| Author: | Wang, Xixi |
| Title: | Participation in care : Investigating foreign domestic workers’ involvement in healthcare decision-making and perceptions of control in a Hong Kong clinical context |
| Advisors: | Watson, Bernadette (ENGL) Cummings, Louise (ENGL) |
| Degree: | Ph.D. |
| Year: | 2022 |
| Subject: | Medical care -- China -- Hong Kong Foreign workers -- China -- Hong Kong -- Public opinion Household employees -- China -- Hong Kong -- Public opinion Hong Kong Polytechnic University -- Dissertations |
| Department: | Department of English and Communication |
| Pages: | ix, 346 pages : illustrations |
| Language: | English |
| Abstract: | In the Western research domain, extensive research has shown that ethnic minority patients routinely encounter various communication barriers during interactions with local healthcare providers. So far, very little attention has been paid to foreign domestic workers'(FDWs) experiences in Hong Kong clinical contexts. To address this gap, this thesis aims to investigate FDW patients' communication with healthcare providers by drawing on both FDW's and race-discordant healthcare providers' perspectives. Specifically, this thesis intends to identify FDWs' expectations and perceptions of their involvement in decision-making and explore FDWs' perceptions of control over their health. Also, it examines healthcare providers' views on FDW patient participation in medical consultations. To gain better insights into the holistic picture of FDW's participation during communication with healthcare providers, Street's Linguistic Model of Patient Participation in Care (LMOPPC) is utilized as the framework to guide the analysis of FDWs' expectations, behaviors and perceptions throughout the medical consultations. This thesis is comprised of three studies. Study 1 constitutes a survey, which aims to broadly understand FDWs' experiences in Hong Kong. These experiences cover FDWs' living conditions, working conditions and health-related issues, which are potentially associated with their health status, access to care and health outcomes. 115 FDWs participated in Study 1, including 76 Filipinas and 39 Indonesians. To gain a more comprehensive view of FDWs' communication with race-discordant healthcare providers, Study 2 was designed, and consisted of a scale and semi-structured interviews. The scale was incorporated in the in-depth interviews as supplemental material to measure the sense of control FDWs had over their health. Interview questions were informed by the LMOPPC framework. Twelve surveyed participants took part in in Study 2, including six Filipinas and six Indonesians. To explore the healthcare provider's views on FDW patient participation in medical consultations, three healthcare providers who had experiences of working with FDW patients were invited to participate in Study 3, which were semi-structured interviews to examine the healthcare provider's perceptions of their own and their FDW patients' communicative performance in their interactions. Interview questions for healthcare providers were designed based on the variables extracted from the LMOPPC framework. Surveys and scales were assessed descriptively, and participants' (both FDWs and healthcare providers) narratives were analyzed through interpretative phenomenological analysis under the guidance of the LMOPPC framework. Filipina participants' and Indonesian participants' narratives were first contrasted to identify the similarities and differences in their perceived medical consultations. Afterwards, FDW participants' narratives were compared to healthcare provider participants' narratives so that similarities and differences could be identified, which would suggest possible approaches to promote FDWs' involvement in medical consultations. Results in Study 1 laid out FDWs' various aspects of experiences in Hong Kong that were directly or indirectly linked to their health status and health outcomes. Survey results offered participants' background information, providing the contextual foundation for Study 2 as the biographical sketches of these interview participants. Results in Study 2 were presented as multiple case studies. Filipina participants and Indonesian participants, in general, reported similar perceptions of their level of involvement in decision-making: Both participant groups perceived a fairly low level of participation in decision-making. Also, Filipina participants and Indonesian participants reported higher internal health locus of control compared to their external health locus of control. However, compared to Filipina participants, more Indonesian participants identified language proficiency as one of the enabling factors that negatively affected their interactions with healthcare providers, such as their way of exchanging information with providers and engagement in decisions. As with Study 2, results in Study 3 were presented as multiple case studies. Three nurses identified the language barrier as one of the challenges they encountered when communicating with FDW patients, which were aligned with the results reported by some FDW participants. Nurses' perceptions of patient participation in medical consultations differed from some FDWs' perceptions of participation in various aspects. For instance, the presence of companions might interfere with the quality of patient-provider communication given some companions' rendering inappropriate interpreting services. This thesis unfolds FDWs' healthcare experiences in Hong Kong. First, I made comparisons within FDW groups (between Filipina and Indonesian participants) about their perceived participation in care. Second, I obtained healthcare practitioners' perceptions about FDW participation in care, and then compared them with FDW groups' perceptions. The examination of FDW participation in care focuses on their participation in decision-making and sense of control over health. This research could be used to guide healthcare professionals in how to design interventions that will increase FDW patient participation in medical consultations. Patient education is necessary to educate FDW patients on the potential benefits of their increased participation in care. This research could also serve to inform policymakers of the barriers that FDW patients encountered in accessing healthcare resources. From a theoretical perspective, this thesis is the first research that applies the LMOPPC framework to the FDW population. The LMOPPC framework is expanded in this research to be more tailored to participants' accounts. It also highlights the potential of using interpretative phenomenological analysis as the methodological approach to research into underserved populations' life experiences. |
| Rights: | All rights reserved |
| Access: | open access |
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