Dimensions of Culture

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How can a provider convey “credibility, empathy, interest, and concern” to a patient from a different culture? The key to adherence is effective communication between provider and patient.

There are four activities that can contribute greatly to this communication:

1. Asking nonjudgmental questions that help the provider understand the patient’s perspective on the illness, its causes, and its possible treatments;
   Explore the patient’s social and family context. Is money a concern, and should we consider less expensive treatment options first? Is your illness having an impact on your spouse or children? Do you have friends or relatives who can help you adhere to treatments—perhaps watch your children while you buy your medicine or attend follow-up visits? Will you be able to read the directions on the medicine bottle, and if not, is there a responsible person in your family who can read them for you?
   
2. Listening carefully to the patient’s replies, trying to pick up clues to the patient’s understanding as well as his or her ability to adhere to a recommended treatment:
   Listen to the patient without interrupting or letting your mind wander. Show your genuine interest in the patient’s replies. Be still—don’t fidget or sigh. Take notes, but don’t doodle. You can show that you have been listening by rephrasing the patient’s comments. This will give your patient an opportunity to understand what you heard him say, and to explain again if what you understood is not what he meant to say. These misunderstandings are common even when the patient and practitioner come from the same culture. When a patient and practitioner come from different cultures, the likelihood of miscommunication is greatly increased.
   
   
3. Working with the patient and family members (as appropriate) to set realistic goals for behavior change, if needed;
   

   Dietary changes are among the most difficult. Adherence to treatment is a complex issue. Cultural factors can further complicate a patient’s ability to adhere to recommended treatment. Food and diet are closely related to culture. (Read more...Making Dietary Recommendations)
   

4. Involving the patient in active problem-solving;
   Acknowledge the need for treatment with the patient, and ask about previous treatments utilized. Discuss potential treatment strategies and options, as well as consequences of non-treatment with the patient. Handle any questions or concerns the patient may have about treatment (e.g., fears or worries, side effects, costs, dosage, frequency, timing, sequence, duration of treatment, drug or food interactions, proper storage techniques). Evaluate the patient’s functional health literacy and understanding of the purpose/rationale for treatment, and assess barriers and facilitators to adherence (e.g., environmental, economic, occupational, and sociocultural factors, family situation and supports). Recommend / Review the therapeutic regimen with the patient. Empower by eliciting the patient’s commitment and willingness to follow-through with the therapeutic regimen.
   

   (Adapted from Like 1998)
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