results Seventy percent of respondents encounter LFP patients at least once a month, but this varied by department. 66% of respondents said they preferred working with ad hoc interpreters (patient's family and bilingual staff), mainly because these were easier to access. During the 6 months preceding the study, ad hoc interpreters were used at least once by 71% of respondents, and professional interpreters were used at least once by 51%. Overall, only nine percent of respondents had received any training in how and why to work with a trained interpreter. Only 23.2% of respondents said the clinical service in which they currently worked encouraged them to use professional interpreters. Respondents working in services where use of professional interpreters was encouraged were more likely to be of the opinion that the hospital should systematically provide a professional interpreter to LFP patients (40.3%) as compared with those working in a department that discouraged use of professional interpreters (15.5%) and they used professional interpreters more often during the previous 6 months. Conclusion Attitudes and practices regarding communication with LFP patients vary across professions and hospital departments. In order to foster an institution-wide culture conducive to ensuring adequate communication with LFP patients will require both the development of a hospital-wide policy and service-level activities aimed at reinforcing this policy and putting it into practice.