Cross Cultural Communication and Patient Care Management

Delivering quality health care for expected outcomes has become more increasingly challenging given the rise in the Nigerian population and continuous discoveries of  cross cultural diversities. With a rising population of over 170Million people and a seeming dynamic 250 ethnic groups and more micro groups, today’s health care provider has to do a lot more to get across to the patient.

Cross cultural communication borders on the ability to communicate effectively and provide quality healthcare to patients from diverse socio cultural backgrounds. The communication process is an exchange of perspectives, values, beliefs, behaviours in form of messages between the sender and receiver through a channel with an intended meaning. In this case, the health care provider and the patient are the principal parties in the process.

Cross Cultural
An African Caregiver with a white patient

This exchange takes place within a cultural context, and no doubt, socio-cultural background affects the delivery and reception of health care as it influences a patient’s perspectives, values, beliefs and behaviour regarding health and well-being. Health Care scholar, Sherry Dineen, rightly noted that culture deeply affects a patient’s attitude about medical care.

Patients and their families have their own values related to health and illness, reporting symptoms to health care providers, and how treatments should or should not be delivered. Culture is not only a vehicle for health communication; it largely influences the performance of providers, patient’s experience and health outcomes.

Challenges For Caregivers

There is need for health care leaders and providers to pay a close attention to effective cross cultural communication. To not know how to communicate across cultures is to be in danger of stark irrelevance in the coming days. The rising world population and growing health challenges, globalisation and “glocalisation”, international terrorism, disasters and crisis; and the need for trans-border health care delivery are staring realities today’s practitioner must face. Health care delivery is becoming unified world over. It will be sheer ignorance to feign cultural singularity.

Apart from these external challenges, health care providers may also suffer from medical ethnocentrism. Without knowing, health care providers, like the patients, operate out of an ethnocentric framework and practice within these beliefs. It may be right that most assumptions and predictions in health care often have cultural roots.

cross cultural
                                Multi-cultural caregivers

This could also be connected to the channel of communication employed in medical, pharmacy, nursing and health technology schools. Health researchers, Ulrey and Awason say medical ethnocentrism can be because health care providers are trained to deal with the dominant culture.

Every health care provider has an existing world view, which is often coloured by her cultural background. A provider with singular world view such as the theory of individualism, which is dominant in the west, can have stress communicating with an African patient, whose world view most likely is that the family or community is greater than the individual.

So, while the health care provider expects communication to begin and end with the patient, the latter is keen on what his family and community stands for. Hence, communication is not just a linear experience, but like Harold Lasswell and Kurt Lewin said, a two-step and multi-step process with opinion leaders acting as information gate keepers. Clinicians can then easily become guilty of approaching health care from their own cultural lens.

Also, health care providers will need to deal with prejudicial ideologies. These are set of ideas based on stereotypes. This phenomenon affects both the care professionals and patients from various cultural groups. Regional differences and identities can influence whether people trust medical professionals.

In fact, some studies have shown that patients tend to trust more health professionals who speak their language and understand their culture.

cross cultural
                    A caregiver and a patient

Since health care and communication are embedded in culture, Nigerian care professionals, like her African counterparts, are greatly faced with the fact that most culture and language on the continent are not properly codified in handy texts for continuous study.

Apart from the many ethnic groups and cultures, even the major languages face extinction. The problem of indigenous knowledge transfer is a shared societal debacle and continues to initiate noise in the health communication process.

What Should Caregivers do?

In order to reduce poor clinical decision making and low quality care, clinicians should strategically strive to be effective cross cultural communicators. Joseph Betancourt and other healthcare scholars observed that there is need for training in cultural competency and racial-ethnic disparities for care providers; and a curriculum guide for trainees and practitioners in primary care. This is necessary because an effective cross cultural communication will provide a framework for an effective clinical encounter.

In addition, health care professionals should be sensitive. This means awareness and respect for other cultures. Ulrey and Amason rightly noted that within each culture, people are connected through a communication system of encoding and decoding messages.

Each has its own codes, verbal and non-verbal meanings. Sensitivity is the ability to relate with each patient with cultural knowledge and with respect for their beliefs. It also includes seeking patient’s consent in the treatment process. Lack of cultural sensitivity can lead to breakdown in communication.

Today’s health care giver must constantly work on increasing her knowledge about other cultures-their values and beliefs especially as it relates to health care issues. This is not limited to community health care practice but all spheres of health care no matter where and when it is being practised-the society has changed.

If they fail to gain more cultural knowledge, they will tend to rely heavily on physical symptoms to evaluate illness rather than actually communicating with patients for proper treatment. This can lead to inaccurate diagnoses. Health care practitioners should ask open ended questions to gain information about a patient’s beliefs and expectations; and should remain non-judgemental when such person’s beliefs differ from theirs.

cross cultural
A black female caregiver and a white patient

There is need for interpreters, posters, pamphlets and other forms of communication. Apart from the support these provide, they can serve as bailouts in cases where bottlenecks occur while communicating with a patient. More importantly is the non-verbal exchange.

Early communication scholars had arguably rated tactile communication above spoken communication. They said man must have communicated through touch before he spoke and that this still constitute a greater part of the exchange.

In health care systems, patients trust care givers and may be more concerned about their non-verbal cues than they do their spoken communication and providers will also need to pay attention to the patient’s body language. Hence, non-verbal communication, if well deployed, can cushion the possibilities of breakdown in cross-cultural communication.

Understanding cross cultural communication has immense benefits for both the patient and the health care provider. Apart from better health outcomes for patients, it reduces stress for care practitioners. A lot has been done at individual and corporate level, only that there is still more to be done.


Betancourt,J.;Green, A. and Carillo, J.(2015) “Cross Cultural Care and Communication”.Wolters Kluwer

Dineen,S.(2013) “Healthcare Provider Strategies for cross cultural communication”. Aiaconnect

Ulrey,K. and Amason,P.(2001) “ Intercultural Communication Between Patients and Health Care Providers: An Exploration of Intercultural Communication Effectiveness,Cultural Sensitivity,Stress and Anxiety.” Health Communication 13(4) 449-463













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