Schouten, B.C., Meeuwesen, L., & Harmsen J. (2007). Cultural diversity in patient participation: The influence of patients’ characteristics and doctors’ communicative behaviour. Patient Education and Counseling, 67(2), 214-223.

Objective: The primary goal of this study was to examine the extent to which patient participation during medical visits is influenced by patients’ ethnic background, patients’ culture-related characteristics (e.g. acculturation, locus of control, cultural views) and features of doctors’ communicative behaviour. Furthermore, the mutual influence between patients’ participatory behaviour and doctors’ communicative behaviour was investigated. An additional goal was to identify the independent contribution of these variables to the degree of patient satisfaction and mutual understanding between GP and patient.
Methods: Communicative behaviour of patients (n=103) and GPs (n=29) was analysed with Roter’s Interaction Analysis System, frequency of patient questions and patients’ assertive utterances (e.g. making requests, suggesting alternative treatment options). Additional data were gathered using GP and patient questionnaires after the consultations.
Results: Results show that non-Western ethnic minority patients display less participatory behaviour during medical consultations than Dutch patients. GPs’ affective verbal behaviour had most effect on degree of patient participation and patient satisfaction. Regression analyses indicate a significant mutual influence between patients’ verbal behaviour and GPs’ verbal behaviour.
Conclusion: Overall, results of this study show some important differences between Dutch and non-Western ethnic minority patients in degree of patient participation. Furthermore, our results indicate that patient participation encompasses several aspects that are not necessarily interrelated.
Practice implications: The necessity for continued education of GPs’ communicative skills, particularly when dealing with non-Western ethnic minority patients, is reflected in the strong influence of GP’s affective verbal behaviour on both patient participation and their satisfaction with the medical encounter.