Respect cultural differences with care

Patient-centered discussion best

In a multicultural society, health care professionals must keep cultural differences in mind when trying to communicate clearly with patients who have immigrated to the United States from other countries. Teaching with an awareness of the cultural differences that may exist is essential for good medical outcomes.

During education, a full understanding of the information is important, and that requires good communication, explains Heide Castaneda, PhD, MPH, an assistant professor in the Department of Anthropology at the University of South Florida in Tampa.

Good communication begins with a medical interpreter to help with the discussion of symptoms, the prognosis, and proper treatment. "Without the aid of an interpreter, there can be a lot of frustration and misunderstanding," says Castaneda.

Even with an interpreter, it is important to be sure that both parties view the medical concepts and treatment instructions being discussed in the same way, because the meaning of a word or a term is not always the same in all cultures. For example, the word "liver" in the United States refers to a specific organ. Yet in other cultures, the term refers to a more generalized abdominal area.

People from different cultures may view the origin of illness and disease differently, as well, says Castaneda. For example, they may think something other than a bacterial infection is the cause of their health issue, such as the supernatural, being too hot or cold, or eating the wrong thing.

Also, something considered a standard diagnostic category in the United States may not exist in another culture. For example, several years ago, a colleague of Castaneda did work on menopause in Japan and found the word for hot flashes did not exist, because this symptom was not connected with the experience of menopause.

"If you were to suggest or talk about hormone replacement therapy to relieve a hot flash, that would make no sense to people in a culture that does not associate hot flashes with menopause," says Castaneda.

When educating about treatment methods, it is important to know that while someone may value a folk treatment or an alternative therapy, it is often used in conjunction with a traditional form of medical treatment and not an either/or situation between the two. Studies have determined that patient groups using different forms of treatment, such as herbs, use them in a complementary fashion, says Castaneda.

Another factor to consider during the education process is that it is not always cultural differences that prompt noncompliance. It can be life circumstances, such as labor and housing conditions, particularly for poor and undocumented immigrants. "I want to emphasize that educators should look beyond the notion of culture and look at the patient's life circumstances — and anything that might be impeding healthy living," says Castaneda.

Improving communication

Efforts to enhance clear communication between health care providers and patients from different cultures should be done in advance. Often, health care facilities treat patients from specific groups, such as Mexican immigrants or Hmong immigrants. In such cases, institutions should conduct as much research on the health practices of their patient groups as possible, says Castaneda. For example, discussions with key people in a cultural community should take place.

Also, health care professionals can read as much as possible and take college courses.

There has been a great deal of emphasis on cultural competency trainings, and while helpful, cultural issues can be oversimplified because of the limited time frame of the instruction, says Castaneda. People can leave with a list of 10 things patients from a certain culture believe about health care practices.

Certainly, background information is helpful, but a patient-centered approach works best, she adds. A dynamic interaction with the patient will bring greater understanding, because within each cultural group are individuals. Not everyone in a group acts the same way, especially when it comes to immigrant populations, says Castaneda. There are different levels of acculturation, and the only way to find out a person's beliefs is to have a patient-centered, one-on-one conversation, she explains.

"Ask about different cultural practices and be interested, open-minded, and respectful about those practices; ask patients in a straightforward manner," says Castaneda.

Health care professionals who are intellectually curious and open-minded will get a lot out of their everyday interactions with patients — maybe more than they would sitting in a classroom, she adds.


• Heide Castaneda, PhD, MPH, Assistant Professor, Department of Anthropology, University of South Florida, 4202 East Fowler Ave., SOC 107, Tampa, FL 33620-8100. Telephone: (813) 974-0786. E-mail: