______________________________________________ Intercultural Competence and Patient-Centered Care
In addition, the gelatin used to make capsules and even some tablets and vaccines is often hydrolyzed collagen from animal tissues. Over-the-counter medications and supplements that may have animal-source ingredients include glucosamine (from shellfish), vitamin D3 (from lanolin, or sheep’s wool), calcium (from oyster shells or bone meal), and omega-3 fatty acids (from fish oils). PROMOTING CULTURALLY SENSITIVE COMMUNICATION Communication, the process of sending a message from one party to another, consists of both verbal and nonverbal com- ponents. Verbal and nonverbal communications are embedded within the culture of the parties disseminating the information and within the culture of the parties receiving the informa- tion. Communication is complex and multilayered because it involves unstated, implicit rules about a variety of factors, including physical distance between parties, tone of voice, acceptable topics of discussion, physical contact, and amount of eye contact [106]. Each of these variables is influenced by the perception of the level of formality/informality of the situation. Frequently, misunderstandings occur because the decoding and interpretation of these nonverbal cues are not accurate. The verbal component of communication is just as compli- cated. Certainly, similarity in language shared by both parties enhances communication, but assuming that both parties in a conversation speak the same language, how the information is interpreted is still influenced by a host of factors. Linguists have posited that approximately 14,000 different meanings and interpretations can be extracted from the 500 most common English words [107]. Consequently, practitioners must be aware of the different communication styles held by diverse ethnic minority patients, as the clinical communication process is the primary vehicle by which problems and solutions are identified and conveyed [108]. Styles of communication can be classified from high- to low- context [109]. High-context cultures are those cultures that disseminate information relying on shared experience, implicit messages, nonverbal cues, and the relationship between the two parties [107; 110]. Members of these cultural groups tend to listen with their eyes and focus on how something was said or conveyed [106; 109]. On the other hand, low-context cultures rely on verbal communication or what is explicitly stated in the conversation [107]. Consequently, low-context communicators listen with their ears and focus on what is being said [106; 109; 110]. Western culture, including the United States, can be classified as a low-context culture. On the other hand, groups from collectivistic cultures, such as Asian/Pacific Islanders, Hispanics, Native Americans, and African Americans, are from high-context cultures [109].
Communicators from high-context cultures generally display the following characteristics [106; 107; 110; 111]: • Use of indirect modes of communication • Use of vague descriptions • Less talk and less eye contact • Interpersonal sensitivity • Use of feelings to facilitate behavior • Assumed recollection of shared experiences • Reliance on nonverbal cues such as gestures, tone of voice, posture, voice level, rhythm of speaking, emo- tions, and pace and timing of speech • Assimilation of the “whole” picture, including visual and auditory cues • Emotional speech • Use of silence • Use of more formal language, emphasizing hierarchy between parties On the other hand, low-context communicators can typically be described as [106; 107; 110]: • Employing direct patterns of communication • Using explicit descriptions and terms • Assuming meanings are described explicitly • Utilizing and relying minimally on nonverbal cues • Speaking more and often raising their voices (more animated, dramatic) • Often being impatient to get to the point of the discus- sion • Using more informal language; less emphasis on hierar- chy, more equality between parties (more friendly) • Being more comfortable with fluidness and change • Uncomfortable using long pauses and storytelling as a means of communicating Understanding the distinctions between individuals who come from high- and low-context cultures can promote cultural sensitivity. However, it is vital that practitioners take heed of several words of caution. First, it is important not to assume that two individuals sharing the same culture (e.g., low-context culture) will automatically have a shared script for communi- cating. Second, it is important to not immediately classify an individual into a low- or high-context culture because of their ethnicity. A Chinese American man may not necessarily be a high-context communicator because he is Asian. A host of factors, such as level of acculturation, upbringing and socializa- tion, education, and family immigration history, will all play a role in how one learns to communicate. Third, a major criti- cism of the discussion of low-/high-context cultures is that they reinforce dualism and ultimately oversimplify the complexities and nuances of communication [112].
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