“What it really takes” – a phenomenological hermeneutic study of how migrant patients and health professionals coproduce health

“What it really takes” – a phenomenological hermeneutic study of how migrant patients and health professionals coproduce health

“What it really takes” – a phenomenological hermeneutic study of how migrant patients and health professionals coproduce health

Background: The concept of co-production shows great promise for meaningful and genuine partnerships between patients and health professionals. This is particularly important for migrant and refugee patients who are less inclined to take an active role in the consultation and less likely to have their involvement supported by the professional. Insight into how to coproduce healthcare with this complex group of patients is scarce. Thus, the aim of our study was to gain an in-depth understanding of how migrant patients and health professionals co-produce the patient´s health. This study will contribute to a model of co-production of healthcare services with migrant patients. We focus on the work that is needed to create a good service.

Method: We conducted field observations of patient consultations and interviews with health professionals at an outpatient clinic providing coordinated care for migrant and refugee patients with complex and multifaceted health or compliance issues. Data were analyzed in three steps: naïve reading, structural analysis, and comprehensive interpretation and discussion. At the interpretation stage, we conducted an additional focus group with the clinic’s health professionals to gain a deeper the understanding of underlying attitudes, motives and specific competencies influencing on the coproduction at the individual and dyadic level.

Result: Overall, the encounter between migrant patient and health professional resembled a jigsaw puzzle solved and coproduced by both sides. The setting of the migrant clinic provided necessary preconditions for working with a holistic mindset, prioritizing time to build trust, and sharing a common set of values while maintaining autonomous ways of working. The health professionals displayed pivotal skills such as tuning in with a patient, working with interpreters, and following the plots in patients’ stories by paying attention to cues and ‘holes’ in their narrative. All of this resulted in a more meaningful, mutual understanding. When a trusting relationship was established, the clinic and its professionals would become an important safety net for many of the migrant patients.

Summary: This phenomenological hermeneutic study provides an in-depth analysis of the organizational preconditions and clinical skills needed for coproducing health service with migrant and refugee patients on the individual level. Our study describes the how and why behind successful coproduction beyond the well-known ingredients of time, trust and patient first. We describe the nature of the work of coproduction, i.e. what it really takes to coproduce health care service with a complex and vulnerable patient group.


Presenter/s: Christina Radl-Karimi (OPEN - Odense Patient data Explorative Network, Denmark)