Culture and health care: Intergroup communication and its consequences

Bernadette Watson, Cindy Gallois, David G. Hewett, Liz Jones

Research output: Chapter in book / Conference proceedingChapter in an edited book (as author)Academic researchpeer-review

12 Citations (Scopus)


Health is a critical part of life, and the quality, safety and appropriateness of health care is of vital importance for both patients and providers. This context raises every type of intercultural matter, from national culture and ethnicity through to intergroup issues around professional, social and personal identity. Indeed, this setting points clearly to the similarity in communication across cultural divides and other intergroup contexts, and we argue that the same theoretical and methodological lens can clarify both. In this chapter, we review the literature on health communication, with a particular emphasis on intercultural issues as they apply to the hospital setting. For many years, research in health communication was criticized for being atheoretical but, in more recent times, theories of identity and accommodation have gained more prominence (see also other chapters in this book, particularly Chapters 14 and 15). We believe that an intercultural lens is appropriate for understanding issues that, although not in the traditional domain of intercultural communication, can nevertheless best be considered as intercultural. These issues frequently involve miscommunication and problematic talk (Coupland et al. 1991), and intergroup models such as that of Coupland and colleagues are helpful in understanding them. In this chapter, we canvass issues of ethnic relations and communication issues arising from cultural and ethnic differences in hospital settings. Our main focus, however, is on the hospital environment as essentially one of different cultures coming together. These differences lead to intergroup conflict and miscommunication. Hospitals are intercultural, or multicultural, entities in the traditional sense, as they include ethnically and culturally diverse staff. In particular, in Western countries, many members of staff are foreign or foreign trained, and patients (and their families) in these multicultural countries come from many places of origin. In this chapter, we will look, albeit briefly, at this aspect of intercultural communication. We propose, however, that this is only one layer in a multilayered and complex intercultural environment. Many challenges in the health context result from the diverse range of health professionals working together, who come from different professional and interspeciality backgrounds. Each health profession (nurses, doctors, physiotherapists, psychologists - the list is extensive) has its own language, rules and norms that coexist but are rarely shared between professions. In this sense, each profession has its own culture. In addition, and equally important, most individuals who enter hospital as patients are confronted with unfamiliar territory; that is, with a different culture. These cultural differences create and reflect an equally important set of issues as those of ethnic differences. In fact, when ethnic differences are combined with interprofessional and interspeciality cultural differences, the problems become more complex. We argue that, by using an intercultural lens for all aspects of the hospital context, it is possible to provide a parsimonious and insightful approach to these problems. Indeed, Teal and Street (2009) describe the physician-patient encounter as intercultural and propose a skills-based model of culturally competent communication (CCC) to deal with it. The delivery of health care occurs in a complex sociotechnical environment with patients and professionals from different disciplinary, ethnic and social backgrounds. Navigating a safe and effective path through this complexity is challenging for patients seeking care and for health professionals seeking to provide care. We know that good communication is vital to effective health care and assists in accurate diagnosis and treatment. For example, a patient's lack of understanding of the treatment regimen has been linked to poor compliance (Ley 1988; Stewart 1995). In turn, poor compliance can impede patient health outcomes. Current research conducted by health communication scholars has also increasingly focused on patient safety and improving patient outcomes, demonstrating the key role of poor or problematic communication (e.g. Bleakley 2006b; Coiera and Tombs 1998; Edwards et al. 2009; Fewster-Thuente and Velsor-Friedrich 2008; Lingard et al. 2004a; Solet et al. 2005). Improving communication, then, is a key factor in outcomes for patients. Trummer et al.(2006) conducted an experiment on the impact of improved communication. Patients due to undergo heart surgery were assigned to either a control or an intervention group. In the latter group, the medical and nursing staff were provided with training in patient empowerment strategies. The results indicated that improved communication from the medical to significantly better health outcomes and shorter hospital stays for those patients in the intervention group. We highlight the two main approaches to communication in health care: skills based (or intercultural communication competence: ICC, which includes Teal and Street's 2009 model of CCC) and system based (or macro-level critiques of the health sector). In our view, another key, but frequently missed, aspect is intergroup communication (IGC) (Giles and Watson 2008), the language and nonverbal behaviour characterizing interactions between health professionals and patients, on the one hand, and among health professionals, on the other. This includes intercultural andintergroup issues in doctor-patient communication (among them ethnicity, age, gender and the nature of illness), multidisciplinary team communication and interprofessional and interspeciality communication among health professionals. In this chapter, we emphasize the intergroup nature of relationships in the health context. We discuss the ways in which cultural diversity contributes to interactions in hospital settings and presents barriers to effective communication. Furthermore, even when ethnic issues are not evident in health care communication, other cultural barriers in the medical social system may impede effective communication and lead to intergroup conflict. First, we look at current issues in the health communication literature. We describe intergroup communication in this context and make a link with ethnicity and cultural diversity (which is most often studied in intercultural health communication). We argue that, by using an intercultural lens to examine all aspects of health communication, we can understand the barriers to effective communication in culturally diverse andother health-related encounters. Before examining the intergroup dynamics in health communication, we briefly present research on the ICC approach in health communication.

Original languageEnglish
Title of host publicationThe Routledge Handbook of Language and Intercultural Communication
PublisherTaylor and Francis - Balkema
Number of pages13
ISBN (Electronic)9781136649530
ISBN (Print)9780415572545
Publication statusPublished - 1 Jan 2012
Externally publishedYes

ASJC Scopus subject areas

  • Arts and Humanities(all)
  • Social Sciences(all)

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