the data collection process commenced, the researcher was responsible for documenting participants’ experiences, analysing the data and, most importantly, making sense of the large amount of data collected. Thus, the thematic analysis based on the grounded theory approach proposed by Ritchie and Spencer (1994) was helpful in providing a sequential structure for data analysis. The approach below describes the process of the analysis however, it simplified the complexity of the process and possibly given an artificial sense of order when in practice the process was very much iterative. 1-Familiarization: Listening to recordings; transcribing verbatim; translating and reading and re-reading through all data. This helped in terms of gaining a holistic overview of the dataset and being familiar with the range, depth and diversity of the collected data. 2- Descriptive coding: The computer-assisted qualitative data analysis software 10 was used for transcription and coding, which increased the efficiency of data organisation and retrieval. The researcher and the main supervisor read the same transcript and agreed on an initial coding frame which was then applied to other transcripts, with the flexibility to enable other codes to be added. 3-Basic analysis: At this emerging themes were found, along with subthemes. Data was removed from its original context and rearranged according to the appropriate thematic orientation. An example of a derived theme is given in Appendix 20. 4-Interpretation:
6 Focus group Syria 38/M Arabic 10/Hospital 70 - 7 Face to face Sudan 32/F Arabic 9/Hospital 80 - 8 Face to face 55/M Arabic 16/Hospital 125 - 9 Face to face Pakistan 46/M Urdu 9y/East1 30 - 10 Telephone interview India 40/M 4y/North1 25 Yes 11 Face to face Syrian 47/F Arabic 6y/North2 30-35 Yes 12 Face to face Sudan 38/F Arabic 2y4m/East1 30 - 13 Telephone interview Egypt 50/M Arabic 8y/East2 25-30 - 14 Face to face Pakistan 40/F Urdu 4y/North3 25 - 15 Face to face 57/F Arabic 9y/South1 35 - 16 Face to face Egypt 32/F Arabic 25-30 Yes 17 Face to face Jordan 59/M Arabic 29y/South1 25 - 18 Face to face Bangladesh 49/F Bangla 3y/West2 30 Yes 19 Face to face Pakistani 51/M Urdu 20y/West2 35 Yes Fifteen IMGs were approached and 11 agreed to be interviewed from the PHCCs, both males and females. Three female and a male Arabic speaking IMGs could not find the time and were not willing to be interviewed by phone. Nine interviews took place on the health care premises. Two telephone interviews were conducted based on physicians’ preference, for which consent forms were signed in advance in the PHCCs. The reason given for preferring telephone interviews was due to the IMGs’ busy schedule during working hours. IMG15 was the only participant who refused to be recorded. Reasons for
In general, the existence of prejudice between physicians and patients can be an obstacle to appropriate interaction and rapport-building and hence to good quality medical care. As noted in 3.3.1, not accepting IMGs can be seen anywhere in the world, so it is to be expected in SA as well. However, patients’ expression of non-acceptance and IMGs’ reaction to these expressions can be different from one setting to another. 6.3.4.2 Positive stereotyping The findings showed that Egyptian IMGs were more highly rated, by themselves and their patients, than other IMGs with regards to their communication skills and professionalism. Most of the Egyptian IMGs believed that they were more effective and popular than other IMGs because of their sociability, good listening abilities and attention to the psychosocial aspects of patients’ care. For example, one Egyptian IMG noted: “Egyptians’ characters attract patients. They always know how to interact with patients. I am sure if you ask patients about their Egyptian physicians you would find that they have a strong bond with them. They care about diabetes patients from all aspects; they listen and care about patients’ psychology” [Translated] (IMG16, Egyptian) Two of the patients also confirmed these positive characteristics when describing Egyptian physicians and even expressed a preference for them over Saudi physicians who share the same cultural beliefs. According to one patient:
Appendix 20 Deriving a Theme Global theme: Interaction and rapport-building in cross-cultural medical encounters Descriptive codes Analytical themes Organizing themes Trust between IMGs and patients Rapport-building Patients’ information disclosure Most of the IMGs were aware of the importance of in improving the quality of care (one IMG disagreed) Most of the IMGs believed that physicians are better able to build rapport with patients and hence more trusted by them Rapport building and quality of care provision Changing approach Formal/informal relationship The IMGs were aware that local patients need different approach than that needed by patients in their home countries The IMGs and the patients showed different expectations IMGs have different expectations regarding shared decision making than that of patients Different expectations between IMGs and patients Equal Dominant/superior Patients control IMGs Patients look inferiorly to IMGs Patient-physician power dynamic IMGs seen as servants Linking IMGs to domestic labour Respect Some IMGs do not feel that they are respected from their patients Prejudice in the medical interaction
IMGs’ financial position because of their cultural backgrounds One IMG thought that patients’ prejudicial behaviours are accepted because they dominate in the community The IMG explained their ways of handling prejudice Frustration Satisfy patients According to some patients, IMGs’ struggle to communicate information may force them compromise the quality of care The influence of coping with challenges on care provision