In the twenty-first century mankind lives in a more multicultural environment than ever before. For many health practitioners this means they have to interact with people from different cultures. Good communication is vital to effective health-care, so communication problems in intercultural encounters have the potential to lead to patient misdiagnosis. In such encounters health practitioners not only face the natural barriers of communicating with patients who may be unfamiliar with the health practitioners’ language, but they may face an extra challenge when patients have culturally different health belief systems.
Researchers have noted that much research on health-care communication has been atheoretical (e.g., Thompson 2003). Research into intercultural communication and healthcare is no exception. Thus, one approach adopted by researchers of intercultural communication and health-care is to focus on the development of skills. When healthcare professionals achieve good communication skills and intercultural understanding, intercultural communication competence (ICC) follows. The underlying assumption of ICC is that communication predominantly occurs at the interpersonal level and through training individuals gain knowledge and appreciation of other cultures, and cultural sensitivity develops. A second approach, which is less commonly adopted in health-care, takes as its starting point the notion that intercultural communication is essentially intergroup rather than interpersonal; this tradition comes from a socio-psychological perspective and is referred to as intergroup communication.
Intercultural Communication Competence
ICC researchers see a need for individuals to move beyond ethnocentrism in order to improve their intercultural communication (for a discussion, see Kreps & Kunimoto 1994). Through training, health professionals can acquire the appropriate intercultural communication skills to achieve effective patient interactions regardless of cultural backgrounds.
Researchers have identified the key cultural differences that health practitioners need to take into account when treating patients from cultures other than their own (Kleinman 1980; Brislin 1993; Kreps & Kunimoto 1994; Davis 2006). Health providers need to be cognizant of both culture-general and culture-specific concepts. While there may be general health expectations across populations regardless of nationality (e.g., the ability for individuals to perform their day-to-day tasks), different cultures attach different meanings to these common concepts. In their concept of “health,” for example, Brislin noted that western cultures may be more concerned with the absence of bacteria or viruses while eastern cultures may concentrate on harmony and balance – each culture believing that the opposite of their definition brings ill health. Such differences may lead to health practitioners’ best practice recommendations being resisted or misunderstood by patients. Related to cultural-specific beliefs is the way that people of different cultures may show different symptoms for the same illness. Health providers need an understanding of how somatization manifests in different cultures (Kreps & Kunimoto 1994; Davis 2006).
Relatedly, Davis (2006) discusses the implications of collectivist and individualistic cultures. Such cultures have respectively high and low context styles of communication. Davis notes that because most health professionals are trained in the western individualistic tradition, they need to be aware of the importance that many eastern collectivist cultures place on developing a trusting relationship over time. Modern curricula now teach health practitioners to consider issues such as those raised above (e.g., Carrillo et al. 1999).
This second tradition focuses on each group’s socio-historical context and the relationships that exist between groups. Researchers from this tradition argue that skills training without an understanding of the dynamics that underpin intergroup communication is insufficient.
Intercultural communication can refer not only to interactions between individuals from different nations and ethnic groups but also between people who come to the interaction from a different cultural experience (Kreps & Kunimoto 1994; Gudykunst & Mody 2002). In the health context, “intercultural” may thus refer to communication between individuals from different social groups (e.g., nurse, physician, physiotherapist, and patient) who interact with each other from different “role” experiences.
Communication accommodation theory (CAT) is a theory of communication that can be applied to intercultural communication in health-care. In CAT, interactions between health providers from different social groups, or between health providers and their patients, are understood as intergroup encounters that occur at the interpersonal level. The theory makes explicit how constructs such as health professionals’ understanding of their professional role, status, and cultural values influence their interactions with other health professionals, who have their own values. Similarly, patients’ previous positive or negative health experiences will serve to shape their perceptions of interactions with health professionals. Thus, using CAT, health communication researchers take account of how interactions are driven by interactants’ motivations and cognitions, which, if not acknowledged, can undermine an approach that focuses only on skills training. CAT provides a model of communication that explains and predicts effective communication both between health professionals and between patients and health professionals.
- Brislin, R. (1993). Understanding culture’s influence on behavior. Fort Worth, TX: Harcourt Brace College.
- Carrillo, J. E., Green, A. R., & Betancourt, J. R. (1999). Cross-cultural primary care: A patient-based Annals of Internal Medicine, 130, 829 – 834.
- Davis, C. M. (2006). Patient practitioner interaction. Thorofare, NJ: Slack.
- Gudykunst, W. B., & Mody, B. (eds.) (2002). Handbook of international and intercultural communication. Thousand Oaks, CA: Sage.
- Kleinman, A. (1980). Patients and healers in the context of culture. Berkeley, CA: University of California Press.
- Kreps, G. L., & Kunimoto, E. N. (1994). Effective communication in multicultural health care settings. Thousand Oaks, CA: Sage.
- Thompson, T. L. (2003). Introduction. In T. L. Thompson, A. M. Dorsey, K. I. Miller & R. Parrott (eds.), Handbook of health communication. Mahwah, NJ: Lawrence Erlbaum, pp. 1– 8.