Question

how might communications differ to reach health disparities within a specific culture or ethnic population, what strategies might be used to reach individuals with low literacy? How might body language indicate understanding or lack understanding?

how might communications differ to reach health disparities within a specific culture or ethnic population, what strategies might be used to reach individuals with low literacy? How might body language indicate understanding or lack understanding?

Answer 1

Cultural competence may be defined as the ability of individuals to establish effective interpersonal and working relationships that supersede cultural differences. At the patient-provider level, it may be defined as a process in which the healthcare provider continuously strives to work effectively within the cultural context of a client, who may be an individual, a family, or community (Campinha-Bacote, 1999).

Some of the factors that influence the communication and thus cause health disparities within a given ethnic or culture population include:

Patient race and ethnicity: Ethnic origin and cultural background contribute not only to the definition of what symptoms are noteworthy, but are also responsible for how symptoms will be presented to the physician. Studies have found that physicians deliver less information, less supportive talk, and less proficient clinical performance to black and Hispanic patients and patients of lower economic class than they do to more advantaged patients, even in the same care settings (Bartlett, Grayson, Barker, Levine, Golden, & Libber, 1984; A. Epstein, Taylor, & Sewage, 1985; Hooper, Comstock, Goodwin, & Goodwin, 1982; Ross, Mirowsky, & Duff, 1982; Waitzkin, 1985; Wasserman, Inui, Barriatua, Carter, & Lippincott, 1984).

Patient social class: The effect of social class on patients' presentation of themselves and their problems also has relevance for the medical treatment patients receive. Doctors talk more with patients who are higher in social class. This has been found in Florida, Massachu setts, California, England, and Scotland (Roter & Hall 1992).

Waitzkin's (1985) large study in the United States found that better educated patients and patients of higher socioeconomic backgrounds received more physician time, more total explanations, and more explanations in comprehensible language than other patients. Ironically, physicians not only gave more information to higher-class patients, they also appeared to go out of their way to offer these explanations in clear, nontechnical language. Multivariate analysis of these data further demonstrated that patients' level of education was more important than social class in general in explaining information transmittal. Thus, Waitzkin concludes that the educational aspect of social class determination is a particularly strong factor in doctor-patient communication.

There are three broad strategic approaches through which multicultural communication can be enhanced:

1) the provision of direct service designed to meet disparate language needs (interpreters and linguistic competency in health education materials)

2) the incorporation of cultural homophilly in the provision of care (use of staff who share cultural background, inclusion of family, inclusion of traditional healers or folk remedies, use of community health workers); and

3) institutional accommodation (clinic location, hours of operation, physical environment, increasing ability of professionals to interact effectively within the culture of the patient population). (Brach & Fraser, 2000).

Each of these strategies is likely to have an impact on the role of patient-provider communication in understanding and eliminating racial and ethnic disparities in healthcare.

Some of the strategies that could help reach out to individuals with low literacy include:

1. Use of simple language, avoiding technical jargon.

2. Health education materials with pictorial representation and simple language.

3. By speaking slowly.

4. Using a medically​ trained interpreter.

5. By asking open ended questions and assessing understanding by eliciting response.

Body language Signs that indicate understanding include:

1. Maintaining eye contact and remaining alert.

2. A smile on their face.

3. Sitting straight or leaning forward.

4. Asking relevant questions.

Body language Signs that indicate lack of understanding include:

1. A dull or confused expression on the face.

2. Not maintaining eye contact, looking away.

3. An indifferent expression on the face.

4. Slouched posture.

5. Restless legs or tapping of foot.

6. Keeping silent and not having any clarifications.