BACKGROUND: A growing body of research is examining how healthcare systems are responding to the increasing numbers of migrants and the resulting superdiversity of patients. The aim of this article is to identify and explain communication barriers in the provision of healthcare to Ukrainian war refugees in the Czech Republic from the perspectives of healthcare professionals and intercultural mediators.
METHODS: The exploratory case study is based on a qualitative analysis of semi-structured interviews with frontline health professionals: 20 with doctors and 10 with nurses. The second source of data is two focus groups aimed at capturing communication problems from the perspective of intercultural mediators who accompany refugees to health facilities. The interview transcripts and FGs were analysed using six-stage thematic coding.
RESULTS: The survey identified five main themes related to barriers to communication: (1) language barriers and interpreting, (2) cultural barriers, (3) differing expectations of health and the healthcare systems in the Czech Republic and Ukraine, (4) prejudices and negative attitudes and unethical behaviour towards refugees and migrants and (5) lack of awareness of patient rights.
CONCLUSIONS: The arrival of large numbers of migrants has highlighted deficiencies in the system that may affect other vulnerable groups and the general population. These include the lack of general communication skills and legal awareness among many health professionals, which are barriers to the development of patient-centred care. The involvement of intercultural mediators fundamentally improves communication between health professionals and (not only) migrant patients. Nevertheless, it is necessary to legally anchor and define the position of intercultural mediators within the healthcare system.
UNASSIGNED: Collaboration with intercultural mediators who interpreted the extensive experiences of Ukrainian refugee patients and also have personal experience as migrant or migrant-origin patients contributed to shaping research questions, facilitating study participation and enriching evidence interpretation. Researchers with multicultural backgrounds and experience with working with people from refugee backgrounds were involved in the study design and analysis.

This study investigates the impact of a minority language on international trade. Using the distance to Hunchun as an instrumental variable, and transaction-level customs data from 2000 to 2015, we investigate the causal impact of common Korean language on international trade between Chinese counties and South/North Korea. The results suggest that a 1% increase in the proportion of population speaking Korean will increase value share and transactions share in trade by 1.8% and 2.3%, respectively. These effects are more pronounced in trade with North Korea and in higher trade share regions. Furthermore, we show that the common Korean language exerts its influence through reducing communication barrier. The impact is mainly observed at the extensive margin rather than the intensive margin. These findings highlight the potential of leveraging minority languages to boost bilateral trade in developing countries.

BACKGROUND: Remote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operate on a remote-first (digital-first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care.
METHODS: Qualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in-person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data.
RESULTS: Three major interlinked themes were identified: (1) reduced access, (2) reduced patient choice and (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face-to-face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non-verbal aspects of communication and \'hands-on\' care leading to perceptions of reduced psycho-social safety.
CONCLUSIONS: SA patients\' experiences of remote-led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face-to-face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South-Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future.
UNASSIGNED: Members of the public were involved in all phases of research in the study. This included co-working in partnership throughout the study including, reviewing patient-facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co-authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components.

BACKGROUND: Global migration has led to a sharp increase in the number of language-discordant consultations (LDCs) in healthcare. Evidence on how healthcare providers (HCPs) meet migrant patients\' needs while mitigating language barriers is lacking.
METHODS: Using purposive and snowball sampling, we recruited twenty-seven Dutch HCPs (Mage = 45.07, SD = 11.46) and conducted semi-structured interviews to collect qualitative, open-ended data for identifying the communication strategies used with migrant patients in LDCs. We analysed the transcripts using deductive and inductive approaches (e.g., constant comparative method from Grounded Theory). Final pattern codes (i.e., key themes) were discussed among the research team until mutual agreement had been achieved.
RESULTS: Five key themes emerged from the analyses: HCPs often \'got-by\' with (1) instrumental and (2) affective communication strategies used in language-concordant consultations to start medical consultations. When some instrumental communication strategies were deemed ineffective (e.g., lingua franca, gesturing, etc.) to bridge language barriers, HCPs turned to (3) incorporating digital tools (e.g., Google Translate). When HCPs were unable to communicate with migrant patients at all, (4) informal, ad-hoc and professional interpreters were involved. Finally, HCPs often (5) involved additional support to engage migrant patients to engage in treatment-related behaviours.
CONCLUSIONS: Our results highlight the importance of raising awareness among HCPs about using various combinations of different strategies. The development of a guideline indicating the optimal combination of communication strategies for different medical consultation goals may be useful in reshaping the current communication behaviour of HCPs in LDCs.
UNASSIGNED: HCPs were the study population involved in this qualitative study. Refugee health advisors, general practitioners and linguistic specialists (i.e., members of the Right2Health consortium) with experience with the Dutch healthcare system were involved throughout the development of this research. This includes a review of the research question, participant information sheet and interview topic guide as well as providing interpretations of the data and feedback to this manuscript.

UNASSIGNED: Migration-related factors, such as language barriers, can be relevant to the risk, healthcare and complications of type 2 diabetes in people with a history of migration. Diabetes-related data from people with selected citizenships were analysed on the basis of the nationwide survey German Health Update: Fokus (GEDA Fokus).
UNASSIGNED: The diabetes risk of persons without diabetes (n = 4,698, 18 - 79 years), key figures on healthcare and secondary diseases of persons with type 2 diabetes (n = 326, 45 - 79 years) and on concomitant diseases (n = 326 with type 2 diabetes compared to n = 2,018 without diabetes, 45 - 79 years) were stratified according to sociodemographic and migration-related characteristics.
UNASSIGNED: Better German language proficiency is associated with a lower risk of diabetes. Diabetes-related organ complications are observed more frequently in persons who report experiences of discrimination in the health or care sector. Both persons with and without diabetes are more likely to have depressive symptoms when they reported experiences of discrimination. A stronger sense of belonging to the society in Germany is associated with reporting depressive symptoms less often in people without diabetes, but not in people with type 2 diabetes.
UNASSIGNED: The differences according to migration-related characteristics indicate a need for improvement in the prevention and care of type 2 diabetes. Migration-sensitive indicators should be integrated into the surveillance of diabetes.

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Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events; however, many patients with AF are noncompliant with medication regimens, which increases said risk substantially. Suboptimal health literacy presents significant hurdles to compliance with medical treatment. Here we present a case of an elderly Hispanic woman with AF and several comorbidities, including a history of dementia, who presented with consecutive recurrence of acute limb ischemia in the bilateral lower extremities just 3 days apart. Both events were successfully treated with endovascular thrombectomy. This case study not only showcases the efficacy of the latest endovascular technologies, but also draws attention to the importance of strict patient medication adherence in AF and the effects that health literacy can have on said adherence.

BACKGROUND: An estimated 2.2 million people from Central and Eastern Europe (CEE) live in the United Kingdom. It has been documented that CEE migrants underutilise health services in the United Kingdom and, as an alternative, seek healthcare in their home country. However, reasons for seeking healthcare abroad are not always clear. This review aims to identify the reasons for the uptake of transnational healthcare among CEE migrants resident in the United Kingdom.
METHODS: Informed by discussions with community members, medical stakeholders and academics, a systematic scoping review was undertaken following the nine-stage Joanna Briggs Institute framework for scoping reviews. A search strategy with MeSH terms, where relevant, was used and adapted in five academic databases, two grey literature databases and Google Scholar. Included records encompassed four concepts: migration, CEE nationalities, UK nations and healthcare utilisation, which were written in English and published between May 2004 and 2022. Data from the literature were coded, grouped and organised into themes.
RESULTS: A total of 16 publications fulfilled the inclusion criteria. There is evidence that some CEE migrants exclusively use healthcare services in the United Kingdom. However, many CEE migrants utilise healthcare both in the United Kingdom and their country of origin. Four themes were identified from the literature as to why migrants travelled to their country of origin for healthcare: cultural expectations of medical services, distrust in the UK NHS, barriers and transnational ties.
CONCLUSIONS: Push factors led CEE migrants to seek healthcare in their country of origin, facilitated by ongoing transnational ties. CEE migrants frequently combine visits to their country of origin with medical appointments. Utilising healthcare in their country of origin as opposed to the United Kingdom can result in fragmented and incomplete records of medications, medical tests and surgeries and risk of unnecessary treatments and complications. This review highlights the need for more targeted health outreach with CEE groups within the United Kingdom, as well as the need for further research on the impact of national events, for example, COVID-19 and Brexit, on transnational healthcare-seeking behaviours.
UNASSIGNED: The concept for this scoping review was informed by discussions with community members, medical professionals and academics, who identified it as a current issue. The results of this scoping review were discussed with healthcare stakeholders.

OBJECTIVE: Effective communication between cancer patients and providers is critical for addressing psychological distress, reducing uncertainty, and promoting patient well-being. This is particularly relevant during medical appointments that may elicit uncertainty, such as surgical consultations for newly diagnosed women with breast cancer. This study aimed to evaluate how pre-appointment anxiety and illness uncertainty affect patient-provider communication in breast cancer surgical consultations and subsequent post-appointment well-being. Breast cancer patient anxiety has been studied as an outcome of provider communication, though less is known about the extent to which preexisting anxiety or uncertainty act as antecedents to effective patient-provider communication.
METHODS: This study analyzed videorecorded breast cancer surgical consultations (N = 51) and corresponding patient surveys to understand how pre-appointment anxiety influences pre-appointment patient uncertainty, patient-provider communication during the appointment, and subsequent post-appointment uncertainty.
RESULTS: The proposed model achieved good fit to the data such that more pre-appointment anxiety was associated with more pre-appointment uncertainty, more pre-appointment anxiety was associated with more empathic opportunities per minute, and more empathic opportunities were associated with less post-appointment uncertainty.
CONCLUSIONS: Results indicate breast cancer patients with anxiety pre-appointment are at-risk for more illness uncertainty and are more likely to explicitly provide empathic opportunities. This supports the need for added attention to empathic opportunities to not only address patients emotionally but to also assess whether a patient may be at higher risk of having preexisting anxiety.

BACKGROUND: The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women\'s maternal health experiences in South Texas as a step toward designing culturally sensitive care.
METHODS: Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data.
RESULTS: We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers.
CONCLUSIONS: The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.