Unit 2: Intercultural competence and cross- cultural Communication

The free movement of people in Europe has been a core part of European Union policy since its inception and, with the signing of the Schengen Agreement in 1985, Europeans have been able to freely travel and work between countries in the Union. This, along with the effects of globalisation and post-colonialism mean that European societies have become increasingly more culturally diverse. In addition, in 2014 there were over 33.5 million non-EU nationals living in EU member states (Eurostat 2015). Thus, with a population of over 500 million people, Europe is one of the most linguistically and culturally diverse places on Earth. For instance, within EU borders there are 3 distinct alphabets, 24 official languages, 60 other European languages and an estimated 175 non-EU nationalities (EC 2015), each with their own varied cultural and linguistic heritage.

  Introduction

The free movement of people in Europe has been a core part of European Union policy since its inception and, with the signing of the Schengen Agreement in 1985, Europeans have been able to freely travel and work between countries in the Union. This, along with the effects of globalisation and post-colonialism mean that European societies have become increasingly more culturally diverse. In addition, in 2014 there were over 33.5 million non-EU nationals living in EU member states (Eurostat 2015). Thus, with a population of over 500 million people, Europe is one of the most linguistically and culturally diverse places on Earth. For instance, within EU borders there are 3 distinct alphabets, 24 official languages, 60 other European languages and an estimated 175 non-EU nationalities (EC 2015), each with their own varied cultural and linguistic heritage.

This diversity can present significant challenges for health and social care practitioners, particularly around topics such as ageing and sexuality, since these are very much influenced by culture, traditions and customs. Moreover, linguistic differences between health and social care practitioners and clients can exacerbate the challenge. Thus, cross-cultural communication is an area of growing importance in health and social care.

  Key message

  • Cross-cultural communication is increasing required in health and social care
  • Cultural influences may be particularly strong around topics such as ageing, sexuality or sexual health
  • Health and social care practitioners should be mindful of the manner in which their views and values have been shaped by their own culture and/or religious background

  Learning outcomes

  1. Raise awareness of the importance of appreciating cross-cultural approaches to communication
  2. Promote cultural awareness amongst health and social care practitioners, which encourages them to recognise their own cultural background as well as those of clients
  3. Recognise strategies to engage effectively with culturally diverse client groups

 

  Content

Culture has been defined many times and most definitions consider culture to include norms, beliefs, values and social practices that are shared by people from a particular national, ethnic, social or religious background. Culture can affect behaviour, patterns of thinking and ways of communicating and interacting with others. As such, cultures are almost as diverse as the people who inhabit them. Thus, there may be little surprise that intercultural communication theorists often use the analogy of an ice-berg to help explain culture (see for example, Hall 1989). On the surface there are the things we can see and easily identify such as dress, food, music or language. At the same time, below these surface elements are the things that are not so easily seen and understood, such as core beliefs and attitudes, concepts of time and patterns and norms of interaction (Hall 1989).

Among these “below the surface” aspects of culture are attitudes and beliefs in relation to matters such as aging, sexuality and gender roles, as well as approaches to doctor/patient interaction, notions of modesty, patterns of verbal and non-verbal communication and definitions of obscenity- all of which can have an impact on how a person from a particular cultural background might interact with a health and social care practitioner and respond to a discussion about sexual health. In particular, beliefs and attitudes about health and illnesses, aging and sexuality can all be affected by a person’s cultural background. Roach (2004), for example found that staff of Swedish nursing homes had a more relaxed attitude to expressions of sexuality among residents than their counterparts in Australian nursing homes, largely because of the more liberal cultural attitudes to aging and sexuality that exist in Sweden.

The Culture and Health Assessment Tool (CHAT) may be used as part of the PLISSIT model when communicating with patients/clients with a distinct cultural background to that of the health and social care practitioner (Rosen et al. 2004). CHAT is a 14 item checklist that includes Kleinman’s ‘Questions for Eliciting a Patient’s Explanatory Model’ (Kleinman, Eisenberg & Good 1978). CHAT is designed to be used in many clinical settings, but with a slight adjustment in language- such as substituting ‘problem’ or ‘issue’ for ‘illness’, it is perfectly suited to be integrated into the PLISSIT model when discussing issues of sexuality and/or sexual health with clients from diverse cultural and/or linguistic backgrounds. The questions are designed to stimulate conversation and give a health and social care practitioner “a greater understanding of the patient’s health-belief model, health practices and expectations for treatment” (Rosen et al. 2004: 127).  Questions that are not relevant to the client’s particular case or situation may be omitted as seen fit by the practitioner.

CHAT

Culture and Health Assessment Tool (CHAT)

1.  Where appropriate I have discussed the role of the interpreter with both the interpreter and the patient.
2.  What do you think caused your illness/problem?
3.  Why do you think your illness/problem started when it did?
4.  What does your illness do to you
5.  How bad (severe) do you think your illness/problem is? Do you think it will last a long time, or will it be better soon, in your opinion?
6.  What do you fear most about your illness?
7.  What are the chief problems that your illness has caused for you?
8.  When you have a problem, to whom do you turn for help?
9.  For your future care, who would you like to be involved?
10. What have you done to treat your illness/problem?
11. What kind of treatment do you think you should receive?
12. What are the most important results you hope to receive from treatment?
13. Is there anything that might conflict with your treatment regimen?
14. Are you feeling uncomfortable or uncertain about what we have decided?

 

 

Reflective Activity

A number of questions in the CHAT tool, particularly questions 6, 7, 8, 9 and 13, relate to the interface between care and social, cultural or religious influences. Reflecting on each of these questions, consider how your society, cultural or religious background might shape your responses.

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This project has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein