Cross-Cultural Communication and Pharmaceutical Care
McDonagh, Marian S, Drug Topics
What do we really mean when we use the term cross-culrural?
Each of us has a cultural background, although some are more mixed than others. Our friends, neighbors, coworkers, and patients also have their own cultural backgrounds. Cross-cultural interaction occurs when two cultures come into direct contact with each other. Because of the unique relationship between the pharmacist and the patient, it is essential to find an effective way to communicate across cultures.
While language differences are a significant barrier to effective communication between pharmacist and patient, cultural differences go far beyond this initial hurdle. Cultural background influences patients' interpretation of disease, health, health care, and the manner in which they relate to health-care providers, and your own cultural background influences the way you interpret the patients disease and treatment. In order to incorporate the patient's perspective into the care provided, pharmacists need to appreciate the patient's view of and approach to health care.
In this article, the main issues surrounding cross-cultural communication are examined and put into the perspective of the pharmacist. Through examples of concepts that may be foreign to the pharmacist, we will look at problems beyond language to increase awareness of the way in which cultural differences affect the pharmacist's communication efforts. We will discuss the use of interpreters and make recommendations for improving outcomes. Additional reading and research are recommended and encouraged.
Defining the terms
A few definitions are in order. Terms that are frequently used in cross-cultural literature are: cultural sensitivity, health belief model, cultural competence, and ethnocentricity.
Cultural sensitivity is learning to respect and honor other cultures. It is also the ability to be open to the ideas of these cultures as they impact your interactions and to have tolerance for beliefs and traditions of others. The health belief model (HBM) is a tool initially created by Rosenstock to try to explain or predict behaviors toward health-specifically in the area of disease prevention in public health. It has been modified to include "sick-role behavior" and compliance with health measures.
The health belief model is based on the patient's own perceptions of his/her health rather than on objective measures or the judgment of health professionals. The HBM includes cultural factors that will influence the patient's chosen action concerning disease prevention, diagnosis, and compliance or acceptance of treatment. Cultural competence is being able to respect and honor the beliefs, interpersonal styles, attitudes, and behaviors of another culture-essentially cultural sensitivity. The goal of pharmacists working in a multicultural environment should be cultural competence. Ethnocentricity implies an awareness of and concern only with one's own culture. This works directly against communicating effectively with other cultures.
Why do pharmacists need to develop skills in cross-cultural communication?
In order to provide pharmaceutical care, the pharmacist must communicate with the patient in a number of ways (see Table 1). For example, in the community setting, when a patient presents a prescription to the pharmacist, three main avenues of communication are required. First, we must obtain specific information from the patient, such as allergy and drug histories. Second, we must impart specific information to the patient about the drug therapy, such as route of administration, dose, side effects, and duration of therapy. Third, we must ascertain the patient's level of understanding of the information given and discover any questions he/she may have. Each of these processes can be hindered by cultural differences, which include but are not limited to language differences.
In the hospital setting, cross-cultural drug counseling during hospitalization and at discharge can be even more difficult due to the added stress of illness. …