Short summary

Immigrant patients are at risk for receiving lower quality of care due to factors related to their immigration background. The concept of coproduction provides a new perspective on the patient-provider relationship and interaction and can help to see the potential of working with patients to create better healthcare. The project includes a scoping review and two qualitative studies carried out at the Migrant Health Clinic at Odense University Hospital. The result - a model for coproduction of healthcare service with vulnerable (immigrant) patients - will provide input on how to design healthcare services that create the best possible value for both the patient and the healthcare system.

Rationale

Supplying high quality healthcare to immigrant patients creates challenges for most healthcare systems. They are at risk for receiving lower quality of care due to reasons such as limited language proficiency and other factors related to their immigration background. Immigrant patients are also known to have limited opportunities to participate in their own health care. They represent heterogeneous populations with a divers mixture of cultures which can be challenging for the care provider to understand and decode. All these factors influence the patient-provider relationship and communication in a negative way. The complexity around immigrant patients makes it very challenging to offer high quality healthcare and requires widening the scope of health issues beyond the patient´s physiology to see the person as part of a complex system. 

In this context, the concept of coproduction provides a new lens on how to design and improve the value of healthcare delivery for immigrant patients, care providers as well as decision makers. Coproduction is not an add-on but rather a natural way of thinking in the delivery of healthcare service. The use of the coproduction concept offers new opportunities for healthcare service improvement. However, we need more investigation on its meaning and application in practice, especially in relation to immigrant patients who would benefit from increased efficiency and equity in healthcare service delivery. 

Purpose: To examine the individual and context-related aspects of coproduction of health services for people with immigrant backgrounds. 

Study 1: A scoping review on the coproduction of healthcare service with immigrant patients.

Study 2: Describing aspects of coproduction of healthcare service for immigrant patients at the Migrant Health Clinic-a case study.  

Study 3: Describing Factors influencing the ability of immigrant patients and health care providers to coproduce health care service by following a number of respondents through the course of their diagnosis, treatment and follow-up.

Method:  Scoping review on individual and context-related factors affecting the coproduction of health services for immigrant patients. The qualitative data collected through interviews with patients and healthcare professionals on the Migrant Health Clinic (Odense University Hospital) and observation of patients throughout their course at the clinic. 

Perspective: This PhD will provide knowledge about how and under which circumstances immigrant patients and health care providers coproduce health care service. The studies will be the basis for a Model of Coproduction of Health care Service for Immigrant Patients. Such a model will be important for designing health care service for immigrant patients and for future research on coproduction for other patient groups and may open new perspectives and possibilities to improve the contribution of healthcare services to health.

Description of the cohort

Immigrant/refugee patients affiliated with the Migrant Health Clinic at Odense University Hospital

Data and biological material

Qualitative data (interview, observations, document analysis)

Collaborating researchers and departments

Main supervisor: 

• Dr. Christian von Plessen MD, PhD

Co-supervisors/collaborating departments:

Migrant Health Clinic, Odense University Hospital, 

• Prof. MD Morten Sodemann

The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA

• Active Emeritus Professor, MD Paul B. Batalden

Publications associated with the project

Radl-Karimi C, Nicolaisen A, Sodemann M, Batalden P, von Plessen C. Coproduction of healthcare service with immigrant patients: protocol of a scoping review. BMJ open. 2018;8(2)