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Communication, its barriers and enablers for cultural competence in health care when working in a cross-cultural environment

Cultural competence in health care is primarily focused on ensuring high quality patient-centered care and it has a direct impact on how health care is provided and received. It explains the ability of a system, agency, or professionals to deliver care to patients with different beliefs, values and behaviours, including designing their approach to delivery of care to meet the cultural, social and linguistic needs of patients (Bainbridge, McCalman, Clifford & Tsey, 2015). Australia is a multicultural environment with different racial and ethnic groups living in various parts of the country, including the Aboriginals in the Northern Territory. Consequently, racial and ethnic disparities in Australia have resulted to health inequalities. However, cultural competence in health care partially serves as a strategy to address inequalities in access to healthcare and the quality of care received, despite its challenges and barriers (Omeri & Raymond, 2009; Bainbridge et al., 2015). This essay critically analyses communication as a challenge for cultural competence in health care, including its barriers and enablers in the delivery of health care for the Aboriginal people.

Effective communication in health care is important when working in a cross-cultural environment and it is considered as critical to achieving quality health care (Ware, 2013). Communication capability in cross-cultural environment is the ability by health professionals to overcome linguistic and cultural barriers so as to attain common understanding and express information. It also involves the ability to adjust to communication styles and understand signs from individuals to gain shared understanding (Queensland Health, 2010; Vass, Mitchell & Dhurrkay, 2011). According to Ware (2013) various studies across Australia indicate the existence of the challenge of communication between non-indigenous health professionals and Indigenous clients. In particular, Baker & Giles (2012) agued that Indigenous people have different cultural model of communication which is likely to cause miscommunication. Equally, a higher level of proficiency in English and cultural appreciation of biomedical concepts is taken for granted in urban medical environments (Ware, 2013). These factors, as argued Baker & Giles (2012) are likely to influence the patients’ level of understanding of diagnosis and treatment regimes, as well as consent for treatment, and hence hindering communication between staff and client.

Poor cross-communication between health professionals and Aboriginal patients leads to disparities in care for this population. As Truong, Paradies & Priest (2014) asserted failure by health care professionals to understand social and cultural differences between themselves and clients from the Aboriginal community affects communication and trust between them. Consequently, this results to patient dissatisfaction, inadequate adherence to medications, and poor health outcomes (Vass et al., 2011; Butow & Baile, 2012). Additionally, health professionals are likely to resort to stereotyping and this can affect their conduct and the clinical decisions they make (Gibson et al., 2015). Ware (2013) noted that many health professionals do not understand that communication gap in Indigenous community exists. This failure can potentially lead to negative health outcomes for Aboriginal clients and may sometimes enhance the risk of outcomes related to life-threatening illness (Gibson et al., 2015). Therefore, awareness of communication challenge when delivering health care to Aboriginal people, as Ware (2013) argued is important in ensuring that they have adequate access to health care services that are most culturally acceptable.

There are different barriers that impact communication in the delivery of health care services in a cross-cultural environment. Truong et al. (2013) in particular noted that linguistic and cultural factors lead to communication breakdown, especially when health professionals and clients differ in any of these aspects. Differences in life expectations, perspectives, interpretations, and understanding between non-Indigenous health care professionals and Aboriginal clients are also a source of failure in communication between them (Butow & Baile, 2012). In regard to linguistic factors, there are many differences between Aboriginal languages and Standard Australian English. Additionally, the Aboriginal English differs from Standard Australian English in various ways (Vass et al., 2011). These differences may cause miscommunication between the non-Indigenous health care professionals and Aboriginal patients, and as Taylor & Guerin, (2010, p. 121) explained being unskilled in a language may cause an individual or group to be disadvantaged because of disempowerment and miscommunication.

The impacts of culture on communication are extensive and complex. As such, it is important for health professionals to understand how Aboriginal people’s perceptions of health and sickness are constructed culturally in order to facilitate clinical interactions through communication and provide culturally appropriate healthcare (Talbot & Verrinder, 2014). Cultural beliefs about causation in Aboriginal community affect health communication, especially the way in which patients interpret health information(Wilson, Ward & Fischer, 2013). For instance, providing warning about the possibility of health problems occurring may be received inappropriately by the Aboriginal people because predicting an illness is associated with sorcery (Ware, 2013). Additionally, the limitations of age, kinship and gender in respect to people who are allowed to know and discuss health information affects the exchange of information between health professionals and patients (Bainbridge et al., 2015). Although health professionals in remote areas normally are interested in learning the languages of people in the local community in order to improve communication, Truong et al. (2013) argued that it is significantly challenging to bridge extensive differences in cultural knowledge simply by developing collective linguistic knowledge.

Since cultural and language differences between non-Indigenous health care providers and Aboriginal people exist, the styles of communication of providers and clients must therefore be appreciated in order to promote effective understanding(Baker & Giles, 2012). Different strategies can be used to facilitate effective communication with the Aboriginal people. According to
Bainbridge et al. (2015) training non-Indigenous health professionals is an important way for them to learn about their clients from Indigenous communities, including their lived experiences and culture. Non-Indigenous health professionals also need to understand power imbalances in their relationship with clients from the Aboriginal community (North Coast Area Health Service, 2009). Ideally, Aboriginal patients may feel insecure to approach the service provider and if they did they may not freely share health information with providers due to lack of self-esteem resulting from power imbalances (Ware, 2013). Phillips (2010) noted that the diversity of languages in Australia makes it difficult for health professionals to communicate with all their clients using individual languages. Therefore, health professionals can use interpreter services to improve communication with clients who speak different language.

Cross-communication skills are important in achieving effective communication when working in a cross-cultural environment. Ware (2013) postulated that although literature on practical solutions to communication problems in inadequate, experience from practice discloses a number of strategies health professionals can use to improve cross-cultural communication in delivering health care to Aboriginal people. Health professionals need to maintain their body language and postures open and non-confrontational, as well as keep away from prolonged eye contact when communication with Aboriginal people (Ware, 2013; NCAHS, 2009). Additionally, health professionals can achieve effective communication when delivering health care to Aboriginal people by avoiding making assertions that are confronting or asking very direct questions (NCAHS, 2009). Importantly, supportive relationships are very important in working with clients from the Aboriginal culture. Equally, health professionals must recognize and respect the culture of Aboriginals in order to create understanding and improve communication during health care delivery (Bainbridge et al., 2015).

In conclusion, cultural competence in health care is essential in ensuring high quality and culturally appropriate care for Aboriginal people. Health professionals with cultural competence in health care can deliver care to clients with different values, behaviours and beliefs with less difficulty, and in a way that ensures cultural needs of such patients is achieved. However, communication is one of the major challenges health professionals experience in delivery of care across different cultures in Australia. Effective communication helps patients to understand diagnosis and treatment regimes, as well as improve relationship between health professionals and clients. Nevertheless, poor communication in cross-cultural environment is closely associated with patient dissatisfaction, inadequate adherence to medications, and poor health outcomes. Poor communication in cross-cultural health environments, particularly Aboriginal community occurs due to linguistic and cultural factors which lead to communication breakdown. Training non-Indigenous health professionals to learn about clients from Indigenous communities, including their lived experiences and culture can help achieve effective communication. Besides the use of interpreters to improve cross-cultural communication, health professionals also need to develop cross-communication skills such as the use of body language and postures, and most importantly recognize and appreciate the culture of the Aboriginal people.


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