Language and Culture
The United States is a country of many races and cultures and each year the challenge of providing care to clients with diverse linguistic and cultural backgrounds becomes more difficult. Understanding health and illness from a cultural perspective is important because they affect and are affected by all the elements of culture.
Language is the way that human beings communicate with each other. Oral language is a part of every society.
Culture is "the whole of ideas, customs, skills, arts, and other capabilities of a people or group, although as a whole, it is more complex than any one of these elements" (Dossey et al., 2000, p. 284). Culture helps us define who we are and what we believe. It influences the way we address life, death, birth, childbearing, child-rearing, illness, disease, dietary habits, relationships, and health behaviors (Hitchcock et al., 2003).
Culture is learned from birth through language and socialization; it is dynamic and changing; and it continually adapts to the environment, social and historical context, technology, and resources. Culture is generally unexpressed or discussed at an unconscious level. Most cultural actions are based on implicit cues instead of written or spoken rules.
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Language and Health Care
When working with clients in the health care setting, many different languages may be encountered. Consider the following (DiversityRx, 2003; Luckmann, 1999):
- More than 14% of the population of the United States speaks a language other than English at home.
- Over 6,000 languages and dialects are spoken worldwide.
- Learning a new language is difficult. Even after years of proficiency, effective use of medical terminology and an understanding of medical concepts may be deficient.
- In times of emotional or physical stress, most individuals for whom English is a second language will revert to their native language.
The ability to handle limited-English-proficient (LEP) patients is a challenge that may include the following (DiversityRx, 2003):
- a delay in making appointments because of the difficulty of communicating by telephone
- a delay in keeping appointments if the staff does not understand the client
- advancement of the disease process because of a delay in getting or keeping an appointment
- potentially serious misunderstandings about the medical condition because of the difficulty in completing a clearly understood physical or psychological assessment
- unnecessary or inaccurate tests because of a difficulty in determining an accurate diagnosis
- patients who are physically or psychologically unprepared for sometimes frightening or painful procedures
- ineffective compliance with medical advice because of language difficulties
Whenever a health care provider is involved in an exchange with an individual from another culture, six dimensions must be considered (Luckmann, 1999):
1. How and when to start a conversation.
2. How best to be understood (for example, you may need an interpreter).
3. How to respond to a patient's gestures or questions.
4. How to be sensitive to the patient's reactions.
5. How to listen to the patient's concerns.
6. How to take the patient's illness and health-related beliefs into consideration as you plan care.
While oral language is one of the most common ways in which people communicate with each other, body language is an equally important method of communication. Cultural differences and similarities in body language must be considered when communicating with patients from other cultures (Luckmann, 1999).
