_____________________________________________________________ Cultural Competence: An Overview
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
• 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 sensi- tivity. 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 communicating. Sec- ond, 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 socialization, education, and family immigration history, will all play a role in how one learns to communicate. Third, a major criticism of the discus- sion of low-/high-context cultures is that they reinforce dualism and ultimately oversimplify the complexities and nuances of communication [112]. Learning to communicate effectively also requires an under- standing of how different conversational traits influence the communication process, or how information is conveyed and interpreted. Again, the goal of this section is not to simply dichotomize individuals’ conversational styles into categories, but rather to understand the factors that play a role in how someone makes a decision on how to communicate [106]. As long as there are two parties involved in a conversation, nonverbal communication is inevitable, and it becomes salient particularly when it is processed from one culture to another. Nonverbal communication is any behavior (including gestures, posture, eye contact, facial expressions, and body positions) that transcends verbal or written forms of communication [113]. Nonverbal communication can enhance or reinforce what is said verbally, and conversely, it can completely contra- dict the message communicated verbally. It can also end up replacing what was verbally communicated if both parties do not share a native language [114]. In Western culture, communication is more direct and eye contact is highly valued. When eye contact is not maintained, many Westerners assume that the party is hiding pertinent information. However, in some cultures, reducing eye contact is a sign of respect [108]. Conversely, patients may interpret direct and indirect gazes differently. For example, in one study, Japa- nese individuals tended to rate faces with a direct gaze as angry and less pleasant compared with Finnish participants [115]. The amount of social space or distance between two com- municating parties is culturally charged as well. Depending upon the social context, Westerners tend to maintain a dis- tance of about three feet, or an arm’s length, in conversations [107]. In a public setting, where both parties are engaged in a neutral, nonpersonal topic, Westerners will feel encroached upon and uncomfortable if an individual maintains a closer conversational distance. However, in other cultures, such as
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 discussion • Using more informal language; less emphasis on hierar- chy, more equality between parties (more friendly)
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