Guidelines and training initiatives that support communication in cross-cultural primary-care settings: appraising their implementability using Normalization Process Theory.
BACKGROUND
Guidelines and training initiatives (G/TIs) available to support communication in cross-cultural primary health care consultations are not routinely used. We need to understand more about levers and barriers to their implementation and identify G/TIs likely to be successfully implemented in practice.


OBJECTIVE
To report a mapping process used to identify G/TIs and to prospectively appraise their implementability, using Normalization Process Theory (NPT).


METHODS
RESTORE is a 4-year EU FP-7 project. We used purposeful and network sampling to identify experts in statutory and non-statutory agencies across Austria, England, Greece, Ireland, Scotland and the Netherlands who recommended G/TI data from the grey literature. In addition, a peer review of literature was conducted in each country. Resulting data were collated using a standardized Protocol Mapping Document. G/TIs were identified for inclusion by (i) initial elimination of incomplete G/TI material; (ii) application of filtering criteria; and (iii) application of NPT.


RESULTS
20 G/TIs met selection criteria: 8 guidelines and 12 training initiatives. Most G/TIs were identified in the Netherlands (n = 7), followed by Ireland (n = 6) and England (n = 5). Fewer were identified in Scotland (n = 2), and none in Greece or Austria. The majority (n = 13) were generated without the inclusion of migrant service users. All 20 were prospectively appraised for potential implementability by applying NPT.


CONCLUSIONS
NPT is useful as a means of prospectively testing G/TIs for implementability. Results indicate a need to initiate meaningful engagement of migrants in the development of G/TIs. A European-based professional standard for development and assessment of cross-cultural communication resources is advised.
Discipline of General Practice, National University of Ireland, Galway, Ireland, tomas.debrun@nuigalway.ie.
Tomas
T
de Brún
Discipline of General Practice, National University of Ireland, Galway, Ireland.
Mary O'Reilly
MO
de-Brún
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.
Evelyn
E
van Weel-Baumgarten
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands, Australian National University, Canberra, Australia.
Chris
C
van Weel
University of Liverpool, Liverpool, UK.
Christopher
C
Dowrick
Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
Christos
C
Lionis
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Catherine A
CA
O'Donnell
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Nicola
N
Burns
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Frances S
FS
Mair
Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
Aristoula
A
Saridaki
Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
Maria
M
Papadakaki
Department of General Practice and Family Medicine, Medical University of Vienna, Vienna, Austria and.
Christine
C
Princz
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.
Maria
M
van den Muijsenbergh
Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
Anne
A
MacFarlane
D001317:Austria; D003142:Communication; D003431:Cross-Cultural Comparison; D065246:Culturally Competent Care / Q000379:methods*; D004739:England; D006115:Greece; D006801:Humans; D007494:Ireland; D009426:Netherlands; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D036301:Qualitative Research; D012017:Referral and Consultation; D012606:Scotland; D014171:Transients and Migrants
Community involvement; Normalization Process Theory; migrant health; primary care.