Module 11: Cross-Cultural Understanding
"Cultural competence… is an acknowledgment and incorporation of the importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs on the part of clinicians and health-care systems. Some clinicians state that they interact with all patients in the same manner. Indeed, being culturally competent implies that clinicians not treat patients the same, given the cultural dynamics each brings to the encounter.”(1) Cross-cultural understanding and cultural competence in healthcare is essential to overcome cultural barriers between patients and healthcare providers in order to ensure effective healthcare delivery and medical compliance. When misunderstood, cultural differences can adversely affect communication between the physician and the patient, and this can negatively impact healthcare outcomes. For example, “not realizing that when a man named Xiong or Lee or Moua walked into the Family Practice Center with a stomachache he was actually complaining that the entire universe was out of balance, the young doctors of Merced frequently failed to satisfy their Hmong patients.”(2) Since the doctors at the Family Practice Center failed to recognize that their Hmong patients attributed their illnesses to causes other than biological pathologies, they were unable to effectively help their Hmong patients.
The way a person understands and explains sickness is embedded and influenced by their beliefs, social values, philosophies and culture. If a healthcare provider does not know how a person perceives their problem, it will be much harder for them to understand their response to it.(3) Thus, it is important that physicians and healthcare providers understand that each individual patient comes from a distinct culture and that they may attribute their illnesses to a variety of causes. For example, many West African cultures attribute illness to causes that are unrecognized by western medicine such as ancestral influence, disruption of customs and social relationships, spirit possession, witchcraft and affliction by gods.(4) Meanwhile, the Hmong attribute illness to imbalances in the universe.
Cultural competency requires empathy, curiosity and respect for other people’s opinions and beliefs. A physician or healthcare provider does not have to agree with the particular beliefs of their patients, but they must recognize that other opinions and explanations exist regarding health and illness besides the western biomedical understanding. In this way, cultural competence and cross-cultural understanding is an “important vehicle for achieving patient satisfaction, patient safety, and improved health outcomes.”(5)
Ensuring Cross-Cultural Understanding in the Medical Field
Learning all aspects of every culture that could influence a medical interaction would not only be impractical, but it also fails to take into consideration the heterogeneity that exists within cultural groups. It is impossible to completely understand or know a culture. Therefore, in order to demonstrate cross-cultural understanding, a physician should recognize the individual biases in a particular situation and be aware of the different social and cultural factors that influence a patient’s understanding of health and illness. It is often helpful for physicians to explore the meaning of an illness with their patients by asking them questions such as, “what do you think has caused your problem?”, “what kind of treatment do you think would work?”, and “how can I be most helpful to you?”(6) In addition, it is also useful for physicians to ask if the patient has seen anyone else about a given problem or used any nonmedical remedies or treatment. Similarly, many cultures associate stigmas and pride with certain health afflictions, so doctors need to exercise caution and respect when discussing culturally controversial diseases, especially concerning HIV/AIDS and other STIs.
Cross-Cultural Understanding and Refugees
The principles of culturally competent health services are especially important and applicable to the delivery of healthcare to refugee populations. Refugees not only come from different cultures and countries, but they also have faced many stressors and traumas, spent prolonged periods of time in refugee camps, and they have unique social situations. Learn more about Cultural Competency in the Cultural Competency Certificate Program.
(1) Kodjo, C. “Cultural competence in clinician communication.” Pediatrics in Review. 30.2 (2009):57-63. Accessed on 25 August 2010. <http://pedsinreview.aappublications.org/cgi/reprint/30/2/57>
(2) Fadiman, A. “The Spirit Catches you and you Fall Down.”
(3) Nyagua, J., Harris, A. “West African refugee health in rural Australia: complex cultural factors that influence mental health.” Rural and Remote Health. 8 (2008):884. Accessed on 24 August 2010. <http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=884>
(5) Kodjo, C. “Cultural competence in clinician communication.” Pediatrics in Review. 30.2 (2009):57-63. Accessed on 25 August 2010. <http://pedsinreview.aappublications.org/cgi/reprint/30/2/57>
(6) Carrillo, J., Green, A., Betancourt, J. “Cross-Cultural Primary Care: A Patient-Based Approach.” Annals of Internal Medicine. 130 (1999): 829-834. Accessed on 25 August 2010. <http://www.annals.org/content/130/10/829.full.pdf+html>