Three-party medical consultations in Saudi Arabia: a mixed-methods study
View/ Open
word thesis.zip (2.288Mb)
Alayyash2016.pdf (2.369Mb)
Date
28/06/2016Item status
Restricted AccessEmbargo end date
31/12/2100Author
Al-Ayyash, Maha
Metadata
Abstract
One of the cultural traditions in Saudi Arabia is that the Saudi female patient
has to be accompanied by a third-party on her medical visits, thus giving rise to
consultations between three parties. By third-party, I mean a chaperone or a family
member who can be a patient’s spouse, parent, adult child, sibling, or relative. This
person shares responsibility for the patient’s health and the patient relies on them to
support them generally with assistance in terms of their health care needs and
especially for medical visits. In this research, I focus on the presence of a third party
in medical consultations with reference to patient satisfaction, how patients perceive
the role of their chaperones during the medical visit and the nature of three-party
medical interactions. To investigate these aspects, a convergent parallel mixed
method design was used in order to develop a better understanding of doctor-patient-three
party interactions, as no mixed method study has been conducted on these
issues in medical consultations in Saudi Arabia. Hence, this study addresses this gap
in literature by focusing on the interaction between the Saudi female patients, their
male physicians and their chaperones. I have concentrated on the Saudi female
patients (from different age groups, i.e. 19-75) for religious and cultural reasons.
Therefore, the overall aim of this thesis is to understand the phenomenon of three-party
consultations in Saudi Arabia through a variety of aspects including patient
satisfaction, patients’ perceptions, and what actually happens in three-party medical
interactions (e.g., alignment and epistemic asymmetry). The data for this study
included quantitative (i.e. questionnaires) and qualitative (i.e. four open-ended
questions and observational and audio-recorded) data collected in one phase from 20
clinics in 3 hospitals in Jeddah in Saudi Arabia (two private and one governmental).
A total of 117 female patients along with their chaperones were recruited.
Statistical analysis of the questionnaire ratings showed that only patient’s
education has a positive effect on patient satisfaction with chaperone involvement.
Findings from thematic analysis of the open-ended questions data revealed that
patients described three supportive roles of the chaperones, namely emotional,
informational and logistical support. The patients’ perceptions regarding their
chaperones’ supportive roles are re-evaluated in a real-life context by observing the
chaperone’s facilitative role in three-party consultations. Therefore, conversation
analysis of the audio-recorded data showed three main patterns of alignment: (1)
doctor-patient, (2) chaperone-patient (and patient-chaperone), and (3) chaperone-doctor
(and chaperone-patient) alignments. All these actions indicate that the
participants were collaboratively involved in the positive interaction and this
enhanced patient participation. However, in analysing three exceptional cases from
the Chemotherapy and Haematology clinics, it was found that the presence of a
chaperone dominates as well as complicates doctor-patient interaction and thus can
significantly override or ostracise the patient who does not know her illness. For
example, by using the Conversation Analysis approach, various epistemic resources
used by the interlocutors (i.e. the oncologist and chaperones) are displayed by which
the patient’s epistemic primacy is usurped and her epistemic access is controlled in
terms of participation and the amount of information given.
In comparing the mixed methods used in this study, congruent and discrepant
results are found between the quantitative and qualitative data. In terms of congruent
results, overall, the findings of this study concurred on the importance of having a
supportive chaperone during a female patient’s medical appointment. Chaperones’
supportive roles appear to differently influence female patients’ symptoms, diagnosis
or treatment plan. Chaperones in the current study have provided a useful
contribution to the doctor-patient interactions. However, in terms of discrepancy,
findings yielded by the conversation analysis (in Chapters 6 and 7) showed a
discrepancy between what patients reported (see Chapter 5) about their chaperones’
supportive roles and what their chaperones did in the consultation. For example, the
thematic analysis of the open-ended questions found that both genders were equally
likely to be active in speaking for the patient. However, the conversation analysis of
observational data adds and clarifies to what patients reported about their chaperones
speaking on their behalf. The conversation analysis has given a good picture of the
chaperone’s supportive role during medical visits in orienting towards patients as
being the actual owners of their bodies and illness (see Chapter 6). Therefore,
patients were given the chance to present their problem. Chaperones, in working
collaboratively with patients and physicians, support the patient and facilitate the
physician’s understanding. However, in only two exceptional cases (see Chapter 7)
of actual medical interactions, the chaperone acts as a surrogate patient and restricts
the patient’s own knowledge of their illness. Therefore, the current study contributes
to three important areas, namely: (1) the literature of three-party interactions, (2)
three-party interactions in Saudi Arabia, and (3) clinical practices in Saudi Arabia.