View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Omsorgsbiblioteket International Journal of Circumpolar Health ISSN: (Print) 2242-3982 (Online) Journal homepage: http://www.tandfonline.com/loi/zich20 Sami speakers are less satisfied with general practitioners’ services Tove Nystad, Marita Melhus & Eiliv Lund To cite this article: Tove Nystad, Marita Melhus & Eiliv Lund (2008) Sami speakers are less satisfied with general practitioners’ services, International Journal of Circumpolar Health, 67:1, 116-123, DOI: 10.3402/ijch.v67i1.18246 To link to this article: http://dx.doi.org/10.3402/ijch.v67i1.18246 © 2008 The Author(s). Published by Taylor & Francis. Published online: 01 Mar 2008. Submit your article to this journal Article views: 14 View related articles Citing articles: 2 View citing articles Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=zich20 Download by: [Universitetbiblioteket I Trondheim NTNU] Date: 16 November 2017, At: 06:04 Patient satisfaction with GP service ORIGINAL ARTICLE SAmi Speakers are Less Satisfied with General Practitioners’ Services Tove Nystad, Marita Melhus, Eiliv Lund Centre for Sami Health Research, Institute of Community Medicine, University of Tromsø, Norway Received 1 August 007; Accepted 9 January 008 ABSTRACT Objectives. The government’s Action Plan for Health and Social Services states as a goal that the Sami population’s encounter with health and social services should be just as good as what the rest of the population experiences. The goal of this study is to investigate patient satisfac- tion with the municipal GP service in areas with both a Sami and Norwegian population. Study design. A cross-sectional population study using questionnaires. Methods. The data were taken from the population based study of health and living condi- tions in areas with both Sami and Norwegian populations (SAMINOR) in which respondents were asked about their satisfaction with GP services in their municipalities. This popula- tion survey was carried out in the period 200–00. The analyses include 1,61 men and women aged 6–79. Results. The Sami-speaking patients were less satisfied with the municipal GP service as a whole than were the Norwegian speakers; RR 2.4 (95% CI 2.1–2.7). They were less satisfied with the physicians’ language skills; RR 5.8 (9% CI 4.8–7.0); and they felt that misunder- standings between physician and patient due to language problems were more frequent; RR .8 (9% CI .–.). One-third expressed that they did not wish to use an interpreter. Conclusions. The results indicate that it is necessary to place greater emphasis on the physi- cians’ language competency when hiring GPs in municipalities within the Administrative Area for the Sami Language. This could improve satisfaction with the physicians’ services. Downloaded by [Universitetbiblioteket I Trondheim NTNU] at 06:04 16 November 2017 (Int J Circumpolar Health 2008; 67(1):114-121) Keywords: patient satisfaction, Sami-speakers, general practitioners’ service, communication 116 International Journal of Circumpolar Health 67:1 2008 Patient satisfaction with GP service INTRODUCTION MATERIAL AND METHODS The government’s Action Plan for Health On request from the Ministry of Health and and Social Services to the Sami Popula- Social Affairs, the Centre for Sami Health tion in Norway, 200–00, states as a goal Research at the University of Tromsø in co- that the Sami population’s encounter with operation with the National Institute of Public the health and social services should be as Health, carried out the health and living good as that as the rest of the population. In conditions survey (SAMINOR), 200–00. 1992 the Sami Language Act was passed. In All municipalities in the Administrative accordance with this Act, those who wish to Area for the Sami Language were included: use the Sami language to take care of their Karasjok, Kautokeino, Porsanger, Nesseby, own interests, vis-à-vis local and regional Tana and Kåfjord. Other municipalities public health and social institutions, should or districts were included if the number have the right to receive such services in of persons with Sami-language affiliation the Sami language (1). The area of applica- constituted at least 5% of the population at tion of this Act is called the Administrative the 1970 Census (). In Finnmark County, the Area for the Sami Language. survey included Lebesby, Kvalsund, Loppa The Plan for Health and Social Serv- and Alta; in Troms County, the municipalities ices (), points out that the Sami popu- of Kvænangen, Storfjord, Lyngen, Lavangen lation experiences big problems in their and Skånland; and in Nordland County, the encounters with health and social services. municipalities of Evenes and Tysfjord as Language obstacles complicate examina- well as the districts of Hattfjelldal, Majavatn tion, diagnosis, treatment, nursing, care (Grane) and Vassdalen (Narvik). In the Trøn- and user information. Lack of knowledge delag region, Røyrvik municipality and the about Sami culture among health and social districts of Trones and Furuly (Namsskogan), service personnel often results in an unsuc- Vinje (Snåsa) and Brekken (Røros) were cessful follow-up of Sami users (). included (Fig. 1). Little research and few studies have been It was decided that all inhabitants of the done on these matters, but some smaller ages 36–79 (born between 1925 and 1968), as qualitative and quantitative user surveys well as all 30-year-olds, should be invited to from areas with a Sami population do exist. participate. In total, 28,071 persons received Most of our knowledge about these topics is an invitation to participate; of these, 85 were Downloaded by [Universitetbiblioteket I Trondheim NTNU] at 06:04 16 November 2017 based on the practical experience of health excluded and the 30-year-olds were left out and social workers in Sami areas (1). of the analyses. Out of the total number of By comparing Sami- and Norwegian- 7,10, the response rate was 60.1%, or speaking users of the health services, we 16,323. Those who only spoke the Kven wished to investigate whether there were language (9), another foreign language (353) any differences in their satisfaction with the or had not answered the question of language municipal physicians’ services. (266) were left out. The final selection consti- tuted 1,612 persons. International Journal of Circumpolar Health 67:1 2008 117 Patient satisfaction with GP service Figure 1. Municipalities investigated in the SAMINOR study. Questionnaire and variables The main question was: How satisfied are The Survey on Health and Living Conditions you with the municipal physicians’ service Downloaded by [Universitetbiblioteket I Trondheim NTNU] at 06:04 16 November 2017 included both a questionnaire and a clinical as a whole? Respondents were also asked survey linked to cardiovascular screening. The how satisfied they were with their physician’s questionnaire was sent together with an invita- language skills, and whether language prob- tion. The form included, among other things, lems could lead to misunderstandings between questions about the population’s perception physician and patient. Finally they were asked of health care services, their ethnicity and whether their physician, to a sufficient extent, their language (see www.fhi.no, Helseunder- offered them an interpreter when the need søkelser/SAMINOR). arose. For this question, respondents had an 118 International Journal of Circumpolar Health 67:1 2008 Patient satisfaction with GP service additional fifth option they could tick off: “I RESULTS do not like to use an interpreter.” Several other questions concerning satis- The results are based on 1,61 men and faction with physicians’ services were asked, women aged 6–79 who participated in the but given the limited length of this article, we present study. A total of 17% spoke Sami as have decided to leave them out. their home language. Within areas geographi- In this survey, ethnic affiliation was defined cally belonging to the Administrative Area for on the basis of self-reported home language; the Sami Language, 48% said they had Sami that is, Sami only, Norwegian only, or both. as their home language as opposed to .0% In order to investigate the number of physi- outside this area (Table I). cians per person within the population during When asked about their satisfaction with the the survey period, the relevant physicians’ municipal physicians’ services as a whole, a offices were contacted by telephone. The vast majority answered that they were satisfied physicians were asked which language(s) they or very satisfied. Clear geographic differences spoke: Norwegian, Sami and Norwegian, or emerged. Outside the Administrative Area, Norwegian and some other foreign language. 87% of the Norwegian-speaking and 79% of All participants involved in our study the Sami-speaking patients were satisfied. gave informed written consent. The Regional Among those who lived within the Adminis- Committee for Research Ethics and the trative Area, 7% of the Sami-speakers said Norwegian Data Inspectorate approved the they were very satisfied or satisfied. Among study. the Norwegian-speakers in the same area, 79% said they were satisfied. The difference Statistical analyses between the linguistic groups was statistically The SAS v 9.1 software (SAS Institute Inc, significant both inside and outside the Admin- Cary, NC, USA) was used for both data istrative Area; p<0.0001 (Table II). processing and analyses. The data were anal- When we compared overall satisfaction ysed using frequency counts, cross-tabula- with the municipal GP services between the tions and the Cochran-Mantel-Haenszel test Sami-speakers and the Norwegian-speakers, for chi-square (χ) and relative risk (RR), with we found that the Sami-speakers were less a 95% confidence interval. Adjustments were satisfied, RR 2.4 (95% CI 2.1–2.7). The find- made for age, gender and geographic area.