Culturally informed communication in primary care consultations between General Practitioners and ethnic minority patients in the United Kingdom: A meta-synthesis and conversation analysis

Abstract

Background: Within the context of ethnic health inequalities where patients from Black and Asian ethnic backgrounds have worse health outcomes compared with their White counterparts, there is still no consensus on the conceptualisation of ‘culturally competent’ care and how it should be delivered, or what even counts as ‘culture’ and how it informs communication in real-life clinical consultations. General practitioners (GPs) are among the first points of healthcare contact in the United Kingdom (UK). However, the GP curriculum indicates that demonstrating the capability related to whole person care, which involves considering a person’s cultural background, and developing related skills can feel less tangible to GPs in training. The overall aim of this thesis was to examine culturally informed communication between GPs and ethnic minority patients in the UK. Methods: Three studies were conducted, alongside two research components exploring the methodological aspects, such as Patient and Public Involvement and Engagement (PPIE) and reflexivity. The first study was a systematic review and meta-synthesis of qualitative evidence, examining ethnic minority patients’ GP communication experiences in the UK. The second and third studies were conducted using conversation analysis (CA) drawing upon real-time contemporary UK data from on-site GP consultations recordings collected first-hand, and the documentary GPs: Behind Closed Doors. Using these two different sources of interactionally rich data, the CA studies examined how ‘culture’ is made relevant by speakers, and the interactional practices that constitute ‘culturally informed’ communication in consultations between GPs and ethnic minority patients. Results: The meta-synthesis of qualitative evidence from 37 primary studies resulted in the formulation of the ‘on PAR’ model (Perceptions, Alignment and Relationship; Chapter 4). This framework depicts how patients’ GP communication experiences vary based on intersectional aspects of patients’ identities and their interplay with GPs’ identities, extending beyond reductionist ethnicity-based classifications linked to patients’ healthcare experiences. The first CA study demonstrated how doctors and patients make culture relevant by signalling their membership related to cultural categories and/or practices, in turn displaying affiliation in interaction (Chapter 5). The second CA study showed how participants achieve alignment in culturally relevant storytelling, particularly using ‘so’-formulations and ‘wh’-questions to establish shared understanding (Chapter 6). Conclusion: This thesis provides communication-based qualitative evidence, exhibiting the utility of an intersectional approach to culture, and advancing the knowledge of culturally informed communication in clinical practice. Using applied CA, I showed tangible interactional practices that participants (including doctors and patients) use to display affiliation and alignment, while making culture visible in consultations. These findings are consequential to doctors’ clinical practice and training related to providing whole person care, building continuing GP-patient relationships, and establishing partnerships with patients from ethnically minoritised backgrounds.

Date of Award	26 May 2026
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Sarah Peters (Main Supervisor), Susan Speer (Main Supervisor) & Dawn Edge (Co Supervisor)