Perceptions of competence and trust in the interactions between clinicians and patients in type 2 diabetes and cardiovascular disease management among South Asians and Anglo-Australians in Australia

Background: It is well established that culture and ethnicity influence beliefs and views regarding health, illness and disease management. Development of appropriate and effective health services requires taking this into account. While there is a robust literature on clinician-patient interaction little is known about the views of South Asian (SA) migrants living with type 2 diabetes and/or cardiovascular disease in Australia compared with their Anglo-Australian (AA) counterparts regarding interaction with clinicians and how this may or may not assist in self-management of these diseases. Methods: Given the paucity of research examining SAs with these diseases in Australia and comparing them with AAs, a qualitative design using in-depth interviewing was considered most appropriate. Theoretical sampling in conjunction with thematic analysis enabled recruitment of 57 study participants from local communities in Victoria, Australia. Results: Choice of clinician was viewed by SAs as constrained by geographic proximity, cost, perceived clinical competence and cultural concordance whereas only the first three factors were of concern to AAs. Most SAs viewed poor interaction as an indicator of clinician incompetence and a lack of trustworthiness. Cultural incompetence was perceived as indicating a broader lack of competence. Conclusions: Choice of clinician acted as a proxy measure of trustworthiness. Competence was perceived as a confluence between clinical knowledge and cultural sensitivity. This suggests that effective clinician-patient interaction requires training of clinicians to recognise the relationship between cultural sensitivity and clinical skill. Main messages: Both SAs and AAs choose clinicians based on perceived trustworthiness as well as pragmatic considerations. Training of clinicians needs to incorporate a model of competence which provides recognition of the relationship between clinical skill and cultural sensitivity.