Intercultural Communication

Chapter 3

“Observe the nature of each country; diet; customs; the age of

the patient; speech; manners; fashion; even his silence … One
has to study all these signs and analyze what they portend.”
Hippocratic writings, 5th century B.C.E.
The Intercultural Challenge
Communication is an action chain
 One phrase or action leads to the next
◦ EX: Thank you -> You’re welcome
 Unwritten expectations
 Expectations are largely cultural
 When someone doesn’t respond as
expected, communication breaks down
 Interpersonal relationships based on
personal communication preferences
 Group interactions depend on cultural or
social norms
Intercultural Communication Concepts

 Symbols represent objects, ideas or

behaviors
 Language and nonverbal actions
◦ Thoughts, emotions, attitudes
 Person sending the message knows
the meaning
 Person receiving must interpret
The Components of the Message
 Content
 Relationship between the speaker and
receiver
 Messages that violate cultural
expectations may be accurate in
content but have a negative impact on
the relationship
Personal and Object Messages
 Personal messages
◦ Demonstrate respect
◦ Improve relationships

 Object messages
◦ Disrespectful
◦ Degrade relationships

 Verbal
◦ Communicates content

 Nonverbal
◦ Communicates information about relationship

 Verbal and nonverbal must be consistent to be successful

Verbal Communication
 Language is abstract and can only be
interpreted within context
◦ Issues common to cultural worldview
 Role of the individual in a group
 Perceptions of power
 Authority, status, time
 Significance of affective and physical expression
 Termed low- or high-context
 Level of tolerance for uncertainty and ambiguity
 Uncertainty avoidance

 Often on unconscious level

Low context cultures
 Information is in a logical, linear
sequence
 Explicit
 Straightforward
 Unambiguous
 Focus on speaker
 Impatient with high-context speakers
 Often miss nonverbal cues
 Ex: Swiss, Germans, Scandinavians
High context cultures
 Meaning is in context, not words
 Attitudes/feelings prominent in the
conversation
 Reading between the lines
 Misunderstandings easily occur
 Nonverbal communication
 Ex: Asian, Middle Eastern, Native
Americans
Healthcare
 Health care situations in America
◦ Low-context.
◦ Provider delivers a verbal message to the client
with little consideration for the nonverbal
message.
 Communication high on content and low on
relationship.
 High context cultures
◦ Dissatisfied or offended by impersonal objective
interactions.
 Communication problems may not be evident
to a low-context clinician until the client
leaves and never returns.
Individuals and Groups
 Low Context
◦ Individual is separate from group
◦ Self-realization is an important goal
 High Context
◦ Group association and oneness with the
group
◦ Mutual dependency
 Affects health care delivery in area of
participation
Individuals and Groups
 Individualism prominent characteristic
in Australia, Canada, Great Britain,
New Zealand, the Netherlands, and
the United States

 Collectivism valued in Denmark,

Ghana, Guatemala, Indonesia,
Nigeria, Panama, Peru, El Salvador,
Sierra Leone, Taiwan, Thailand, and
Venezuela
Communication
 Individuals:
◦ To establish self
◦ Flexible conversations
◦ Personal preferences
 Groups
◦ Focus is society
◦ Silence highly valued
◦ Ritual interactions
◦ Need greater interaction with group for
care
Uncertainty Avoidance
 Tolerance for uncertainty and ambiguity
 High uncertainty avoidance cultures
◦ Anxious about behavior that deviates from
the norm
 Low uncertainty avoidance cultures
◦ More curious about the unknown and
different
◦ More informal
◦ Willing to accept dissent
◦ Open to change
Power, Authority, Status
 Low-context:
◦ Attributed to role or job person fulfills
◦ People are equals
◦ Common to ask questions or for instructions
 High context:
◦ Superiors are fundamentally different from
subordinates
◦ Authority is rarely questioned
◦ Provider expected to provide all answers with
little participation from person
Gender Orientations
 Masculine culture
◦ Aggressive, task-oriented, materialistic
◦ Sex roles strongly differentiated
◦ Men accorded more authority
 Feminine cultures
◦ Quality of life is important
◦ Men and women share equally in the power
structure
 Can cause conflict within a health care
team
 Must include compromise and
consensus
Time perception
 Low context:
◦ Monochronistic
◦ Complete one task
◦ Deadlines most important
 High context:
◦ Polychronistic
◦ Many tasks pursued at once but not at the
exclusion of personal relationships
◦ Courtesy and kindness most important
Nonverbal Communication
 Reinforce content of verbal message
 May contradict the words
 May be confusing
 Should be consistent with verbal
communication
 Very important in high context cultures
Nonverbal Communication: Touch
 Touching
◦ Handshakes
◦ Hugging
◦ Kissing
◦ Hand on arm or shoulder
◦ Bumping
 Norms vary due to gender, age, physical
condition
 Vigorous handshaking may be seen as
aggressive
 Head may be considered sacred
 Aversion to touch may also be offensive
Nonverbal Communication: Gestures,
Facial Expression, & Posture
 Crossed arms may indicate hostility
 Thumbs-up may be obscene
 Beckoning with a finger may be lewd
or threatening
 Nods of head may not mean yes or no
 Smiles
 Feet may be considered lowest and
dirties part of body
◦ Soles of feet may be especially offensive
Nonverbal Communication:
Eye Contact
 Eye contact rules are complex
◦ Direct
◦ Prolonged
◦ Averted
◦ Avoided
◦ Most subtle of all nonverbal movements
Nonverbal Communication:
Spatial Relationships
 Personal space
◦ May be CLOSE
◦ Ideally should be flexible
 Positioning affects communication
◦ Both at equal levels
 Ex: Both sitting or standing
Role of Communication in Health
Care
 Interaction between Provider and Client
◦ Object messages more common than
personal messages
◦ Content more relevant than relationship
◦ Client responsibility
◦ Practitioner responsibility
◦ Underestimates the complexity of
intercultural communication
◦ Confidence and Caring contributes to
outcome
Barriers to Communication
 Fear
 Pain
 Stress
 Language
 Cultural differences
 Interpersonal aspects ignored
5 Ways Misunderstandings Occur
1. A provider can never fully know a
client’s thoughts, attitudes, and
emotions, especially when the client is
from a different cultural background.

2. A provider must depend on verbal and

non verbal signals from the client to
learn what the client believes about
health and illness, and these signals
may be ambiguous.
5 Ways Misunderstandings Occur
3. A provider uses his or her own cultural
understanding of communication to
interpret verbal and nonverbal signals
from the client, which may be
inadequate for accurate deciphering of
meaning in another cultural context.

4. A provider’s state of mind at any given

time may bias interpretation of a
client’s behavior.
5 Ways Misunderstandings Occur
5. There is no
correlation between
what a provider
believes are correct
interpretations of a
client’s signals or
behaviors and the
accuracy of the
provider’s belief.
Misunderstandings
of meaning are
common.
Ineffective Communication Can Be
Serious
 Noncompliance issues
 Reject recommendation
 Fail to return
 May turn to traditional healers due to
better communication
 Development of interpersonal
relationship is crucial
Intercultural communication
awareness
 Unconscious incompetence
◦ Speaker misunderstands communication
behaviors but doesn’t know it
 Conscious incompetence
◦ Aware of misunderstandings but doesn’t correct
them
 Conscious competence
◦ Considers own cultural characteristics and
modifies as necessary
 Unconscious competence
◦ Skilled in intercultural communication practices
and no longer thinks about them during
conversation
Successful Intercultural
Communication
 Culture
 Respect
 Assess/affirm
 Sensitive
◦ Self-aware
 Humility
Intercultural Communication Skills
 Name traditions
 Appropriate language
◦ Specific verbs
◦ Slang
◦ Idioms
◦ Avoid yes/no questions
Intercultural Communication Skills:
Interpreters
 Title VI of the Civil Rights Act
◦ No health care discrimination based on
language
 Nonprofessional interpreters often used
 Problems with informed consent, patient
safety and noncompliance occur when
inadequate
 Speak directly with the client
 Telephone interpretation services are
appropriate
Precounseling Preparation
 Information transfer
◦ Verbal/nonverbal ability to convey object
messages
 Relationship development and
maintenance
◦ Create rapport, establish trust,
demonstrate empathy and respect
 Compliance gaining
◦ Obtain client’s cooperation
In-depth Interview
 Determines many of the iceberg
issues
 High-context
◦ May feel personal questions about
background are invasive or unnecessary
◦ May indicate practitioner incompetence
Respondent-Driven Interview
(see book page 68)
 What do you call your problem? What name do you give to
it?
 What do you think caused it?
 Why did it start when it did?
 What does your sickness do to your body? How does it
work?
 Will you get better soon, or will it take a long time?
 What do you fear about your sickness?
 What problems has your sickness caused for you personally?
For your family? At work?
 What kind of treatment will work for your sickness? What
results do you expect from treatment?
 What home remedies are common for this sickness? Have
you used them?
 How would a healer treat your sickness? Are you using that
treatment?
Nutrition Assessment
 Can what you eat help cure your
sickness or make it worse
Do you eat certain foods to keep
healthy? To make you strong?
 Do you avoid certain foods to prevent
sickness?
 Do you balance eating some foods
with other foods?
 Are there foods you will not eat?
Why?
Intercultural Nutrition Assessment
 Standardized tools may be biased
◦ Cultural unfamiliarity with concepts and
terminology
◦ Mixed dishes
◦ Underestimate nutrients
 Health attitude models, acculturation scales
and indexes also unsuited
 Anthropometric measurement tools may be
inappropriate
 Development of culturally specific techniques
and tools is a critical need in nutrition
assessment
 Use 24 hour recall in an open-ended manner
Intercultural Nutrition Education:
Cultural Factors Influencing
Participation
Intercultural Nutrition Education
 Target audience
◦ Gather demographic information
◦ Involve members of culture in planning
◦ Keep culturally homogenous
 Goals and objectives
◦ Clear, realistic
◦ Include cultural beliefs
◦ Contact health care providers in targeted
community for assistance
 May prefer groups of peers or family
members as opposed to one on one.
Culturally Relevant Program
Preparation: Triangulation
 Confirms congruence
between data
collected on the target
audience and
proposed program
goals and objectives
◦ Target population
◦ Credible communication
channels
◦ Program plan toward
culturally relevant
interventions
◦ Resource development
Developing the Message
 Keep as direct and explicit as cultural
norms allow
 Use language relevant to the group
 Use personal educational messages
 Storytelling
 Pilot test the message
 Focus groups
Implementation Strategies
 Influence Channels
◦ TV, video, computers, etc.
◦ Each cultural group has distinct media
patterns
 Most effective presentation requires
pictures, sounds and words in the
broadcast and print media
 Multiple channels and repetition
 Health fairs, clinics, farmer’s markets,
etc, can be used to distribute culturally
relevant nutrition education materials
Marketing Mix
 Product
◦ Well-developed message
 Price
◦ Minimal economic or psychological cost
 Placement
◦ Presented in a method congruent with target
audience media preferences
 Promotion
◦ Encourage target audience members to
become more involved
Evaluation
You will be group into 6. each group will be
assigned to have a specific country that they will
represent.

We will be having an intercultural exhibit. Your

exhibit includes the following information:
a. Country
b. culture, tradition and customs
c. tourism
d. food, national costume, language
Evaluation
 You will be rated according to the
rubric that will be given by your
teacher.
 This will be presented on June 21,
2019, Friday 7:30-9:30 am at Grade
11 HUMSS A and B porch.
 The countries to be presented are as
follows: China, Korea, France, Spain,
Philippines and Indonesia.