Developing Cultural Competence

Multicultural Health

An Assessment of Health and Personal Social Service Needs relating to Ethnic Minority Groups within the HSE Mid West Region (Limerick, Clare, North Tipperary)


In response to changing population dynamics based on immigration and the impact that this change will have on the demands and the needs of the health service, its providers and its users, the HSE Mid-West has commissioned this research.


The aim of the research was to develop a profile of minority ethnic communities living in the Mid- West Area and conduct a high level assessment of the health and personal social service needs of minority ethnic communities across the Mid-West Area.


The majority of immigrants have been employed prior to coming to Ireland. They are generally well educated by their own and Irish standards, with those from the EU and Eastern Europe attaining higher educational standards than the rest of the group. More than 50% stated their intension to live permanently in Ireland. Most with this intention came from the EU and Africa. Interestingly, those who planned to live here permanently had their family members living with them and were mainly asylum seekers, refugees, resident IBCs and EU migrant workers. The majority of them had English as their first language, followed by Spanish, Russian, Polish and French. Despite the fact that studies have cited language as a major barrier to accessing health services, many of the study participants spoke English well and claimed to have had little difficulty communicating.

Many of the service providers consulted in this research stated that communication difficulties created problems in terms of lengthening consultations as well as the understanding of advice and instructions. The importance of basic information on health services for the EM community is crucial. There is a lack of understanding of the Irish health system and the roles of service providers and thus, a need for orientation and cultural training for both service providers and immigrants to cultivate mutual understanding and appreciation.

Access to existing health services by EM proved to be lower than their Irish counterparts. The highest use is for primary care services followed by A&E with a low level of satisfaction with both services. Language was not the only difficulty in attempting to provide health care for this population. Different cultural backgrounds and religious beliefs led to practices that are sometimes difficult for service providers to understand. There are differing birthing practices among some ethnic minorities, which have implications for Irish maternity services. Muslim women will not attend male doctors. There is a need for EM to be understood by Irish service providers but there is also a need for those providing services to understand the subtleties of the backgrounds and traditions of individual patients and groupings. Therefore, those providing healthcare service to EM must address cultural differences.

Training and education is needed, in particular, when dealing with those who are diagnosed with mental health conditions, and in the provision of maternity services. An understanding of the nuances and backgrounds of individuals and groups is essential. Problems with physical access to health services such as opening hours, travelling distance and lack of knowledge about the specifics of Irish healthcare lead to tensions between health service users and providers. The situation is getting more difficult because of the lack of accessible and available information on services, rights and entitlements, and generally the health system. A more proactive approach needs to be taken regarding the issue of information outreach for EM communities, particularly for those most isolated.

Quality of the services was indicated as very important for the EM communities, but there are also high expectations from the health system by EM communities. This often necessitates longer consultation times and explanations. Clarification of the role of GPs and other health professionals, as well as waiting lists and overcrowding of the hospitals is needed.

The physical health of EM in Mid-West is reported to be generally good but their long-term health status has not been studied. Despite apparent good health, one third of the respondents stated they feel some or severe pain and their self-reported ability to undertake daily tasks are poor. This may be a reflection of general unhappiness or poor emotional health. However, the majority of the group reported high satisfaction with their health and to a lesser extent their lives. Their quality of life is much poorer than that reported for the general Irish population in surveys.

Health related lifestyle factors were considered: one fifth of respondents were current smokers the majority of whom were from Eastern Europe and predominantly male. Alcohol consumption is present for half of the group with generally low amounts consumed per week. At present, there are differences in patterns to the Irish population and health promotion messages must be more targeted.

Staff working across a wide range of agencies identified communication and access to services as key issues of concern. Cultural competence was also identified and there was a strong view the ethnic composition of staff in health services should more closely reflect that of the communities they serve. The importance of sharing information across HSE departments and other agencies was highlighted. Social exclusion and poverty in general were identified as the prime determinants of ill-health. The contributors also explored the key aspects to addressing inequalities in health and achieving cultural competence. These are: Recognizing and valuing diversity; auditing systems and processes within HSE; creating a more inclusive organizational culture; and challenging individual attitudes and behaviour.