Experiências de competência cultural de profissionais de saúde na atenção às mulheres refugiadas em situação de violência: revisão sistemática qualitativa

Abstract

Cultural competence is an important determinant of the (in)accessibility of health care for refugee women, especially in situations of violence, and applying the same protocols, diagnoses and treatments to a culturally different population implies not recognizing the cultural validity of health actions. Objective: This review synthesized the evidence of health professionals' experience of cultural competence in caring for refugee women in situations of violence. Inclusion criteria: primary studies with qualitative data, as well as interpretative studies based on the experiences of health professionals in caring for refugee women in situations of violence. Method: The JBI methodological guidelines for qualitative syntheses were followed, with a meta-aggregative approach. The sources of information were Scielo; MEDLINE via Pubmed, Scopus, Embase, ERIC, WoS, Cinahl, PMC, APA and the VHL. The search strategy was applied to the databases in November 2022, and all languages were considered for inclusion. Studies were selected using bibliographic software. Data was extracted using a standardized extraction tool. The standardized tool was used to critically evaluate the primary studies. Data was synthesized, extracted and grouped using the standardized software. All the studies identified by the search were examined against the eligibility criteria, and were included regardless of methodological quality. The results were gathered and categorized based on similarity of meaning. These categories were subjected to meta-synthesis to produce a single comprehensive set of synthesized results. Results: Fifty-nine studies were included. Most of the studies were of moderate to low quality after critical appraisal. From these studies, 219 findings were extracted and grouped into 18 categories. The synthesis of the findings resulted in six meta-aggregations which were analyzed in the light of the theoretical framework of the Conceptual Model of Cultural Competence. The theoretical convergence of the model showed that the construct of Cultural Awareness converged with meta-aggregation 04, aggregating 27 findings; Cultural Knowledge with meta-aggregations 02 and 05, aggregating 56 findings; Cultural Competence or Practical Skills converged with meta-aggregations 03 and 06, aggregating 98 findings and Organizational Support with meta-aggregation 01, and 37 findings. Conclusion: in the professional's experience, there are barriers and facilitators to providing culturally competent care to refugee women, even if they are often not perceived as such. These barriers and facilitators, in turn, were classified into domains, such as: the professional's individual domain; the refugee woman's individual domain; the professional's collective domain and the institutional domain. It is understood that culture needs to be seen as an important social marker. Knowing and understanding the impact of social markers of differences as determinants of violence is imperative for professionals to develop their social reasoning and act with cultural intelligence. Recommendations are made for professional practice, policy and research.