Academic journal article Cross - Cultural Communication

Considerations for Clinicians When Working Cross-Culturally: A Review

Academic journal article Cross - Cultural Communication

Considerations for Clinicians When Working Cross-Culturally: A Review

Article excerpt

Abstract

Communication between cultural groups, termed intercultural communication, is often difficult or not successful within a mental health setting. It is important to gain a greater understanding of intercultural communication, in order to provide appropriate treatment and care. This literature review first defines what is meant by intercultural communication, before examining the literature on the intercultural dynamics that must be considered when working cross-culturally within a mental health setting. Particular focus is given to the clinical interview, as it is the key mode of communication within therapeutic practice. Intercultural communication is a dynamic process, and to be effective many socio-cultural factors must be considered. Theoretical models of effective intercultural communication within a health context highlight the need for clinicians to possess cultural knowledge and communication skills; however, the utility of such models is yet to be assessed. The research suggests that cultural competency training is one method to promote more effective intercultural communication within a mental health setting, with cultural adaptations to therapies and assessment tools shown to increase communication effectiveness.

Key words: Intercultural communication; Cross-cultural psychology; Mental health services; Patient-clinician relations

INTRODUCTION

Communication between cultural groups, termed intercultural communication, is often difficult or not successful, due to the demands cultural diversity places on communication (Porter & Samovar, 1991). The quality of communication within a medical encounter is diminished where there is a cultural difference between the clinician and patient. Cross-cultural medical encounters tend to be shorter in duration than same culture interactions (Meeuwesen, Harmsen, Bernsen, & Bruijnzeels, 2006) with both doctors and patients responding less affectively (Schouten & Meeuwesen, 2006), and patient participation and satisfaction heavily linked to the clinician's use of affective verbal language (Schouten, Meeuwesen, Tromp, & Harmsen, 2007). This is of importance, as the better quality the clinician-patient communication during assessment and treatment, the better patient outcomes (Patten & Kammer, 2006).

Globally, research shows that ethnic minority status increases the risk of poorer health treatment. Minority cultural groups show poorer health status overall as they are less able to access or receive timely, adequate care (Armstrong & Swartzman, 2001; Cummings & Druss, 2011). Poor community awareness, inadequate linguistic support and a lack of culturally competent practitioners results in difficulty accessing appropriate services for ethnic minorities in the UK (Cowan, 2001). In the United States the growing disparities in care across different ethnic groups highlights a need for cross-cultural medical care, particularly in regards to cross-cultural communication (Betancourt & Cervantes, 2009). Whilst in Australia, physical and mental health outcomes are hindered by communication difficulties between Aboriginal and Torres Strait Islander patients and Non Indigenous clinicians (Cameron, 2010).

Migrant and ethnic minority status also places a heightened risk for the experience of mental illness. Assimilation and acculturation of migrants into another culture add stressors, which increase the risk of mental health problems (Hwang, Myers, Abe-Kim, & Ting, 2008). Specifically, migrant status has been shown to increase the risk for the development of schizophrenia, depressive symptoms and anxiety disorders (Bäämhielm & Mösko, 2012). Consequently, cultural awareness, and culturally competent care specifically, is increasingly important within a health care setting (Engebretson, Mahoney, & Carlson, 2008).

Due to the importance of communication in providing adequate health services, the inherent difficulties of crosscultural communication, and the risk that ethnic minority status places on the provision of adequate treatment and experience of psychological distress, the phenomena of intercultural communication needs to be understood within a health care setting. …

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