Dimensions of Culture: Cross-Cultural Communications for Healthcare Professionals

Praise from readers about Dimensions of Culture.®

What educators and students working in health care in the U.S. are saying...

As an African American with grandchildren of mixed races, I feel your chapter Healthcare for African American Patients and Families is a must read for providers. When a family is blended with different ethnic backgrounds, the same old assumptions should not be made. I hope our providers will read this. —R. Buckner, Children’s Hospital Colorado

I am a psychiatric nursing student and wish to use your website as a reference when completing our assignment on cross-cultural care. I would like your permission to post the www.dimensionsofculture.com website on our forum for other students to visit. —Heidi O’Neil

I am a RN nursing. As a member of the medical field, I believe that culture should be a part of the learning experience. It is necessary to have the information to help your patients to the best of your ability.—R. Moberg

Dimensions of Culture®:

Cross-Cultural Communications for

Healthcare Professionals

by Marcia Carteret, M.Ed.

This book is dedicated to

Keith & Carlene who helped keep things flowing,

Helene for her steadfast support and encouragement,

and Rodger for showing me the possibilities.

✹✹✹

Published at Smashwords by Carteret Communications

www.dimensionsofculture.com

Copyright 2012 Marcia Carteret M.Ed.

©All rights reserved.

No portion of this ebook publication may be reproduced without the author’s permission.

ISBN:9781301533985

Smashwords Edition, License Notes

This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.

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Table of Contents

Part 1: How Culture Affects Communication

Chapter 1—Cultural Aspects of Communication

Chapter 2—Understanding Your Own Culture First

Chapter 3—Developing a Cross-Cultural Mindset - Four Key Steps

Chapter 4—Eight Dimensions of American Culture

Chapter 5—A Provider’s Culture and the Culture of Medicine

Chapter 6—Culturally Responsive Health Care

Chapter 7—Eliciting Quality Patient Responses in Cross-Cultural Health Care

Chapter 8—Cultural Barriers to Treatment and Compliance

Chapter 9—How Culture Affects Expectations of Physicians

Chapter 10—Culture and Family Dynamics

Chapter 11—Key Determinants of Heritage Consistency

Chapter 12—Culturally Based Theories of Illness Causation

Part 2: Culture Specific Topics

Chapter 13—Cultural Values and Beliefs of Latino Patients and Families

Chapter 14—The Importance of Familismo

Chapter 15—Folk Illnesses and Remedies in the Latino Community

Chapter 16—Cultural Values of Asian Patients and Families

Chapter 17—Traditional Asian Health Beliefs and Healing Practices

Chapter 18—Providing Health Care to Hmong Patients and Families

Chapter 19—Health Care for African American Patients and Families

Chapter 20—Health Care for Middle Eastern Patients and Families

Chapter 21—Observing Ramadan

Chapter 22—Health Care for Patients and Families from African Cultures

Chapter 23—Culture and Clinical Care of American Indians and Alaska Natives

Part 3: Special Topics

Chapter 24—The Role of Religion in Providing Culturally Responsive Care

Chapter 25—Cultural Aspects of Pain Management

Chapter 26—Modesty in Health Care: A Cross-Cultural Perspective

Chapter 27—Cultural Aspects of Death and Dying

Chapter 28—How Culture Affects Oral Health Beliefs and Behaviors

Chapter 29—Culturally Based Attitudes Contribute to No-Show Rates

Chapter 30—The Challenge of Low Health Literacy Among Patients

About the Author

Contact Dimensions of Culture®& Marcia Carteret Online

Training for your staff, students, faculty and providers available now through Dimensions of Culture®

PART 1: HOW CULTURE AFFECTS COMMUNICATION

Chapter 1

Cultural Aspects of Communication

Have you ever wondered why people from some cultures talk louder than you may be used to people talking? Perhaps, to you at least, they seem too assertive and maybe even a bit aggressive in their directness. Or maybe you’ve been in a conversation with someone from a different culture who moved too close to you while speaking? Did you automatically respond by backing up a little to maintain comfortable personal space? Or, perhaps you noticed some of your patients being reluctant to speak up to answer your questions. Did any of them avoid direct eye contact with you? Could these kinds of communications behaviors be cultural? Absolutely.

In cross-cultural health care interactions, there are many situations where communication is challenging because patients and their families exhibit different values, beliefs, and behaviors from those of their American physicians. Physicians educated in western medicine, who work in the health care system in the United States, operate within a highly specific medical culture though they may not even realize how acculturated they have become within that world of medicine. So, American physicians sometimes get frustrated by long answers to seemingly simple questions. They may get even more frustrated when patients nod and smile in agreement to treatment plans but don’t follow through. In private practice settings, the biggest challenge can be dealing with people who are late for appointments or don’t show up at all. Time is money for people in private practices and clinics - indeed this seems to be true about everyone in American society. But people from other cultures may not understand the value Americans place on time and productivity; they may show a lax attitude towards punctuality. This commonly creates frustration on both sides of the medical interaction.

Intercultural Communication For Health Care Professionals

Intercultural communications in is a field closely related to anthropology, social psychology, and sociology. Specific to the domain of intercultural communications is the study of how people create meaning from the world around them and communicate with others to achieve cooperation. Intercultural communications theory, when applied in health care settings, can be useful in helping doctors and their staffs relate more effectively to their patients from diverse cultural backgrounds.

The most effective communication skills are very much the same in a cross-cultural setting as within our own culture: listen without judging, repeat back what you understand to clarify, confirm meanings, give suggestions and acknowledge when mutual understanding is reached— or not! However, when communicating with a person from a different culture, we need to add to these basic skills. We need to build some understanding of how our own values, beliefs, and attitudes create particular expectations within us, and further how these expectations may not match those of other cultures. Misalignment of expectations causes confusion and discomfort between people. In patient-doctor interactions, the stakes are sometimes high. Conversations often involved complex concepts. Confusion over which bus takes you downtown is one thing, but confusion that leads to a misunderstanding of a diagnosis is quite another.

At first glance, it might make sense to try to learn the beliefs, customs, and taboos of each foreign culture we interact with regularly. But memorizing lists of do’s and don’ts is both impractical and ineffective because it is the context of an intercultural interaction that is key. Once we lose sight of the context of an interaction, we lose the essential foundation by which we guide ourselves and the other to achieve understanding. A very simple example would be the following: You might be told that in Japan it is customary to bow when you are greeting someone. True, but you need to understand the status relationships of the people involved to know how to bow. If you don’t bow appropriately, you will surely offend someone more severely than if you don’t bow at all because a Japanese person doesn’t expect a foreigner to understand the nuances of this custom. In any case however, it would be peculiar to bow to a Japanese patient during an office visit here in the United States. It would be totally out of context.

If rote learning about beliefs, customs, and taboos is ineffective, then how can we learn to be better cross-cultural communicators? The answer lies in developing both an cross-cultural mindset and skill set. We need to learn to recognize cultural differences and also be able to maintain an open attitude towards those differences. We need to develop a skill set, beginning with a thorough understanding of what culture is and what our own culture like. Many Americans find it difficult to describe American culture - just as a fish can’t describe the water it swims in. In fact, many will say there is no American culture. That simply isn’t true. What lens do we look through when judging other cultures - our own! Our skill set also includes a thorough understanding of the difference between stereotypes and generalizations. Generalizations, if used mindfully, are necessary to making sense of the human experience. You can’t talk about culture without talking about groups of people, and you can’t talk about groups of any kind without making generalizations. What is important is that the generalizations be well-informed and that they not be applied to individuals like stamps or tags.

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Chapter 2

Understanding Your Own Culture First

In all affairs it's a healthy thing now and then to hang a question mark on the things you have long taken for granted. -- Bertrand Russell

Self-reflection is crucial to the cross-cultural learning process. Without understanding that everyone has a culture and that knowledge of one's own culture first is crucial, we have a tendency to look for cultural recipes or lists to guide us. Lists lead to stereotyping.

In this book you will be given a way to understand and apply dimensions of culture to create a framework for making more effective comparisons between cultures. Dimensions of culture are points of comparison used to explain how different groups of people prefer to approach and solve the universal problems of human existence. Applying dimensions of culture (we focus on eight) to your own culture first enables you to create a baseline for making effective comparisons between your own values, beliefs, and behaviors and those of people who come from cultures unlike your own.

The Meaning of Culture

The meaning of culture has been widely debated and it can be defined in many ways. For our purposes here, and in the medical field, the following definition is useful:

Culture can be seen as an integrated pattern of learned beliefs and behaviors that can be shared among groups and includes thoughts, styles of communicating, ways of interacting, views on roles and relationships, values, practices, and customs.¹ (Robins et al., 1998)… Culture should not be considered exotic or about others. We all are influenced by and belong to multiple cultures that include, but go beyond, race and ethnicity.² (IOM)

As humans, we develop our self-esteem and identity within a particular cultural context. Without a clear cultural identity, we would experience confusion and isolation. Our resistance to cultural difference is natural. It is important to recognize the resistance we feel, to see it as part of being human and avoid turning it into something negative. Resistance to cultural difference is a phase we pass through on the way to becoming more cross-culturally aware and skillful.

To begin moving beyond resistance, we first have to ask some basic questions. Do we see our own culture as the one that is central to reality? Do we assume our way of operating in the world is better, thereby trivializing difference automatically? In the field of intercultural communications, the terms ethnocentric and ethnorelative are often used. Ethnocentric means that we view our own culture as being central to reality. Ethnorelative means we can indeed experience our own culture within the context of other cultures. Moving through resistance means moving towards a place of comfort in the ethnorelative stage.

You might be thinking at this point, "OK, I understand the concepts here, but what can I DO to become more cross-culturally skillful. The answer may surprise you. The