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Cultural influence on communication

Culture and language are two huge barriers to effective communication.

This is an excerpt from the CDHA Journal 2008 42(1):43

“Canadian health professionals in all disciplines are gaining awareness of the enormous influence that culture may have on their clients’ attitudes and beliefs about health and health care. Darby and Walsh (1) state, “Cultural diversity is evident in different languages, foods, dress, daily cultural practices, motivational factors, cultural beliefs and values and cultural influences on disease and health behaviors.”

Canada has become an ethno-diverse society, attracting a growing number of new Canadians from non-traditional sources such as Asia, Africa, Central America, and the Caribbean. Current levels of immigration suggest that our multicultural diversity will continue to flourish well into the twenty-first century with much of this growth concentrated in Montreal, Vancouver, and Toronto. According to the 2006 census, Statistics Canada reports that 1 out of every 5 Canadians is an allophone. The allophone population is very heterogeneous, with more than 200 different languages reported in response to the question on mother tongue. (2) The United Nations recognizes Toronto as the most multicultural city in the world.

How does this  effect dental hygienists?
Delivering effective, optimal oral health care in this multicultural environment requires that the dental hygienist be sensitive to cultural differences in values, beliefs, traditions, experiences, customs, rituals, and language.

The CDHA Code of Ethics, Principle I: Beneficence states that dental hygienists should “provide services to their clients with respect for their individual needs, values and life circumstances.” Providing such individualized preventive, therapeutic and supportive oral therapy is the foundation of the dental hygiene process of care. This obligation to act without discrimination and to effectively interact with varied populations demands that the dental hygienist be sensitive to cultural differences and be competent in multicultural communication skills.

English across cultures, cultures across English: a reader in cross-cultural communication by Ofelia García, Ricardo Otheguy is one of many texts to help us understand this complex topic.

This language disparity can be a significant barrier to communication, and subsequently to dental hygiene care. Use of a family member interpreter has it’s downside:  if it’s a  family member may be too emotionally involved to be objective ; there may have privacy concerns; the client/patient may withhold sensitive/personal information to avoid upsetting the family member. 

Using an interpreter also makes it more difficult to develop rapport.  It is important to remember to look at and concentrate on  the client rather than at the interpreter during the communication process. Use of visual aids when possible. Active listening is crucial. Be sure to allow adequate “wait time for the client to formulate a response, paraphrasing to ensure accurate transfer and understanding of information, and encouraging the client to talk are all sound strategies when attempting to enhance intercultural communication and ultimately increase the chances of effective care delivery. In somecultures it is disrespectful to ask questions, so they simply smile and nod politely; the dental hygienist may mistakenly interpret these behaviors as being indicative of agreement on the part of the client.” (3)  As always use open-ended questions as a means of conveying interest in the client and his/her needs.  “Respect for age and formality also varies from culture to culture; some clients may resent being called by his/her first name. To be successful in the mediation of cultural differences, the dental hygienist must be mindful of not only the verbal, but also the non-verbal cultural variations in communication.”(3)

When speaking with clients where English is not their first language, face the client then possible, speak slowly and paraphrase. I often ask that they speak slowly as well, if they are trying to speak english and have a heavy accent, on the pretense that I have difficulty hearing, this gives me more time to understand their pronounciation. Keep the verbage simple, avoid unneccessary  words and medical terminolology. There are also a number of online resources for dental information, and health histories in multiple languages that can be a huge benefit.

Child Dental Health – Multiple Languages

Cosmetic Dentistry – Multiple Languages

the US site of you can select the language of your choice from the drop down menu

Nonverbal communication and behaviors comprise at least 70% of all communication. When there is a language barrier, use of nonverbal communication often increases dramatically. This powerful aspect of interaction can vary greatly cross-culturally. Use and meaning of hand gestures, acceptable physical touching, proximity, and eye contact differ depending upon cultural background. Because these gestures can convey very different meanings to different cultural groups, they should be used with caution. I’ll talk more about this in our next blog entry.

Darby ML, Walsh MM. Dental hygiene Theory and Practice. Philadelphia:Saunders, 1995:103-119.
2. Statistics Canada:2006 census (cited 2007, December 4)  
3. Fitch, Paul  Caultural competence and dental hygiene care delivey: integrating cultural care into the dental hygiene process of care  J Dental Hygiene  2004

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