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Cited by 131Patient-Provider Communication in HealthcareCultural Competency in Health CareInterpreting and Communication in Healthcare

Perceptions of Barriers to Patient Participation: Are They Due to Language, Culture, or Discrimination?

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Schinkel, Sanne, Schouten, Barbara C., Kerpiclik, Fatmagül, Van Den Putte, Bas, Van Weert, Julia C.M.·2019·Health Communication
DOI 10.1080/10410236.2018.1500431
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Abstract

Previous research has shown that ethnic minority patients participate less during medical encounters than patients from majority populations. Given the positive outcomes of active patient participation, such as higher understanding of information and better treatment adherence, interventions are required to enhance ethnic minority patients' participation levels. However, little is known about what patients perceive as barriers hindering their participation. This study therefore aimed to explore differences in perceptions of barriers to patient participation among ethnic minority and ethnic majority patients in general practice. Eight focus-groups with Turkish-Dutch and indigenous Dutch participants were performed. A semi-structured topic-list concerning patients' enabling and predisposing factors to participate, and physicians' responses guided the interviews. Interviews were recorded, transcribed verbatim, and transcripts were analyzed using the constant comparison method described in Grounded Theory. Regarding Turkish-Dutch patients' enabling factors to participate, two perceptions of barriers were identified: (i) low Dutch language proficiency; (ii) a preference for an indirect communication style. Three perceptions of barriers to Turkish-Dutch patients' predisposition to participate were identified: (i) collectivistic values; (ii) power distance; (iii) uncertainty avoidance. Regarding doctors' responses, discrimination was identified among Turkish-Dutch patients as a perception of barrier to their patients' participation. None of these perceptions of barriers emerged among indigenous Dutch patients. This study contributes to our understanding of which perceptions of barriers might impede ethnic minority patients' level of patient participation. To enhance their participation, a combined intervention is needed, tackling the language barrier, raising awareness about cultural differences in values, and increasing doctors' cultural competencies to communicate adequately with ethnic minority patients.

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  • Communication style differences between Turkish participants and their Dutch doctors often led to patient dissatisfaction, and direct questions about health problems felt impersonal and careless, leading to disengagement during consultation.

    “communication style differences between Turkish participants and their Dutch doctors often led to patient dissatisfaction. When doctors asked questions directly about their health problems, participants felt this approach was impersonal and careless, leading to their disengagement during the consultation [74].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [74]

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Authors
Schinkel, S., Schouten, B. C., Kerpiclik, F., Van Den Putte, B., & Van Weert, J. C. M.
Affiliations
  • University of Amsterdam (NL)
  • University Medical Center Utrecht (NL)
  • Amsterdam School of Communication Research/ASCoR, University of Amsterdam and Trimbos Institute, Netherlands Institute for Mental Health and Addiction
  • Amsterdam School of Communication Research/ASCoR, University of Amsterdam
Corresponding author
Schinkel, Sanne
ORCID
Schouten, Barbara C.
Venue
Health Communication
Publisher
Informa UK Limited
Published
2018-07-24
Volume
34
Issue
12
Pages
1469-1481
ISSN
  • 1041-0236 (ISSN-L)
  • 1532-7027
DOI
10.1080/10410236.2018.1500431
OpenAlex
W2883113844
Cited by
131
References
49
Citations by year
2026: 15 · 2025: 58 · 2024: 14 · 2023: 12 · 2022: 10 · 2021: 9 · 2020: 10 · 2019: 3
FWCI
8.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Health Communication (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
  • Health Sciences › Health Professions › General Health Professions › Interpreting and Communication in Healthcare
Keywords
patient participation, ethnic minority patients, barriers to participation, language barriers, cultural barriers, discrimination, collectivism, power distance, uncertainty avoidance, cultural competence, physician-patient communication, general practice
MeSH terms
Adult, Communication Barriers, Cultural Characteristics, Ethnicity, Female, Humans, Male, Netherlands, Patient Participation, Prejudice, Turkey, Focus Groups

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