Migrants’ health beliefs and their impact on general practice encounters: an in-depth interview study of French- and Swahili-speaking Africans and general practitioners working with migrant patients

Cooper, Maxwell John Francis (2014) Migrants’ health beliefs and their impact on general practice encounters: an in-depth interview study of French- and Swahili-speaking Africans and general practitioners working with migrant patients. PhD thesis, University of Glasgow.

Abstract

Background. The growing population of migrants (including sub-Saharan Africans) in the United Kingdom poses challenges to British general practice. First, migrants tend to seek health care at times of crisis rather than for preventive measures. This is despite being at increased risk of certain chronic conditions compared with the indigenous population. For sub-Saharan Africans this includes hypertension-related diseases and some cancers. Little has been published about Africans’ awareness of this risk or their knowledge of associated causative factors. Second, discordant health beliefs and healthcare expectations between migrants and doctors in the UK have been found to undermine trust during consultations with general practitioners and to lead to poor patient satisfaction. Little is known about the health behaviours of African migrants whose expectations are not met by primary care in the UK. A related area where health beliefs and practices differ between African migrants and their GPs is in the use of traditional medicines. A final challenge lies in considering the wider issues that GPs must address when consulting with migrant patients, including time pressures, organisational factors and the complex nature of problems presented by migrant patients. These issues are the focus of this study.

Aims. To examine African migrants’ perceptions of chronic disease and their experience of seeking primary health care in the UK. To explore the impact upon GPs of caring for migrants.

Objectives. To explore: 1) perceptions of chronic disease risk facing African migrants and their underlying explanatory models; 2) experiences of consultations about antibiotic prescriptions; 3) traditional African medicine use in the UK; and (4) to consider the effect of workload and work patterns on GP consultations with migrants.
Design. In-depth interviews were conducted with 19 Africans from French- or Swahili- speaking countries, one African key informant and 13 GPs working with migrants. African participant recruitment was from community organisations and GPs were approached via an informal network of doctors. Interviews were transcribed and ten were translated by the principal investigator (three Swahili and seven French). Data analysis was undertaken following the approach of applied thematic analysis using the Nvivo software package. Data collection and analyses were underpinned by the following theoretical frameworks: Kleinman’s explanatory models of illness and of cultural health care systems and Lipsky’s street-level bureaucracy.

Results. Narratives suggested low awareness of chronic disease risk amongst Africans. Infectious diseases were considered the dominant health threat for African migrants, mainly HIV but also tuberculosis and ‘flu’. Chronic diseases were sometimes described by Africans as contagious. Explanatory models of chronic disease included bodily/dietary imbalance, stress/exertion, heredity/predisposition and food contamination. Cancer was feared but not considered a major threat. Cancer was considered more common in Europe than in Africa and was attributed by Africans to chemical contamination from fertilizers, food preservatives and industrial pollution. Evidence cited for these chemicals was rapid livestock/vegetable production, large size of farmed products (e.g. fish), softness of meat and flavourless food. Chemicals were reported to circulate silently inside the body and cancer to develop in the part where they deposit, sometimes years later.
Africans’ belief in infective explanations of disease extended to minor illnesses and was manifested in an expectation of antibiotics from GPs for problems such as a sore throat. This arose from participants’ experience in Africa, witnessing life-threatening infectious diseases and experience of unregulated access to antibiotics. Africans described various alternative measures to fulfil their unmet expectations, including approaching other National Health Service doctors, importing medication, and using private healthcare services in London, francophone Europe and east Africa. A further option was the use of traditional African medicine, reported by one quarter of African participants. Traditional African herbal medicine use was based upon a perception of its purity and natural origin in African soil and a deep belief in its efficacy. Consulting traditional African healers in the UK was reported to be undertaken in secret.
Some GPs and Africans described consultations in terms of pressure, processing and conflict. Migrants were reported to present with complex health problems that were frequently compounded by language barriers. GPs described a need to remain in control of consultations and this included some use of personal discretion to render their tasks easier to complete. The most common example was accepting patients’ family and friends as informal interpreters – a choice that ran contrary to formal policy of only using professional interpreters. Burnout was reported to be one consequence of excessive workload for patient-centred GPs working with vulnerable groups like asylum seekers.

Conclusions. There is a need to improve health literacy amongst African migrants in order to promote preventive behaviours for chronic disease and alternatives to antibiotics for minor illnesses. As part of this, further research is required into the use and properties of traditional African medicine. Interventions should be built upon participants’ existing knowledge of disease causation, their self-reliance in the pursuit of a healthy lifestyle and desire to retain cultural practices. One challenge to improving migrant health lies in the service dilemmas facing GPs, including excessive workload, the complex nature of migrants’ presenting problems and professional dilemmas. GPs who act as advocates for vulnerable migrant patients may be at increased risk of burnout and greater consideration should be given to providing them with appropriate support.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Africa Migrants Refugees Asylum Lipsky Herbal Antibiotics General Practitioners Traditional medicine
• Subjects: R Medicine > R Medicine (General); R Medicine > RM Therapeutics. Pharmacology; R Medicine > RV Botanic, Thomsonian, and eclectic medicine; R Medicine > RZ Other systems of medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Supervisor's Name: O'Donnell, Professor Kate, Mullen, Dr. Kenneth and Harding, Professor Seeromanie
• Date of Award: 2014
• Depositing User: dr maxwell Cooper
• Unique ID: glathesis:2014-5087
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 17 Apr 2014 13:35
• Last Modified: 20 Apr 2017 12:45
• URI: https://theses.gla.ac.uk/id/eprint/5087