Adapting Communication to Different Populations: Difference between revisions

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== Introduction ==
<div class="editorbox"> '''Original Editor '''- [[User:Robin Tacchetti|Robin Tacchetti]] based on the course by [https://members.physio-pedia.com/course_tutor/marissa-fourie/ Marissa Fourie]<br>
Patient-centred care is provided when communication is shared amongst provider, patients and their families.  This process encourages and invites patients and their families to actively participate in the healthcare decision-making process.  Through this open communication patient's dignities and rights are valued with subsequent positive care outcomes and perceptions of quality of care.<ref>Kwame A, Petrucka PM. [https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2 A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward.] BMC nursing. 2021 Dec;20(1):1-0.</ref>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


Effective communication for providers begins with respect and building trust with their patients.  Having that mutual understanding and openness is important for building a relationship.  Successful communication is knowing how to adapt interactions to different groups such as children, seniors, people with disabilities, hearing impairments, cognitive impairments, mental health issues, people who speak another language etc.  Providers working with these populations will need to be patient and flexible as they might need to spend more time with these individuals.<ref>Iedema R, Greenhalgh T, Russell J, Alexander J, Amer-Sharif K, Gardner P, Juniper M, Lawton R, Mahajan RP, McGuire P, Roberts C. [https://bmjopenquality.bmj.com/content/bmjqir/8/3/e000742.full.pdf Spoken communication and patient safety: a new direction for healthcare communication policy, research, education and practice?]. BMJ Open Quality. 2019 Sep 1;8(3):e000742.</ref>


In order to be an effective communicator working with different populations and cultures, providers need to demonstrate culturally sensitive communication.  This type of communication demonstrates a mutual respect and understanding of each other's beliefs, values, preferences and culture to promote culturally sensitive care.  Clinicians will need to identify patient's needs through verbal and nonverbal communication.  Without culturally sensitive care, patients and their families feel less satisfied with their care and consequently there are risks of miscommunication, poor adherence to treatment and poorer health outcomes.<ref name=":1">Brooks LA, Manias E, Bloomer MJ. [https://www.sciencedirect.com/science/article/pii/S1322769617303153 Culturally sensitive communication in healthcare: A concept analysis.] Collegian. 2019 Jun 1;26(3):383-91.</ref>


For providers to effectively communicate to all types of individuals, three factors are important:
== Introduction ==
Patient-centred care can be achieved when there is open communication between providers, patients and their families. This process encourages and invites patients and their families to actively participate in healthcare decisions. Through open communication, a patient's dignity and rights are valued, which results in positive care outcomes and higher perceptions of care quality.<ref>Kwame A, Petrucka PM. [https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2 A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward.] BMC nursing. 2021 Dec;20(1):1-0.</ref>


# Adapting the questioning strategy
Effective communication begins with providers showing respect and building the trust of their patients. Mutual understanding and openness are important for building a relationship. A provider may need to alter their communication style over the course of the day as they interact with many different patient populations. Some populations may require providers to be more flexible and patient during an interaction, such as:
# Be comprehensible to the patient
# Treating patients in a dignified, respectful, and courteous manner, regardless of who and where they are in life<ref name=":3">Fourie, M. Adapting Communication to Different Populations.  Plus. 2023</ref>
 
=== Question Strategy ===
When interacting with a patient for the first visit, open-ended questions are strongly recommended for gathering medical information.  Open-ended questions can produce lengthy narratives, short answers or lists.  They can be used alone or with close-ended questions that elicit a yes or no response.<ref>Weller SC, Vickers B, Bernard HR, Blackburn AM, Borgatti S, Gravlee CC, Johnson JC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010234/ Open-ended interview questions and saturation]. PloS one. 2018 Jun 20;13(6):e0198606.</ref> Clinicians working with patients can use a combination of question strategies to gain information.  Questions can be classified into the five categories below:
 
# general inquiries:  "what can I do for you today", "what brings you in"
#* allows patients to describe their concerns in their own terms
# gloss questions for confirmation: "sounds like you are uncomfortable"
#* formatted for a yes/no response however can have subsequent expansion of answer
# confirming questions about symptoms: "you have been having pain at night for a week"
#* confirmation of concrete symptoms
# how are you inquiries: "how are you doing"
#* general evaluations rather than problem presentations .
# history-taking questions:  "what medicine do you take"
#* close-ended; yes/no, fill in the blank, multiple choice<ref name=":2">Abe T, Nishiyama J, Kushida S, Kawashima M, Oishi N, Ueda K. [https://onlinelibrary.wiley.com/doi/full/10.1002/jgf2.593 Tailored opening questions to the context of using medical questionnaires: Qualitative analysis in first‐visit consultations]. Journal of General and Family Medicine. 2023 Mar;24(2):79-86.</ref> <ref>Heritage J, Robinson JD. [https://www.sscnet.ucla.edu/soc/faculty/heritage/Site/Publications_files/OPENING_QUESTIONS.pdf The structure of patients' presenting concerns: physicians' opening questions.] Health communication. 2006 Mar 1;19(2):89-102.</ref>
<nowiki>**</nowiki> General inquiries are used most often to elicit problem presentation and increased patients satisfaction<ref name=":2" />


== Comprehensibility ==
* children
After gaining information from the patient through question strategies, the provider then needs to be able to communicate to the patient about the plan of care. In general provider should:
* older persons
* people with disabilities
* people with hearing impairments
* people with cognitive impairments
* people with mental health issues
* people who speak another language<ref>Iedema R, Greenhalgh T, Russell J, Alexander J, Amer-Sharif K, Gardner P, Juniper M, Lawton R, Mahajan RP, McGuire P, Roberts C. [https://bmjopenquality.bmj.com/content/bmjqir/8/3/e000742.full.pdf Spoken communication and patient safety: a new direction for healthcare communication policy, research, education and practice?]. BMJ Open Quality. 2019 Sep 1;8(3):e000742.</ref>


# Not use jargon or technical terms as it might inhibit patients from asking questions and thus have a poorer outcome in care
Providers must demonstrate culturally sensitive communication when working with different populations and cultures. This helps to build mutual respect and an understanding of each other's beliefs, values, preferences and culture to promote culturally sensitive care. Clinicians need to identify a patient's needs through verbal and non-verbal communication. Without culturally sensitive care, patients and their families are likely to feel less satisfied with their care and there are risks of miscommunication, poor adherence to treatment and poorer health outcomes.<ref name=":1">Brooks LA, Manias E, Bloomer MJ. [https://www.sciencedirect.com/science/article/pii/S1322769617303153 Culturally sensitive communication in healthcare: A concept analysis.] Collegian. 2019 Jun 1;26(3):383-91.</ref>
# Use patients experiences when describing medical terms versus anatomical terms
# Use pictures and/or videos to help explain difficult concepts<ref name=":3" />


As each patient is unique, providers will need to be able to adapt their communication style when explaining medical terminology and intervention techniques.
For providers to effectively communicate with patients from all backgrounds, they must be able to do the following:


==== Language Barrier ====
# Adapt their questioning strategy
When there is a language barrier, it can be very difficult for the provider and patient to communicate effectively.  Studies have shown that patients that face language barriers have poorer health outcomes and less access to healthcare  than those who speak the language.  Patients with language barriers have decreased understanding of their diagnoses, decreased satisfaction with their healthcare and increased medication complications. <ref>Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201401/ Implications of language barriers for healthcare: a systematic review]. Oman medical journal. 2020 Mar;35(2):e122.</ref>
# Make sense to the patient
# Treat patients in a dignified, respectful, and courteous manner, regardless of who and where they are in life<ref name=":3">Fourie, M. Adapting Communication to Different Populations. Plus. 2023</ref>


Professional translators or language services help are the recommended practice when language barriers present themselves.  They can provide precise, clear translations without any interpretation or biases.  Using apps like "google translate" can assist with simple questions however they are not reliable for history taking.  Avoid using a family member or friend to translate as they are may reinterpret or edit information to avoid conflict or protect family members.  In addition, the patient may be less forthcoming when their family members are translating.  <ref name=":0">Ladha T, Zubairi M, Hunter A, Audcent T, Johnstone J. Cross-cultural communication: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815116/ Tools for working with families and children]. Paediatrics & Child Health. 2018 Feb 15;23(1):66-9.</ref><ref name=":1" />
=== Questioning Strategy ===
When interacting with a patient for the first time, providers must often ask many questions to attain the necessary information to provide optimal care.  Types of questions might include:<ref name=":3" />


== Respect ==
# open-ended: eliciting a sentence for the response
Establishing trust and respect are essential to the communication process between providers, patients and their families.  Trust transpires through interactions that are respectful and flexible to the practices, beliefs and needs of the patient.  <ref name=":1" />
# close-ended: verifying a piece of information
# probing: can either be open or closed with the intent to find out more information about a topic
# checking: used to make sure the patient understands what has been said


''stead consider the importance of spiritual, cultural, and emotional needs of families and their influence on decision making. We might also consider routinely assessing patient and family role preferences in decision making at the outset of difficult'' <ref>Bogetz J, Rosenberg A, Curtis JR, Creutzfeldt CJ. [https://www.jpsmjournal.com/article/S0885-3924(19)30571-8/pdf Applying an adaptive communication approach to medical decision making]. Journal of Pain and Symptom Management. 2020 Jan 1;59(1):e4-7.</ref>''conversations t''
'''Open-ended questions are strongly recommended for gathering medical information'''. Open-ended questions produce lengthy narratives, short answers or lists. They can be used alone or with close-ended questions that elicit a yes or no response.<ref>Weller SC, Vickers B, Bernard HR, Blackburn AM, Borgatti S, Gravlee CC, Johnson JC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010234/ Open-ended interview questions and saturation]. PloS one. 2018 Jun 20;13(6):e0198606.</ref> We should, however, be careful to avoid ''leading'' ''questions.'' Leading questions are formatted in a way that it encourages the answer we want or expect.<ref name=":3" />


''The LEARN (Listen, Explain, Acknowledge, Recommend, Negotiate) model is a framework for cross-cultural communication that helps build mutual understanding and enhance patient care (6).''
Clinicians can use a combination of question strategies to gain information. Questions can be classified into five categories:


'''''Listen:''' Assess each patient’s understanding of their health condition, its causes and potential treatments. Elicit expectations for the encounter, and bring an attitude of curiosity and humility to promote trust and understanding.''
# General inquiries: e.g. "What can I do for you today?", "What brings you in?"
#* these questions allow patients to describe their concerns using their own words and terms
# Gloss questions for confirmation: e.g. "Sounds like you are uncomfortable?"
#* formatted for a yes/no response, but can lead to further expansion of the answer
# Confirming (or checking) questions about symptoms: e.g. "You have been having pain at night for a week?"
#* confirmation of concrete symptoms
# How are you inquiries: e.g. "How are you doing?"
#* general evaluations rather than questions on problem presentations
# History-taking questions: e.g. "What medicine do you take?"
#* close-ended; yes/no, fill-in-the-blank, multiple-choice questions questions<ref name=":2">Abe T, Nishiyama J, Kushida S, Kawashima M, Oishi N, Ueda K. [https://onlinelibrary.wiley.com/doi/full/10.1002/jgf2.593 Tailored opening questions to the context of using medical questionnaires: Qualitative analysis in first‐visit consultations]. Journal of General and Family Medicine. 2023 Mar;24(2):79-86.</ref> <ref>Heritage J, Robinson JD. [https://www.sscnet.ucla.edu/soc/faculty/heritage/Site/Publications_files/OPENING_QUESTIONS.pdf The structure of patients' presenting concerns: physicians' opening questions.] Health communication. 2006 Mar 1;19(2):89-102.</ref>
<nowiki>**</nowiki> General inquiries are used most often in practice. These questions tend to elicit long problem presentations and improve patient satisfaction.<ref name=":2" />


'''''Explain:''' Convey your own perceptions of the health condition, keeping in mind that patients may understand health or illness differently, based on culture or ethnic background.''
== Comprehensibility ==
After gaining information from the patient through their questioning strategy, the provider needs to communicate the care plan to the patient. When explaining intervention options, the provider should keep these three rules in mind:


'''''Acknowledge:''' Be respectful when discussing the differences between their views and your own. Point out areas of agreement as well as difference, and try to determine whether disparate belief systems may lead to a therapeutic dilemma.''
# Do not use jargon or technical terms as they might stop a patient from asking questions, potentially resulting in poorer care outcomes
# Explain clinical information with a focus on patient experience rather than on theoretical concepts.
# Use pictures and/or videos to help explain complex concepts<ref name=":3" />


'''''Recommend:''' Develop and propose a treatment plan to the patient and their family.''
<nowiki>**</nowiki> As each patient is unique, providers will need to be able to adapt their communication style when explaining medical terminology and intervention techniques.


'''''Negotiate:''' Reach an agreement on the treatment plan in partnership with the patient and family, incorporating culturally relevant approaches that fit with the patient’s perceptions of health and healing.''<ref name=":0" />
=== Language Barrier ===
When there is a language barrier, it can be very difficult for the provider and patient to communicate effectively. Studies have shown that patients with language barriers have less access to healthcare and poorer health outcomes. If they are able to access healthcare, they tend to have decreased understanding of their diagnoses, reduced satisfaction with their healthcare and increased complications associated with medication use.<ref>Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201401/ Implications of language barriers for healthcare: a systematic review]. Oman medical journal. 2020 Mar;35(2):e122.</ref>


''The first attribute involves encouraging patients and families to participate in communication and decision making to the degree where they feel comfortable. encouraging patient and family input, and by promoting effective interactions to overcome communication barriers.  prioritising cultural considerations in the planning and provision of care. This prioritisation can be achieved by demonstrating respect for the culture of the patient and their family by asking culturally sensitive questions about the patient’s and family’s values, beliefs and practices; obtaining information about the patient’s perceptions and beliefs associated with their presenting illness; and assessing the individual’s psychological, physiological and sociocultural needs, secondary languages, non-verbal communication techniques, religion and food preferences. developing a trusting relationship with the patient and family. This trust can be achieved through using open and non-threatening body language that demonstrates a willingness to help and learn. Establishing rapport and trust are critical to the communication process between clinicians, the patient and family. Trust can be created through active listening, using appropriate body language, using the patient’s actual words to communicate, and being flexible and respectful to the needs, beliefs and practices of the patient and their family''<ref name=":1" />
When there are language barriers, professional [[Working With Interpreters|interpreters]] / translators or language services are recommended. Using apps like "google translate" can assist with simple questions, but they are not reliable for history taking. It is best to avoid using a family member or friend to translate as they may reinterpret or edit information to avoid conflict or protect family members. In addition, the patient may be less forthcoming when their family members are translating.<ref name=":0">Ladha T, Zubairi M, Hunter A, Audcent T, Johnstone J. Cross-cultural communication: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815116/ Tools for working with families and children]. Paediatrics & Child Health. 2018 Feb 15;23(1):66-9.</ref><ref name=":1" />


Go to:
== Respect ==
 
Establishing trust is essential to the communication process between providers, patients and their families. Trust develops through interactions that are respectful and flexible to the patient's practices, beliefs and needs. These qualities demonstrate a willingness by the provider to help and learn.<ref name=":1" /> As a provider, it is important to consider the emotional, spiritual and cultural needs of the patient / family and their influence on decision-making.<ref>Bogetz J, Rosenberg A, Curtis JR, Creutzfeldt CJ. [https://www.jpsmjournal.com/article/S0885-3924(19)30571-8/pdf Applying an adaptive communication approach to medical decision making]. Journal of Pain and Symptom Management. 2020 Jan 1;59(1):e4-7.</ref> Cross-cultural communication can be enhanced by using the LEARN model:
https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2
 
# talk directly to the patient
# speak in normal tone
# include the patient
 
W/c: eye to eye
 
hearing loss: less ambient noise
 
speech impediment: be patient, shorter concrete questions
 
intellectual: simple direct sentences, more media and visual forms, no abstract ideas and be prepared to repeat


older adults:feel vulnerable and exposed
# Listen: bringing an attitude of humility and curiosity can promote understanding and trust
 
# Explain: communicate your perceptions of the health issues while realising the patient might understand it differently based on their culture or ethnic background
peds: need family member and kid- three way relatoinship, be patient, understandable language
# Acknowledge: identify areas of agreement and disagreement, and try to determine if a patient's belief systems may lead to a therapeutic dilemma
 
# Recommend: design / suggest an intervention plan to the patient and family
# relationship buidling
# Negotiate: partner with the patient and family to create a treatment plan that incorporates culturally relevant approaches that consider the patient's and family's perceptions of health<ref name=":0" />
# promote pateint engagement
# address emotion
# enhancing of info
# management of uncertaintity
# fostering of hope
 
poor health literacy: ask less questions, healthcare person might see as not engaged, communicate clearly and in laymans terms


== Resources ==
== Resources ==
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* [https://www.physio-pedia.com/Using_Communication_to_Enhance_Therapeutic_Interactions_With_People_Living_With_Dementia Using Communication to Enhance Therapeutic Interactions with People Living with Dementia]
* [https://www.physio-pedia.com/Using_Communication_to_Enhance_Therapeutic_Interactions_With_People_Living_With_Dementia Using Communication to Enhance Therapeutic Interactions with People Living with Dementia]
* [https://www.physio-pedia.com/Communication_and_Children_with_Cerebral_Palsy Communication and Children with Cerebral Palsy]
* [https://www.physio-pedia.com/Communication_and_Children_with_Cerebral_Palsy Communication and Children with Cerebral Palsy]
== References ==
<references />
[[Category:Communication]]
[[Category:Professional Issues]]
[[Category:ReLAB-HS Course Page]]
[[Category:Course Pages]]

Latest revision as of 10:37, 10 March 2024

Original Editor - Robin Tacchetti based on the course by Marissa Fourie
Top Contributors - Robin Tacchetti and Jess Bell


Introduction[edit | edit source]

Patient-centred care can be achieved when there is open communication between providers, patients and their families. This process encourages and invites patients and their families to actively participate in healthcare decisions. Through open communication, a patient's dignity and rights are valued, which results in positive care outcomes and higher perceptions of care quality.[1]

Effective communication begins with providers showing respect and building the trust of their patients. Mutual understanding and openness are important for building a relationship. A provider may need to alter their communication style over the course of the day as they interact with many different patient populations. Some populations may require providers to be more flexible and patient during an interaction, such as:

  • children
  • older persons
  • people with disabilities
  • people with hearing impairments
  • people with cognitive impairments
  • people with mental health issues
  • people who speak another language[2]

Providers must demonstrate culturally sensitive communication when working with different populations and cultures. This helps to build mutual respect and an understanding of each other's beliefs, values, preferences and culture to promote culturally sensitive care. Clinicians need to identify a patient's needs through verbal and non-verbal communication. Without culturally sensitive care, patients and their families are likely to feel less satisfied with their care and there are risks of miscommunication, poor adherence to treatment and poorer health outcomes.[3]

For providers to effectively communicate with patients from all backgrounds, they must be able to do the following:

  1. Adapt their questioning strategy
  2. Make sense to the patient
  3. Treat patients in a dignified, respectful, and courteous manner, regardless of who and where they are in life[4]

Questioning Strategy[edit | edit source]

When interacting with a patient for the first time, providers must often ask many questions to attain the necessary information to provide optimal care. Types of questions might include:[4]

  1. open-ended: eliciting a sentence for the response
  2. close-ended: verifying a piece of information
  3. probing: can either be open or closed with the intent to find out more information about a topic
  4. checking: used to make sure the patient understands what has been said

Open-ended questions are strongly recommended for gathering medical information. Open-ended questions produce lengthy narratives, short answers or lists. They can be used alone or with close-ended questions that elicit a yes or no response.[5] We should, however, be careful to avoid leading questions. Leading questions are formatted in a way that it encourages the answer we want or expect.[4]

Clinicians can use a combination of question strategies to gain information. Questions can be classified into five categories:

  1. General inquiries: e.g. "What can I do for you today?", "What brings you in?"
    • these questions allow patients to describe their concerns using their own words and terms
  2. Gloss questions for confirmation: e.g. "Sounds like you are uncomfortable?"
    • formatted for a yes/no response, but can lead to further expansion of the answer
  3. Confirming (or checking) questions about symptoms: e.g. "You have been having pain at night for a week?"
    • confirmation of concrete symptoms
  4. How are you inquiries: e.g. "How are you doing?"
    • general evaluations rather than questions on problem presentations
  5. History-taking questions: e.g. "What medicine do you take?"
    • close-ended; yes/no, fill-in-the-blank, multiple-choice questions questions[6] [7]

** General inquiries are used most often in practice. These questions tend to elicit long problem presentations and improve patient satisfaction.[6]

Comprehensibility[edit | edit source]

After gaining information from the patient through their questioning strategy, the provider needs to communicate the care plan to the patient. When explaining intervention options, the provider should keep these three rules in mind:

  1. Do not use jargon or technical terms as they might stop a patient from asking questions, potentially resulting in poorer care outcomes
  2. Explain clinical information with a focus on patient experience rather than on theoretical concepts.
  3. Use pictures and/or videos to help explain complex concepts[4]

** As each patient is unique, providers will need to be able to adapt their communication style when explaining medical terminology and intervention techniques.

Language Barrier[edit | edit source]

When there is a language barrier, it can be very difficult for the provider and patient to communicate effectively. Studies have shown that patients with language barriers have less access to healthcare and poorer health outcomes. If they are able to access healthcare, they tend to have decreased understanding of their diagnoses, reduced satisfaction with their healthcare and increased complications associated with medication use.[8]

When there are language barriers, professional interpreters / translators or language services are recommended. Using apps like "google translate" can assist with simple questions, but they are not reliable for history taking. It is best to avoid using a family member or friend to translate as they may reinterpret or edit information to avoid conflict or protect family members. In addition, the patient may be less forthcoming when their family members are translating.[9][3]

Respect[edit | edit source]

Establishing trust is essential to the communication process between providers, patients and their families. Trust develops through interactions that are respectful and flexible to the patient's practices, beliefs and needs. These qualities demonstrate a willingness by the provider to help and learn.[3] As a provider, it is important to consider the emotional, spiritual and cultural needs of the patient / family and their influence on decision-making.[10] Cross-cultural communication can be enhanced by using the LEARN model:

  1. Listen: bringing an attitude of humility and curiosity can promote understanding and trust
  2. Explain: communicate your perceptions of the health issues while realising the patient might understand it differently based on their culture or ethnic background
  3. Acknowledge: identify areas of agreement and disagreement, and try to determine if a patient's belief systems may lead to a therapeutic dilemma
  4. Recommend: design / suggest an intervention plan to the patient and family
  5. Negotiate: partner with the patient and family to create a treatment plan that incorporates culturally relevant approaches that consider the patient's and family's perceptions of health[9]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC nursing. 2021 Dec;20(1):1-0.
  2. ↑ Iedema R, Greenhalgh T, Russell J, Alexander J, Amer-Sharif K, Gardner P, Juniper M, Lawton R, Mahajan RP, McGuire P, Roberts C. Spoken communication and patient safety: a new direction for healthcare communication policy, research, education and practice?. BMJ Open Quality. 2019 Sep 1;8(3):e000742.
  3. ↑ 3.0 3.1 3.2 Brooks LA, Manias E, Bloomer MJ. Culturally sensitive communication in healthcare: A concept analysis. Collegian. 2019 Jun 1;26(3):383-91.
  4. ↑ 4.0 4.1 4.2 4.3 Fourie, M. Adapting Communication to Different Populations. Plus. 2023
  5. ↑ Weller SC, Vickers B, Bernard HR, Blackburn AM, Borgatti S, Gravlee CC, Johnson JC. Open-ended interview questions and saturation. PloS one. 2018 Jun 20;13(6):e0198606.
  6. ↑ 6.0 6.1 Abe T, Nishiyama J, Kushida S, Kawashima M, Oishi N, Ueda K. Tailored opening questions to the context of using medical questionnaires: Qualitative analysis in first‐visit consultations. Journal of General and Family Medicine. 2023 Mar;24(2):79-86.
  7. ↑ Heritage J, Robinson JD. The structure of patients' presenting concerns: physicians' opening questions. Health communication. 2006 Mar 1;19(2):89-102.
  8. ↑ Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of language barriers for healthcare: a systematic review. Oman medical journal. 2020 Mar;35(2):e122.
  9. ↑ 9.0 9.1 Ladha T, Zubairi M, Hunter A, Audcent T, Johnstone J. Cross-cultural communication: Tools for working with families and children. Paediatrics & Child Health. 2018 Feb 15;23(1):66-9.
  10. ↑ Bogetz J, Rosenberg A, Curtis JR, Creutzfeldt CJ. Applying an adaptive communication approach to medical decision making. Journal of Pain and Symptom Management. 2020 Jan 1;59(1):e4-7.
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