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International journal of health care quality assurance
Mar 27, 2025;

Quality of patient-physician intercultural communication in healthcare tourism and medical interview experiences at an Indian hospital.

Payal Mehra, Himanshu Tyagi
Author Information
  1. Payal Mehra: Communication Area, Indian Institute of Management Lucknow, Lucknow, India.
  2. Himanshu Tyagi: Communication Area, Indian Institute of Management Lucknow, Lucknow, India.
PMID: 40134048 DOI: 10.1108/IJHCQA-06-2024-0061

Abstract

PURPOSE: While many studies have addressed health communication and physician-patient interactions, knowledge about intercultural communication in medical tourism is limited. Our empirical study, therefore, investigates aspects related to patients' cultural beliefs regarding the quality of healthcare and the way this shapes their expectations and experiences in an intercultural medical interview setting at a Joint Commission International (JCI) accredited host country hospital in India. The theoretical foundation is the Communication Accommodation Theory.
DESIGN/METHODOLOGY/APPROACH: A quantitative design was used in this study using the convenience sampling method. Data were collected from 300 medical tourism (MT) patients immediately after their face-to-face medical interview at the hospital.
FINDINGS: The non-Western cultures displayed higher intercultural communication (ICC) expectations from the host country doctors than the Western patients, possibly on account of cultural similarity with and proximity to the host country. ICC beliefs of MT patients supported by convergent communication accommodation by the doctors led to the perception of better ICC experience in clinical consultations with the potential to improve word-of-mouth promotion, patient satisfaction and revisit intentions; patients' expectations mediated the relationship. Consultation time in minutes controlled the relationship between patient ICC beliefs, expectations and experience in the medical consultations. The proposed model was undifferentiated for age, gender and geography of the MT patient as well as wait time (in minutes).
ORIGINALITY/VALUE: While culture has been recognised as a significant factor in shaping the growth in medical tourism, research is scant on cultural and religious communication accommodation practices of host country doctors and medical staff and its effects on patient experience. Most studies on culture and MT have either evaluated the role of culture on the destination choice of international patients (cultural affinity or cultural familiarity) or have analysed the effect of distance between the host and the guest country as critical determinants of the choice of MT country. This study is probably the first to assess the quality of ICC beliefs, expectations and effects on MT patients' experiences. It is also the pioneering study to relate the context of MT with the well-regarded Communication Accommodation Theory, especially the manner in which convergent and divergent accommodation occurred between MT patients and MT service providers in the host country.

Keywords

Intercultural communication Medical interview Medical tourism Patient expectations Patient experiences

References

  1. Ali, P.A. and Johnson, S. (2017), ���Speaking my patient���s language: bilingual nurses��� perspective about provision of language concordant care to patients with limited English proficiency���, Journal of Advanced Nursing, Vol. 73 No. 2, pp. 421-432, doi: 10.1111/jan.13143.
  2. Alkhamees, M. and Alasqah, I. (2023), ���Patient-physician communication in intercultural settings: an integrative review���, Heliyon, Vol. 24, pp. 9-12.
  3. Allied Market Research (2023-2032), Report on Medical Tourism Industry, available at: https://www.alliedmarketresearch.com/press-release/medical-tourism-market.html
  4. Beach, M.C., Tulsky, J.A., Butow, P.N., Hickman, S.E., Mack, J.W., Morrison, R.S., Street, R.L., Sudore, R.L., White, D.B. and Pollak, K.I. (2017), ���A research agenda for communication between health care professionals and patients living with serious illness���, JAMA Internal Medicine, Vol. 177 No. 9, pp. 1361-1366, doi: 10.1001/jamainternmed.2017.2005.
  5. Berhane, A. and Enquselassie, F. (2016), ���Patient expectations and their satisfaction in the context of public hospitals���, Patient Preference and Adherence, Vol. 10, pp. 919-928, doi: 10.2147/PPA.S109982.
  6. Berwick, D., Downey, A., Cornett, E. and National Academies of Sciences, Engineering, and Medicine (2016), ���Overview of contemporary civilian and military trauma systems���, in A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury, National Academies Press, Washington, DC.
  7. Betancourt, J.R., Green, A.R. and Carrillo, J.E. (2002), ���Cultural competence in health care: emerging frameworks and practical approaches���, Field Report, 5.
  8. Betancourt, J.R., Green, A.R., Carrillo, J.E. and Park, E.R. (2005), ���Cultural competence and healthcare disparities: key perspectives and trends���, Health Affairs, Vol. 24 No. 2, pp. 499-505, doi: 10.1377/hlthaff.24.2.499.
  9. Betancourt, T.S., Brennan, R.T., Vinck, P., VanderWeele, T.J., Spencer-Walters, D., Jeong, J., Akinsulure-Smith, A.M. and Pham, P. (2016), ���Associations between mental health and Ebola-related health behaviours: a regionally representative cross-sectional survey in post-conflict Sierra Leone���, PLoS Medicine, Vol. 13 No. 8, e1002073, doi: 10.1371/journal.pmed.1002073.
  10. Campinha-Bacote, J. (2002), ���The process of cultural competence in the delivery of healthcare services: a model of care���, Journal of Transcultural Nursing, Vol. 13 No. 3, pp. 181-184, doi: 10.1177/10459602013003003.
  11. Cham, T.-H., Lim, Y., Sia, B., Cheah, J.-H. and Ting, H. (2020), ���Medical tourism destination image and its relationship with the intention to revisit: a study of Chinese medical tourists in Malaysia���, Journal of China Tourism Research, Vol. 17 No. 2, pp. 1-29, doi: 10.1080/19388160.2020.1734514.
  12. Cohen, E. (1988), ���Authenticity and commoditization in tourism���, Annals of Tourism Research, Vol. 15 No. 3, pp. 371-386, doi: 10.1016/0160-7383(88)90028-x.
  13. Connell, J. (2013), ���Contemporary medical tourism: conceptualisation, culture and commodification���, Tourism Management, Vol. 34, pp. 1-13, doi: 10.1016/j.tourman.2012.05.009.
  14. David, G., Hewett, A., Bernadette, M.W. and Cindy, G. (2015), ���Communication between hospital doctors: under-accommodation and interpretability���, Language and Communication, Vol. 41, pp. 71-83, doi: 10.1016/j.langcom.2014.10.007.
  15. Dragojevic, M., Gasiorek, J. and Giles, H. (2016), ���Communication accommodation theory���, in Berger, C.R. and Roloff, M. (Eds), The International Encyclopedia of Interpersonal Communication, Wiley Blackwell, Vol. 1, pp. 176-196.
  16. Esiyok, B., ��akar, M. and Kurtulmu��o��lu, F.B. (2017), ���The effect of cultural distance on medical tourism���, Journal of Destination Marketing and Management, Vol. 6 No. 1, pp. 66-75, doi: 10.1016/j.jdmm.2016.03.001.
  17. Fetscherin, M. and Stephano, R.M. (2016), ���The medical tourism index: scale development and validation���, Tourism Management, Vol. 52, pp. 539-556, doi: 10.1016/j.tourman.2015.08.010.
  18. Foronda, C., MacWilliams, B. and McArthur, E. (2016), ���Interprofessional communication in healthcare: an integrative review���, Nurse Education in Practice, Vol. 19, pp. 36-40, doi: 10.1016/j.nepr.2016.04.005.
  19. Gallois, C. and Giles, H. (2015), ���Communication accommodation theory���, The International Encyclopaedia of Language and Social Interaction, pp. 1-18.
  20. Ganguli, S. and Ebrahim, A.H. (2017), ���A qualitative analysis of Singapore. A medical tourism competitiveness���, Tourism Management Perspectives, Vol. 21, pp. 74-84, doi: 10.1016/j.tmp.2016.12.002.
  21. Giles, D.C. (2015), ���DSM-V is taking away our identity: the reaction of the online community to the proposed changes in the diagnosis of Asperger���s disorder���, Health, Vol. 18 No. 2, pp. 179-195, doi: 10.1177/1363459313488006.
  22. Giles, H. and Gasiorek, J. (2013), ���Parameters of nonaccommodation: refining and elaborating communication accommodation theory���, Social Cognition and Communication, pp. 155-172.
  23. Giles, H., Dailey, R.M., Sarkar, J.M. and Makoni, S. (2007), ���Intergenerational communication beliefs across the lifespan: comparative data from India���, Communication Reports, Vol. 20 No. 2, pp. 75-89, doi: 10.1080/08934210701643701.
  24. Goodarzi, M., Taghvaei, M. and Zangiabadi, A. (2014), ���Factor analysis of effective factors on the improvement of medical tourism in shiraz megalopolis���, Environmental Management and Sustainable Development, Vol. 3 No. 1, p. 138, doi: 10.5296/emsd.v3i1.4876.
  25. Goretzko, D., Pham, T.T.H. and B��hner, M. (2021), ���Exploratory factor analysis: current use, methodological developments, and recommendations for good practice���, Current Psychology, Vol. 40 No. 7, pp. 3510-3521, doi: 10.1007/s12144-019-00300-2.
  26. Guan, T., Chen, X., Li, J. and Zhang, Y. (2024), ���Factors influencing patient experience in hospital wards: a systematic review���, BMC Nursing, Vol. 23 No. 1, p. 527, doi: 10.1186/s12912-024-02054-0.
  27. Guiry, M. and Vequist, D.G. (2011), ���Traveling abroad for medical care: US medical tourists��� expectations and perceptions of service quality���, Health Marketing Quarterly, Vol. 28 No. 3, pp. 253-269, doi: 10.1080/07359683.2011.595644.
  28. Hair, J.F., Ringle, C.M. and Sarstedt, M. (2013), ���Partial least squares structural equation modeling: rigorous applications, better results and higher acceptance���, Long Range Planning, Vol. 46 Nos 1-2, pp. 1-12, doi: 10.1016/j.lrp.2013.01.001.
  29. Hair, J.F., Gabriel, M. and Patel, V. (2014), ���AMOS covariance-based structural equation modelling (CB-SEM): guidelines on its application as a marketing research tool���, Brazilian Journal of Marketing, Vol. 13 No. 2, pp. 44-55.
  30. Hair, J., Hollingsworth, C.L., Randolph, A.B. and Chong, A.Y.L. (2017), ���An updated and expanded assessment of PLS-SEM in information systems research���, Industrial Management and Data Systems, Vol. 117 No. 3, pp. 442-458, doi: 10.1108/imds-04-2016-0130.
  31. Hair, J.F., Risher, J.J., Sarstedt, M. and Ringle, C.M. (2019), ���When to use and how to report the results of PLS-SEM���, European Business Review, Vol. 31 No. 1, pp. 2-24, doi: 10.1108/ebr-11-2018-0203.
  32. Hall, J.A. (2016), ���Interpreting social���sexual communication: relational framing theory and social���sexual communication, attraction, and intent���, Human Communication Research, Vol. 42 No. 1, pp. 138-164, doi: 10.1111/hcre.12071.
  33. Hanefeld, J., Lunt, N., Smith, R. and Horsfall, D. (2015), ���Why do medical tourists travel to where they do? The role of networks in determining medical travel���, Social Science and Medicine, Vol. 124, pp. 356-363, doi: 10.1016/j.socscimed.2014.05.016.
  34. Hasnain, H., Ali, H., Zafar, F., Sial, A.A., Hameed, K., Shareef, H., Mallick, N., Tariq, A. and Fatima, R. (2017), ���Drug-drug interaction: facts and comparisons with national and international benchmarks���, The Professional Medical Journal, Vol. 24 No. 03, pp. 357-365, doi: 10.29309/tpmj/2017.24.03.1551.
  35. Hofstede, G. (1984), ���Cultural dimensions in management and planning���, Asia Pacific Journal of Management, Vol. 1, pp. 81-99, doi: 10.1007/BF01733682.
  36. Hordila-Vatamanescu, E.M. and Pana, A.D. (2010), ���The application of the Communication Accommodation Theory to virtual communities: a preliminary research on the online identities���, International Journal of Interdisciplinary Social Sciences, Vol. 5 No. 4, pp. 279-290, doi: 10.18848/1833-1882/cgp/v05i04/51684.
  37. Howard, M.C. (2021), ���A more comprehensive measure of vaccine hesitancy: creation of the Multidimensional Vaccine Hesitancy Scale (MVHS)���, Journal of Health Psychology, Vol. 27 No. 10, pp. 2402-2419, doi: 10.1177/13591053211042062.
  38. Howard, M.C. (2023), ���A systematic literature review of exploratory factor analyses in management���, Journal of Business Research, Vol. 164, 113969, doi: 10.1016/j.jbusres.2023.113969.
  39. IOM (2024), ���Emergency health. 2023 highlights���, available at: https://www.iom.int/sites/g/files/tmzbdl486/files/documents/2024-05/iom-emergency-health-infosheet-2023_08.05.2024.pdf (accessed 5 November 2024).
  40. Johnston, M.E. and Herzig, R.M. (2006), ���The interpretation of culture: diverging perspectives on medical provision in rural Montana���, Social Science and Medicine, Vol. 63 No. 9, pp. 2500-2511, doi: 10.1016/j.socscimed.2006.06.013.
  41. Keblusek, L., Giles, H. and Maass, A. (2017), ���Communication and group life: how language and symbols shape intergroup relations���, Group Processes and Intergroup Relations, Vol. 20 No. 5, pp. 632-643, doi: 10.1177/1368430217708864.
  42. Kim, Y.S. (2015), ���Language and cognitive predictors of text comprehension: evidence from multivariate analysis���, Child Development, Vol. 86 No. 1, pp. 128-144, doi: 10.1111/cdev.12293.
  43. Kogut, B. and Singh, H. (1988), ���The effect of national culture on the choice of entry mode���, Journal of International Business Studies, Vol. 19 No. 3, pp. 411-432, doi: 10.1057/palgrave.jibs.8490394.
  44. Kovacs, E. and Szocska, G. (2015), ���Informed patient choice in treatment abroad ��� a response to recent commentaries���, International Journal of Health Policy and Management, Vol. 4 No. 7, pp. 491-492, doi: 10.15171/ijhpm.2015.86.
  45. Lateef, F. (2011), ���Patient expectations and the paradigm shift of care in emergency medicine���, Journal of Emergency and Trauma Shock, Vol. 4 No. 2, pp. 163-167, doi: 10.4103/0974-2700.82199.
  46. Lateef, F. (2019), ���The impact of the COVID-19 pandemic on emergency department attendance: what seems to be keeping the patients away?���, Journal of Emergencies, Trauma, and Shock, Vol. 13 No. 4, pp. 246-251, doi: 10.4103/jets.jets_133_20.
  47. Lee, K., Lee, N. and Lee, T.J. (2023), ���Korean tourist��� experience of intercultural communication through English as a Lingua Franca (ELF) in overseas travel: a grounded theory approach���, Tourism Management Perspectives, Vol. 48, 101145, doi: 10.1016/j.tmp.2023.101145.
  48. Liu, G. and Chen, J.S. (2013), ���A dynamic model for managing cultural tourism���, Asia Pacific Journal of Tourism Research, Vol. 20 No. 5, pp. 500-514, doi: 10.1080/10941665.2014.904805.
  49. Mahmud, M.S., Rahman, M.M., Lima, R.P. and Annie, E.J. (2020), ���Outbound medical tourism experience, satisfaction, and loyalty: lesson from a developing country���, Journal of Hospitality and Tourism Insights, Vol. 4 No. 5, pp. 545-564, doi: 10.1108/jhti-06-2020-0094.
  50. Majeed, S. and Kim, W.G. (2023), ���Toward understanding healthcare hospitality and the antecedents and outcomes of patient-guest hospital-hotel choice decisions: a scoping review���, International Journal of Hospitality Management, Vol. 112, 103383, doi: 10.1016/j.ijhm.2022.103383.
  51. Manaf Abd, N.H., Maulan, S., Hussin, H., Jahn Kassim, P.N. and Alavi, R. (2015), ���Service quality, value, satisfaction, and future intention in medical tourism���, Journal of Tourism, Hospitality and Culinary Arts, Vol. 9 No. 3, pp. 1-12.
  52. Moghavvemi, S., Woosnam, K.M., Paramanathan, T., Musa, G. and Hamzah, A. (2017), ���The effect of residents��� personality, emotional solidarity, and community commitment on support for tourism development���, Tourism Management, Vol. 63, pp. 242-254, doi: 10.1016/j.tourman.2017.06.021.
  53. Ng, S.I., Chia, K.W., Ho, J.A. and Ramachandran, S. (2017), ���Seeking tourism sustainability���a case study of Tioman Island, Malaysia���, Tourism Management, Vol. 58, pp. 101-107, doi: 10.1016/j.tourman.2016.10.007.
  54. Nwoye, A. (2015), ���African cultural values: the past, present, and future���, Journal of Black Studies, Vol. 46 No. 3, pp. 263-282.
  55. Podsakoff, P.M., MacKenzie, S.B., Lee, J.Y. and Podsakoff, N.P. (2003), ���Common method biases in behavioural research: a critical review of the literature and recommended remedies���, Journal of Applied Psychology, Vol. 88 No. 5, pp. 879-903, doi: 10.1037/0021-9010.88.5.879.
  56. Purnell, L. (2018), ���Update: the Purnell theory and model for culturally competent health care���, Journal of Transcultural Nursing, Vol. 30, doi: 10.1177/1043659618817587.
  57. Saha, S., Islam, M., Saha, S., Uddin, M.J., Rahman, H., Das, R.C., Hasan, M., Amin, M.R., Hanif, M., Shahidullah, M. and Hussain, M. (2018), ���Designing comprehensive public health surveillance for enteric fever in endemic countries: importance of including different healthcare facilities���, The Journal of Infectious Diseases, Vol. 218 No. 4, pp. S227-S231, doi: 10.1093/infdis/jiy191.
  58. Sakaluk, J.K. and Short, S.D. (2017), ���A methodological review of exploratory factor analysis in sexuality research: used practices, best practices, and data analysis resources���, The Journal of Sex Research, Vol. 54 No. 1, pp. 1-9, doi: 10.1080/00224499.2015.1137538.
  59. Sarstedt, M., Henseler, J. and Ringle, C.M. (2011), ���Multigroup analysis in partial least squares (PLS) path modelling: alternative methods and empirical results���, Measurement and Research Methods in International Marketing, Vol. 22, pp. 195-218.
  60. Schinkel, O.F.W., Schinkel, J., Stolte, I.G., Prins, M. and Sonder, G.J. (2018), ���Dengue virus infection among long-term travellers from the Netherlands: a prospective study, 2008-2011���, PLoS One, Vol. 13 No. 2, e0192193, doi: 10.1371/journal.pone.0192193.
  61. Schwartz, S.P., Adair, K.C., Bae, J., Rehder, K.J., Shanafelt, T.D., Profit, J. and Sexton, J.B. (2019), ���Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis���, BMJ Quality and Safety, Vol. 28 No. 2, pp. 142-150, doi: 10.1136/bmjqs-2018-007933.
  62. Shabankareh, M., Nazarian, A., Golestaneh, M.H. and Dalouchi, F. (2023), ���Health tourism and government supports���, International Journal of Emerging Markets, Vol. 20 No. 13, pp. 1746-8809, doi: 10.1108/ijoem-03-2022-0391.
  63. Sheeran, P., Suls, J., Bryan, A., Cameron, L., Ferrer, R.A., Klein, W.M. and Rothman, A.J. (2022), ���Activation versus change as a principle underlying intervention strategy to promote health behaviours���, Annals of Behavioural Medicine, Vol. 57 No. 3, pp. 205-215, doi: 10.1093/abm/kaac045.
  64. Skountridaki, L. (2017), ���Barriers to business relations between medical tourism facilitators and medical professionals���, Tourism Management, Vol. 59, pp. 254-266, doi: 10.1016/j.tourman.2016.07.008.
  65. Smith, R., Hanefeld, J., Lunt, N. and Horsfall, D. (2016), ���Why do medical tourists travel to where they do? The role of networks in determining medical travel���, Social Science and Medicine, Vol. 124, pp. 356-363, doi: 10.1016/j.socscimed.2014.05.016.
  66. Soliz, J., Thorson, A.R. and Rittenour, C.E. (2009), ���Communicative correlates of satisfaction, family identity, and group salience in multiracial/ethnic families���, Journal of Marriage and Family, Vol. 71 No. 4, pp. 819-832, doi: 10.1111/j.1741-3737.2009.00637.x.
  67. Stivers, T. and Tate, A. (2023), ���The role of health care communication in treatment outcomes���, Annual Review of Linguistics, Vol. 9 No. 1, pp. 233-252, doi: 10.1146/annurev-linguistics-030521-054400.
  68. Stone, M. (1974), ���Cross-validation and multinomial prediction���, Biometrika, Vol. 61 No. 3, pp. 509-515, doi: 10.2307/2334733.
  69. Taheri, B., Chalmers, Wilson, J. and Arshed, N. (2021), ���Would you really recommend it? Antecedents of word-of-mouth in medical tourism���, Tourism Management, Vol. 83, pp. 1-18, doi: 10.1016/j.tourman.2020.104209.
  70. Usakli, A. and Kucukergin, K.G. (2018), ���Using partial least squares structural equation modeling in hospitality and tourism: do researchers follow practical guidelines?���, International Journal of Contemporary Hospitality Management, Vol. 30 No. 11, pp. 3462-3512, doi: 10.1108/ijchm-11-2017-0753.
  71. Watkins, M.W. (2018), ���Exploratory factor analysis: a guide to best practice���, Journal of Black Psychology, Vol. 44 No. 3, pp. 219-246, doi: 10.1177/0095798418771807.
  72. Watson, B. and Gallois, C. (1998), ���Nurturing communication by health professionals toward patients: a communication accommodation theory approach���, Health Communication, Vol. 10 No. 4, pp. 343-355, doi: 10.1207/s15327027hc1004_3.
  73. Whittaker, A. and Chee, H.L. (2015), ���Perceptions of an ���international hospital��� in Thailand by medical travel patients: cross-cultural tensions in a transnational space���, Social Science and Medicine, Vol. 124, pp. 290-297, doi: 10.1016/j.socscimed.2014.10.002.
  74. Zhao, X. (2023), ���Challenges and barriers in intercultural communication between patients with immigration backgrounds and health professionals: a systematic literature review���, Health Communication, Vol. 38 No. 4, pp. 824-833, doi: 10.1080/10410236.2021.1980188.
Journal Article

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