title: Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: a theoretically informed participatory study.
abstract: Guidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings.
  
  
  
  As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands.
  
  
  
  A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners).
  
  
  
  We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs.
  
  
  
  The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project.
  
  
  
  This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants.
authors.affiliation: Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.affiliation: Faculty of Medicine, University of Crete, Heraklion, Greece Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Heraklion, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Papadakaki
authors.affiliation: Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Aristoula
authors.initials: A
authors.lastname: Saridaki
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowrick
authors.affiliation: Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: O'Donnell
authors.affiliation: Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow.
authors.forename: Frances S
authors.initials: FS
authors.lastname: Mair
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands Pharos Centre of Expertise on Health Disparities, Utrecht, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: van den Muijsenbergh
authors.affiliation: Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow Faculty of Health and Medicine, Lancaster Medical School, Furness College, University of Lancaster, Lancaster University, Lancaster, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Burns
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Tomas
authors.initials: T
authors.lastname: de Brún
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: O'Reilly de Brún
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Evelyn
authors.initials: E
authors.lastname: van Weel-Baumgarten
authors.affiliation: Centre for Public Health, Medical University of Vienna, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Spiegel
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
mesh_terms: D000293:Adolescent; D001317:Austria; D003142:Communication; D065246:Culturally Competent Care; D004739:England; D005260:Female; D017144:Focus Groups; D006115:Greece; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D036301:Qualitative Research; D014171:Transients and Migrants; D055815:Young Adult
keywords: PRIMARY CARE; community involvement; cross-cultural consultation; migrant health