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

Doctor A

Doctor B

Doctor C

Doctor D

Doctor E

  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

  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

  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

  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.

  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