Research and Clinical Interactions with Asian Indians with Aphasia: A Primer for English-Speaking North American Clinicians and Researchers

Article excerpt

Keywords: aphasia, Asian Indian, Adult Language Disorders, neurogenic communication disorders, multicultural, multilingual

Developing cultural competence in interacting with people with aphasia who represent varied racial, ethnic, and linguistic backgrounds is an important goal for all aphasiologists in clinical and research contexts. Given that Asian Indians (a) are one of the largest and fastest growing ethnic minority groups to migrate to the United States and Canada and (b) have a higher incidence of stroke than most other immigrant populations as well as whites, North American clinical aphasiologists are likely, through the course of their careers, to interact with Asian Indians with aphasia. It is important that aphasiologists know at least basic aspects of culture and etiquette as well as means of addressing general cultural and linguistic differences when interacting with Asian Indians residing in the United States and Canada, especially first-generation immigrants and others who identify primarily with and have been raised in Asian Indian subcultures in English-speaking North America. To that end, this primer is offered as a means of introducing related key principles that will be helpful for North American aphasiologists. Additionally, resources to aid clinicians and researchers and information about aphasia tests in Indian languages are provided.

INTRODUCTION

There is an increased concern about racial, ethnic, and language disparities in the delivery of health care, including speech-language services. In this context, clinical aphasiologists share a growing emphasis on developing cultural competence in interacting with people with aphasia representing varied racial, ethnic, and linguistic backgrounds (American Speech-Language-Hearing Association [ASHA], 2004; National Standards on Culturally and Linguistically Appropriate Services, 2007). Not only is cultural competence essential to appropriate diagnosis and treatment planning but also to ethical considerations related to virtually every aspect of service provision (ASHA, 2005). Published practice guidelines are invaluable for educating health care professionals about the nuances of any specific cultural or linguistic group. Such sociocultural descriptions and guidelines for interaction are widely available for some cultures (e.g., see Workgroup on Adapting Latino Services, 2008), however, relatively little has been published for persons originally from the Indian subcontinent (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka). Persons from these countries are commonly referred to as South Asians, and persons of Indian origin are the largest subgroup (henceforth Asian Indians).

Given that Asian Indians (a) are one of the largest and fastest growing ethnic minority groups to migrate to the North America (BC Stats, 2010; Statistics Canada, 2009; U.S. Census Bureau, 2007a, 2007b), and (b) have a higher incidence of coronary artery disease and stroke than most other immigrant populations (Superko, Enas, Kotha, Bhat, & Garett, 2007), clinical aphasiologists in the United States and Canada are likely to interact with Asian Indian clients during their careers. The purpose of this paper is twofold: (a) to highlight key sociolinguistic characteristics of Asian Indians that might impact assessment and service delivery and (b) to provide guidelines for interacting with Asian Indian clients. Although the guidelines in the present paper refer primarily to Asian Indians, these may generally also be applied to South Asians because there are some overarching sociocultural and linguistic similarities.

HEALTH DISPARITIES

Compared with white Americans and other immigrant populations, Asian Indians, especially those residing in the United States, tend to have a higher incidence and younger average age of onset of coronary artery disease and stroke despite lower alcohol and tobacco use (Baweja, Nanda, Parikh, Bhatia, & Venkataraman, 2004; Superko et al. …