Time investment ● Allow the interviewee to direct the pace of the interview. ● Allow extra time for interviews conducted in English with people who speak English as a second language – these take longer because the interviewee needs additional time to formulate responses. ● Plan ahead to be able to give more time to the interview, and schedule more than one interview. Tone of voice and demeanor ● Use voice and demeanor to convey two things: respect and support. ● Recognize that the demeanor being conveyed by the therapist may not be the demeanor that is actually perceived by the interviewee. ● Consider the way to best ask questions, take notes, fill out forms and examine injuries. ● Solicit feedback from a colleague, or view a videotape of an interview to recognize how the techniques may be viewed by others. ● Convey patience and avoid verbal or nonverbal signs of criticism or impatience. ● Use a gentle, direct, non-threatening tone. ● Avoid being too loud or too quiet. ● When speaking English to a non-native English speaker, avoid mumbling or talking while chewing gum. ● Vary your tone of voice for adults and children. ● Avoid using a loud voice or making direct commands. ● Manage your responses to the tone of voice and speaking style of the interviewee, as many speakers of English as a second language use the tone and volume typical of their first language, and may not be the same as native English speakers. Understanding the family’s communication style Ask yourself: ● Does the family communicate with each other in a direct or indirect style? ● Does the family tend to interact in a quiet manner or a loud manner? ● Does the family ask the therapist direct questions? Working with interpreters First consider: ● With which culture is the interpreter primarily affiliated? ● Is the interpreter familiar with the colloquialisms of the family members’ country or region of origin? ● Is the family member comfortable with the interpreter? Would the family member feel more comfortable with an interpreter of the same sex? ● If written materials are used, are they in the family’s native language? Tips: ● Arrange for an interpreter if not proficient in the language of the interviewee, or if the interviewee is not proficient in the therapist’s language. ● Whenever possible, interview people in their native language. ● Use a professional interpreter; do not ask children to interpret for their parents. ● Focus on the interviewee, not the interpreter. Maintain eye contact and non-verbal communication with the interviewee. Additional considerations: ● Avoid placing a physical barrier, such as a desk, between the interviewer and interviewee. ● Avoid non-verbal displays of power such as sitting back with hands behind the head, putting hands on hips, sitting with legs apart, or showing the bottom of the foot or shoe which are taken as disrespect in some cultures.
A client or patient’s culture can shape their views of causation, symptoms, and treatment of illnesses. It is important to recognize that providers and patients may differ in their perceptions and their use of time, personal space, gestures, eye contact, body language, privacy, acceptability and preferences for treatment and care. Several communication models exist to help elicit patients’ perceptions of their conditions, as well as what treatments they have tried. These communication models can be helpful in facilitating a mutually acceptable plan of treatment. Two examples of cross-cultural communication models include Kleinman’s (1978) and LEARN (Berlin 1983). Kleinman’s tool to elicit health beliefs in clinical encounters includes the following questions: ● What do you call your problem? What name does it have? ● What does your condition do to you? How does it work? ● How severe is it? Will it have a short or long course? ● What do you fear most about your disorder? ● What are the chief problems that your condition has caused for you? ● What do you think caused your problem? ● Why do you think it started when it did? ● What kind of treatment do you think you should receive? ● What are the most important results you hope to receive from the treatment? The LEARN communication model is shorter and includes the following: ● L isten with sympathy and understanding to the patient’s perception of the problem. ● E xplain your perceptions of the problem. ● A cknowledge and discuss the differences and similarities. These two models are still widely referenced and implemented, despite their publication dates. Lisa Aronson Fontes expanded these models in 2009, and wrote I nterviewing Clients Across Cultures: A Practitioners Guide . Her article Tips for Cross Cultural Interviewing is summarized as follows: Interview content ● Take time at the beginning of the interview to provide thorough information about the scope of the interview and the role of the interviewer. ● Continue to check in with the interviewee throughout the interview, providing explanation when needed and ensuring the interviewee understands the process as it evolves. ● Leave time in the interview for the interviewee to ask questions and, allow for a period of silence to give the interviewee time to formulate questions. ● If needed, suggest typical questions to help the interviewee begin to ask questions. ● Reassure interviewees that they are free to share any and all information, and that the therapist will not be shocked or upset by what they say. Emotional content ● Use active listening: maintain eye contact, lean forward, repeat responses from the client if needed for clarification. ● Show evidence of caring on a personal level by asking ● R ecommend treatment. ● N egotiate agreement. personal questions about the interviewee’s likes and dislikes or hobbies, and by finding a personal connection with these.
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