Developing Approaches To Guide Improved Patient Engagement And Communication With Refugees And Asylum Seekers In Australian General Practice

Abstract

Background Communication in healthcare consultations is a key component in providing good care and enabling patient engagement. This thesis explores the perceptions and communication experiences of refugee and asylum seekers, as well as general practitioners in the Australian primary healthcare setting, to better understand how to provide better care.

Methods A range of methods were used in this study to report and understand the complexities in relation to particular sets of experiences regarding communication in the general practice settings; that of those who identify refugee or asylum seeker background and general practitioners who provide care to these individuals. A literature review of published data on communication in primary care was conducted to synthesise the existing evidence base about the communication needs of asylum seekers and refugees. This informed an environmental scan of online communication tools available to Australian primary healthcare providers. The knowledge developed from these two sets of data, alongside stakeholder input, then informed the qualitative interviews conducted with community member and general practitioner to better understand how their experiences of communication in Australian general practice influenced their perceptions of care.

Results The communication needs of refugees in primary care are nuanced and influenced by language barriers, health and system literacy and other practical considerations. General practitioner participants had access to and used a multitude of resources and experiences to help them engage their patients in consultations. However, the presence of language concordance and responding to the individual were critical factors impacting the overall experience. Key findings identified across the study include the need for the continuous provision of compassionate, person-centred care; importance of non-verbal elements such as visual cues and actions; acknowledgement of the differences in the expectations of the quality of care; the need for active listening and responding alongside applying principles of cultural safety and trauma informed care; and the need for consideration of the patients’ individual experiences both current circumstances and prior experiences. In addition to their social circumstances, individual capacity and how these influence their engagement in healthcare.

Conclusions Despite challenges with communication, there are a vast array of strategies and ad-hoc methods employed by general practitioners to engage their refugee and asylum seeker patients in their care. The implications of the research findings suggest that addressing patients’ previous experiences, expectations and providing individualised care provide avenues for better communication. Further systemic support is greatly needed to allow the allocation of greater time to meet the communication needs of these individuals in general practice.