Background Healthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals’ experiences in healthcare and improve their capacity to communicate with these populations. Methods This study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention. Results Main qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients. Conclusions Findings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs’ perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment.

BACKGROUND:The expression of chronic pain remains a delicate matter for those older persons who suffer from this condition. If many studies highlight the difficulties of putting pain into words, scarce are those that take into account how given social networks can facilitate or prevent its expression. Based on a qualitative study that explores the communication about chronic pain in older persons' social network, this article reports on this key issue of talking about health in later life within family settings and provides clinicians with information about the way older persons with chronic conditions perceive their everyday realities and social relations.METHODS:A multidisciplinary research team (medicine, linguistics and psychology) interviewed 49 persons with chronic pain, all from the French-speaking part of Switzerland, aged 75 and older, without any major cognitive or auditory impairments. After transcription, the interviews were analyzed by combining content and discourse analysis with social network theories.RESULTS:Communication about chronic pain depends significantly on the position of the interlocutors within the family structure, with a preference for direct relatives or individuals with similar difficulties. In social networks, the ability to communicate about chronic pain is both a resource (by allowing older persons to get help or by strengthening interpersonal relations) and a challenge (by threatening their autonomy, social relations or self-esteem).CONCLUSIONS:The study shows the predominance of the nuclear family (partner, children) in communication relating specifically to the everyday management of chronic pain. This state of affairs is, nevertheless, balanced by issues of (loss of) autonomy. These findings, in line with current trends in geriatrics, could benefit future reflections on the scope and limits of including relatives in the care of older patients with chronic conditions.

L’APPROCHE COMMUNAUTAIRE COMPTE parmi les moyens mis en œuvre pour permettre aux migrants allophones d’accéder pleinement aux systèmes de soin dans un certain nombre de pays, essentiellement occidentaux. Cette approche qui veut que l’agent de santé s’exprime dans la langue première du « patient » migrant est précisément celle qu’a soutenue en Suisse l’Office Fédéral de la Santé Publique (OFSP) s’agissant de la prévention du VIH/sida auprès des migrants d’origine subsaharienne (OFSP, 2010a). Au travers des résultats d’une étude récente (Singy & Guex, 2008), la présente contribution vise au questionnement de certains des fondements de l’approche dite communautaire en regard du profil de ceux qu’elle vise à prévenir.

Cette enquête exploratoire s'inscrit dans le cadre d’une étude en cours financée par le Collège de la Psychiatrie Universitaire Lausannoise (CPUL). Conçue sous la forme d’une recherche-action, celle-ci vise à une meilleure compréhension, dans leur complexité, des besoins de la population formée des migrant-e-s subsaharien-ne-s francophones de Suisse romande – population hétérogène de fait – en matière de prévention du VIH/sida. Plus précisément, elle cherche à évaluer le degré de l'opportunité d’une prévention fondée sur une approche foncièrement communautaire, impliquant des médiateurs d'origine subsaharienne qui assureraient la prévention dans les langues premières des migrante(e)s. De plus, elle vise à dégager l'idéal communicationnel des migrante(e)s subsaharien(ne)s s'agissant de leur prévention du VIH/sida.

OBJECTIVE:In Switzerland, palliative sedation consists of using sedatives to relieve terminally ill patients. It is divided into several steps, with one of them consisting of informing patients and relatives about the procedure. In the current recommendations, there is a lack of orientation about how and when this discussion should take place. Hence, we aim to explore perceptions and experiences of palliative care professionals regarding these questions.METHODS:Qualitative semi-structured interviews with five physicians and five nurses working in specialised palliative care were conducted. They were then analysed with thematic analysis.RESULTS:Results showed a uniformity around definition, goals and indications of palliative sedation. However, there was a lack of consistency regarding the process of delivering this information to patients and relatives. Finally, some participants strongly opposed the idea of systematically informing patients in specialised palliative care, while others were more divided on this question.CONCLUSION:Despite a common understanding of the concept of palliative sedation, there is no standard practice when informing patients on palliative sedation among palliative care professionals. Therefore, this study demonstrates the need for further guidelines on this question and calls for a better understanding and knowledge of palliative sedation among health professionals outside palliative care.

Deux raisons au moins militent en faveur de la présence dans ce volume d'un chapitre consacré au français. La première, évidente, tient dans le fait que même s'il fait encore clairement figure de « visitor language » – pour reprendre l'éclairante expression d'Efurosibina ADEGBIJA (1994 : 66), le français constitue aujourd'hui l'unique langue officielle de la République du Niger. Dans ces conditions, on comprendrait mal qu'une étude sociolinguistique conduite à large échelle sur le sol nigérien ne s'arrête pas sur certaines des conséquences attitudinales qu'entraîne un tel état de fait. La seconde raison tient au rapport particulier que le français entretient avec certaines des langues locales, rapport dont les effets de véhicularisation - caractéristique majeure du paysage linguistique africain (NICOLAÏ, 2001 : 399) - qui lui sont associés ont toutes chances de peser sur le devenir des Nigériens. Ainsi, l'observation montre qu'en divers points de l'espace nigérien (c'est le cas notamment dans les agglomérations de Niamey, de Maradi et de Tillabéri), le hausa et/ou le songhay-zarma permettent la communication entre des locuteurs qui ne l'ont pas tous pour langue première (CALVET, 1996 : 452). De ce point de vue, assurant une fonction véhiculaire dans certaines circonstances, ils s'opposent ici aux autres idiomes en présence qui, eux, se limitent! à permettre la communication intra-ethnique. Attendu la véhicularité que confère - de jure serait-on tenté de dire - au français son statut de langue de l'Etat, on peut donc poser l'existence dans certaines régions du Niger d'une diglossie véhiculaire (CALVET, 1996).

BACKGROUND:This article focuses on how older persons perceive their friends' role in their daily experience of chronic pain. It reports part of the results of a study in which we interviewed 49 participants, aged 75 and older, about the way they communicate about chronic pain within their social network.METHODOLOGY:Using discourse and content analysis, we first examine older persons' definition of friendship, and then identify the various dimensions of friendship that are engaged in the communication about chronic pain.RESULTS:Participants define close friends as people with whom they share intimacy and social proximity (same gender, age and experience of pain). These dimensions allow older persons to talk freely about their pain without the fear of being judged or rejected, particularly when it is related to a dynamic of reciprocity.CONCLUSIONS:This article shows that the contribution of friends to the everyday life of older persons with chronic pain is mainly that of providing emotional support.

Background Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and research can help determine and support the implementation of appropriate training. In Switzerland, health policies address diversity and equity issues, and there is a need for educational research on cross-cultural training in palliative care. The aim of this study was to investigate the clinical challenges faced by Swiss palliative care professionals when working with migrant patients and their relatives. We also documented professionals’ interests in cross-cultural training. Methods A web survey of professionals working in specialized palliative care in the French- and Italian-speaking areas of Switzerland investigated clinical challenges with migrant populations and interests in various training opportunities. Results A total of 204 individuals responded to the survey, 48.5 % of whom were nurses. The major difficulties they reported were communication impediments associated with patients’ linguistic and/or cultural backgrounds. In relation to educational needs, they expressed a particular interest in communication techniques that would allow them to deal with these issues autonomously. The professionals expressed less interest in training on collaborating with other professionals and examining one’s own stereotypes. Conclusions Palliative care professionals’ post-graduate and continuing education must address communication techniques for sensitive palliative and end-of-life topics in cross-cultural contexts. Beginning with their pre-graduate studies, health professionals should assimilate the importance of collaborating with other professionals in complex cross-cultural situations and learn to reflect on their stereotypes and pre-conceptions in clinical practice.

A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.

Background: D/deaf and hard of hearing populations are at higher risk for experiencing physical and mental health problems compared to hearing populations. In addition, they commonly encounter barriers to accessing and benefiting from health services, which largely stem from challenges they face in communicating with healthcare providers. Healthcare providers commonly lack tailored communication skills in caring for D/deaf and hard of hearing populations, which lead to difficulties and dissatisfaction for both staff and D/deaf and hard of hearing communities. This research project aims to develop and evaluate a capacity-building intervention for healthcare providers with the goal of increasing their awareness of D/deaf and hard of hearing individuals' experiences with the healthcare system, their distinct needs, and improving their capacity to communicate effectively with this patient population. Methods: This research project features a participative action research design using qualitative and quantitative methods. Consistent with participative action research, the study will actively involve the target populations, key stakeholders and representative associations. The intervention will be developed and tested through iterative phases. The Integrated Model of Training Evaluation and Effectiveness will guide prospective evaluation of the intervention. The latter will involve qualitative and quantitative assessments in participants before and after the intervention and at 6-months follow-up. Discussion: Results will contribute to research aimed at decreasing barriers to accessing and benefiting from healthcare services for D/deaf and hard of hearing individuals. Findings will be presented to representative associations and political authorities, as well as disseminated at research conferences and in peer-reviewed journals.

Our medical practice brings us to meet people from all walks of life. Some of our patients experience multiple vulnerabilities and are at greater risk of stigma and discrimination. In the field of asylum, they are often firstly designated by words reflecting their socio-administrative reality. These words are supposed to define their identity. The individual is dehumanized because reduced to an administrative status. These terms carry a denotative meaning, valuable in understanding the context in which the patient evolves ; but also a connotative meaning, which through implicit bias leads the caregiver to adopt attitudes that may be detrimental to the proper care of the patient. Words must be carefully chosen and brought in a timely manner, because words matter.

Asile, santé et discrimination : attention aux mots Notre pratique médicale nous amène à rencontrer des personnes de tout horizon.Certains de nos patients vivent des situations de vulnérabilités multiples et sont plus à risque de subir stigmatisations et discriminations.Dans le domaine de l'asile, ils sont souvent premièrement désignés par des mots traduisant leur réalité socio-administrative. Ces mots sont sensés définir leur identité.L'individu est déshumanisé car réduit à un statut administratif.Ces termes sont porteurs d'un sens dénotatif, précieux dans la compréhension du contexte dans lequel évolue le patient ; mais aussi d'un sens connotatif, qui par biais implicite amène le soignant à adopter des attitudes pouvant être préjudiciables à une prise en charge adéquate du patient.Les mots doivent être choisis avec soin et amenés de manière opportune, car les mots comptent. Asylum, health and discrimination: words matterOur medical practice brings us to meet people from all walks of life.Some of our patients experience multiple vulnerabilities and are at greater risk of stigma and discrimination.In the field of asylum, they are often firstly designated by words reflecting their socio-administrative reality.These words are supposed to define their identity.The individual is dehumanized because reduced to an administrative status.These terms carry a denotative meaning, valuable in understanding the context in which the patient evolves ; but also a connotative meaning, which through implicit bias leads the caregiver to adopt attitudes that may be detrimental to the proper care of the patient.Words must be carefully chosen and brought in a timely manner, because words matter.

BACKGROUND:The linguistic and cultural diversity found in European societies creates specific challenges to palliative care clinicians. Patients' heterogeneous habits, beliefs and social situations, and in many cases language barriers, add complexity to clinicians' work. Cross-cultural teaching helps palliative care specialists deal with issues that arise from such diversity. This study aimed to provide interested educators and decision makers with ideas for how to implement cross-cultural training in palliative care.METHODS:We conducted four focus groups in French- and Italian-speaking Switzerland. All groups consisted of a mix of experts in palliative care and/or cross-cultural teaching. The interdisciplinary research team submitted the data for thematic content analysis.RESULTS:Focus-group participants saw a clear need for courses addressing cross-cultural issues in end-of-life care, including in medical disciplines outside of palliative care (e.g. geriatrics, oncology, intensive care). We found that these courses should be embedded in existing training offerings and should appear at all stages of curricula for end-of-life specialists. Two trends emerged related to course content. One focuses on clinicians' acquisition of cultural expertise and tools allowing them to deal with complex situations on their own; the other stresses the importance of clinicians' reflections and learning to collaborate with other professionals in complex situations. These trends evoke recent debates in the literature: the quest for expertise and tools is related to traditional twentieth century work on cross-cultural competence, whereas reflection and collaboration are central to more recent research that promotes cultural sensitivity and humility in clinicians.CONCLUSION:This study offers new insights into cross-cultural courses in palliative and end-of-life care. Basic knowledge on culture in medicine, variable practices related to death and dying, communication techniques, self-reflection on cultural references and aptitude for interprofessional collaboration are central to preparing clinicians in end-of-life settings to work with linguistically and culturally diverse patients.

Objectives: This study explores the intimate relationship context in which sub-Saharan young immigrants (18-25) adopt HIV sexual risk behaviors. Methods: Qualitative data from 37 in-depth semistructured interviews and two focus groups were analyzed through an inductive approach and constant comparative analyses. Results: HIV sexual risk behaviors occurred in four types of intimate relationships. However, reasons for taking risks varied by relationship type and also depended on material resources, as well as interactional, cultural, and social dimensions related to sexual socialization and migration. Conclusions: Findings support the importance of considering the intimate relationship context to understand how HIV sexual risk behaviors occur.

In Switzerland, one person out of a hundred suffers from serious hearing impairment or complete hearing loss, whereas 13 % of the population is hard of hearing. Scientific literature shows that the global health of the hearing-impaired population is also an issue (psychological distress, sexual health, chronic diseases, access to messages of prevention). It is a little-known fact that deaf people form a real community, with a complete and proper system of communication ; they share cultural norms and values. The difficult access to care for this population calls for adaptations in the socio-sanitary world, thus enabling an effective level of communication and an appropriate handling of deaf patients.

No study to date has focused on barriers to condom use specifically among young immigrants to Europe from sub-Saharan Africa. Based on a qualitative study in sociology, this paper explores generational differences in barriers to condom use between first-generation immigrants (born in Africa and arrived in Switzerland after age 10) and second-generation immigrants (born in Switzerland to two native parents or arrived in Switzerland before age 10). Results are based on in-depth, semistructured individual interviews conducted with 47 young women and men aged 18 to 25 to understand how individual, relational, and cultural dimensions influence sexual socialization and practices. Six main barriers to consistent condom use were identified: reduced pleasure perception, commitment and trust, family-transmitted sexual norms and parental control, lack of accurate knowledge on HIV transmission, lack of awareness about HIV in Switzerland, and gender inequalities. The three first barriers concerned both generations of immigrants, whereas the three last revealed generational differences. These findings can help sexual health providers identify social causes for young sub-Saharan immigrants not using condoms. The findings also highlight the necessity of offering accurate, accessible, and adapted information to all young immigrants, as well as the particular importance of addressing families' lack of discussions about sex, understanding the sexual norms transmitted by parents, and taking into consideration cultural differences among young people born in immigration countries.

Les personnes sourdes sont plus a risque de maladies chroniques du a leurs difficultes d’acces aux soins, a une prise en charge medicale problematique et aux difficultes de communication.