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Table 4 Themes from doctor and patient interviews, and their related content

From: Effects of individual immigrant attitudes and host culture attitudes on doctor-immigrant patient relationships and communication in Canada

Doctor A Doctor B Doctor C Doctor D Doctor E
 Challenges in treating immigrants
  Patients often not proactive Needs more time to talk with/understand Level of difficulty depends on how long patient was in their previous country Level of difficulty depends how long they’ve been in Canada Can be difficult adjusting communication to their level
  Not sure they follow her advice Not always sure they understand what she said and vice versa Some are compliant but not proactive Some immigrants have different perspectives on health. Different approaches to medicine can be hard: many cultures not preventive
  Hard to explain different concepts   Difficult to approach topic of background: where to start?   
  Hard to advise on psychosocial aspects but they play big role   Unknown daily parts of life that influence health, but neither side thinks to ask about   
  Beliefs can conflict     
  Unclear what they expect her role to be Sometimes they don’t follow advice because it’s different in their country Different expectations of medicine (e.g. cures from pills) Expects patients to take control of own health. Sometimes they initially expect same treatment as they get in home country
  Education makes a difference to how much they understand Patients don’t always understand the health system. Education makes a difference how much the they understand/respond to treatment. It takes time for patients to understand the healthcare system. Don’t always understand:
- role of the doctor
- health system
 Keys to success/ideas for improvement
  More accessible community resources for psychosocial aspects Adjusts approach depending on integration level Understand bigger picture of where they come from Both doctors and patients can adapt and meet in the middle Establish rapport
  Translators, even if person speaks English Cultural sensitivity training Interpreters would be useful Be open to idea they won’t always take advice
   Questions about culture on health history form   Explain system when they first arrive
Patient A Patient B Patient C Patient D Patient E
(Philippines) (China) (Trinidad) (Philippines) (Brazil)
  Lived in 3 different countries (Saudi Arabia, Malaysia, Canada) Eats healthy, tries to get physical activity Took about 10 yearsto adjust to the culture Medical advice falls in line with her own beliefs Lives healthy lifestyle
  Follows doctor advice but follows own diet Believes in needing to adapt to new culture fully and with an open mind Medical advice falls in line with own beliefs because she reads what’s going on in the country and tries to adapt Learned to become healthier after pregnancy Was willing to learn and adapt to Canadian syste
  Dismisses difficult experiences with moving: one has to adapt Hard to adapt at first    People who complain don’t accept that the system is just different
 Healthcare experience in home country
  No healthcare in previous countries, have to pay for everything. Had to pay for everything, much poorer conditions (e.g. no privacy from other patients) Not as developed Nothing free, have to pay for everything Used to going to hospital for everything
Has pacemaker, wouldn’t have got that in Trinidad
 Healthcare experience in Canada
  Free care Advice matches own beliefs. All her needs are taken care of Her expectations of the treatment are always met Likes concept of family doctor and having history
Learned more about health
  Bad experience before present clinic Problems finding doctor at first Previous doctor was not attentive or caring Problems finding doctor at first Doesn’t like wait times
Long wait times, would rather pay and not have to wait.
 Experience with present doctor
  Likes doctor: good pep talks very happy Likes doctor: supportive answers questions Loves doctor: takes care of her concerns takes time with her Likes doctor: makes her laugh feel comfortable truly cares Likes doctor: takes time explains listens