Barriers and facilitators in providing care for patients with a migration background.

AIMS AND OBJECTIVES: The aim of this study was to identify the barriers and facilitators experienced by healthcare professionals while caring for patients with a migration background. BACKGROUND: People with a migration background often face several structural inequalities and barriers in terms of accessibility to, and affordability of, healthcare. In order to provide quality care for patients with a migration background, it is important to understand which barriers healthcare professionals experience that prevent them from providing care and which factors can facilitate this. DESIGN AND METHODS: Qualitative research following the COREQ criteria. A total of six focus groups (n = 37) and 12 individual interviews were conducted with a multidisciplinary sample: doctors, nurses, social workers, and occupational therapists. Nursing and medical students were also included. Thematic content analysis was used. RESULTS: Key findings suggest that the main barrier is that healthcare professionals regard people with a migration background as "the other". Healthcare professionals do not feel secure or competent to provide care for these "others." According to the healthcare professionals, the hospital structures-and, particularly, the managerial instances-appear to be only slightly supportive. Structural barriers at the level of the healthcare system, such as limited implementation of care coordination and austerity measures (time pressure or economic restrictions), were also perceived as barriers. Facilitators can be the healthcare professionals' attitude or the flexibility of the management. CONCLUSIONS: Healthcare professionals experience barriers in caring for people with a migration background. Othering plays a key role in building or maintaining several barriers. A multilevel approach is necessary to tackle these barriers and enable facilitators. RELEVANCE TO CLINICAL PRACTICE: Raising awareness about "othering" in the educational programs of students and healthcare professionals is essential. Also, deploying support mechanisms and valuing the competences of multicultural and multi-lingual healthcare professionals can help facilitate quality care for patients with a migrant background. PATIENT OR PUBLIC CONTRIBUTION: Patients, informal and formal caregivers participated in the study at several stages (e.g.: by involving them during the research design phase or providing feedback and input at specific moments across the study). In addition, community participants played a key role also during the research design and data analysis phases as well as by facilitating patients' recruitment.

Doing research on the intersection of ethnicity and old age: Key insights from decolonial frameworks.

Population aging and international migration are two of the most critical social trends shaping the world today. As a result, scholars across the globe have begun to investigate how to better incorporate ethnicity into gerontological research. The integration of insights from life-course theory, post-colonial, and feminist theories have resulted in valuable attempts to tackle issues related to ethnicity and old age. Inspired by these bodies of research, this paper explores how decolonial perspectives can strengthen social gerontological research at the intersection of ethnicity and old age. This theoretical paper advances four key insights drawn from decolonial perspectives that expose some current blind spots in gerontological research at the intersection of aging and ethnicity. Through a process of awareness and resistance decolonial perspectives reveal that: 1) colonial thinking is deeply embedded in research; 2) critical reflection about who is considered the "knower" in research is warranted; 3) alternative ways to generate, analyze, and publish knowledge exist; and 4) the places and systems of knowledge production are not neutral. To address these issues empirically, decolonial frameworks call us to actions that include decolonizing the conceptual underpinnings of the research enterprise, scholars themselves, research-in-action (through "epistemic disobedience"), and current knowledge systems and structures that reflect and reinforce colonialism. Potential applications of these insights are explored, but acknowledged as an essential first step on a nascent path. This paper concludes by arguing that decolonial perspectives offer a more genuine gaze by demanding nuanced reflections of contemporary realities aging persons embodying the intersection of aging and ethnicity, like racialized older migrants and ethnic minorities, while simultaneously revealing how historically-rooted power hierarchies that are often invisible constrain their aging experiences.

Culturally Sensitive Care: Definitions, Perceptions, and Practices of Health Care Professionals.

INTRODUCTION: Research highlights that patients from ethnic minority groups often receive lower quality of care. This study contributes to the knowledge and understanding of culturally sensitive care and explores health care professionals' definitions and perceptions of this concept and how they deliver this in practice. METHOD: This qualitative study conducted a total of six focus groups (n = 34) and four in-depth interviews with six categories of health care professionals in Belgium. Thematic content analysis was used. RESULTS: The results indicate that the concept of culturally sensitive care is perceived quite narrowly. Professionals are likely to portray their own frame of reference and find it challenging to show empathy with patients with a different background. Othering (micro-racism by defining "the other") is a powerful example. DISCUSSION: The discussion reveals the significance of increasing cultural awareness and understanding, sensitizing about current narrow perceptions, and enhancing culturally sensitive care in the Belgian health care setting.