Culturally appropriate

Good Attendant care is culturally appropriate

Culture

All of us are cultural beings. All of us have culture. Our culture shapes how we see the world and make sense of it. Culture influences all of our behaviours and interactions.

Culture is acquired - we learn about culture from others in our community, including our parents.

Culture is shared - culture does not exist in a vacuum, it is shared amongst a group of people.

Culture defines core values - because we have been taught our culture and share it with our cultural group, we tend to form the same core values.

Cultures resist change but are not static - culture does and can change, but change is usually slow and gradual.

Good attendant care will be culturally appropriate.

For attendant care to be culturally appropriate the service providers and the workers must be culturally competent.

Cultural competence is not just knowing about other cultures, being culturally aware or being sensitive to other cultures. 

Cultural competence is the knowledge, behaviours, attitudes, policies and systems that enable service providers and workers to work effectively in cross-cultural situations and respond to the needs of a culturally diverse population.

Cultural competence is required by organisations and individuals.

Culturally competent  service provider:

Culturally competent  service providers:

  • Value diversity by accepting that the people they serve are from different cultural backgrounds and will make different choices based on culture
  • Acknowledge and accept that cultural differences exist and have an impact on service delivery
  • Believe that diversity within cultures is as important as diversity between cultures
  • Respect the unique, culturally defined needs of various client populations
  • Recognize that concepts such as "family" and "community" are different for various cultures and even for subgroups within cultures
  • Incorporate cultural knowledge into all levels of service planning, delivery and evaluation
  • Understand that people from different racial and ethnic groups and other cultural subgroups are usually best served by persons who are a part of or in tune with their culture

Culturally competent workers

Culturally competent workers:

  • Understanding the concept of culture and how culture influences behaviours and the meaning of behaviours
  • Show an openness and willingness to become aware of and explore their own cultural values, beliefs and attitudes
  • Show an openness and willingness to explore the same things from the perspective of people from other cultural backgrounds  
  • Show they can identify useful and culturally appropriate strategies for working with people from diverse cultural backgrounds

Knowledge of particular cultures

To be culturally competent in working with a particular client does require some knowledge of their culture and beliefs.
Service providers and workers can ask clients and the family members about their culture and beliefs.
There are also community profiles available that service providers and workers can use to help gain the specific knowledge they need to best work with particular clients.

Good attendant care in practice

The worker

  • Asking about the client and their family’s culture and beliefs.
  • Cooking culturally appropriate meals when helping with meal preparation.
  • Being aware of and taking into account the cultural significance of
    • gender roles
    • religious belief

The person receiving attendant care and/or their family

  • Describing for the worker and the service provider your culture and beliefs.
  • Understanding the role of the worker and the limits to their work.

 

Generalising versus Stereotyping

In order to understand culture and compare cultures, we need to generalise but not stereotype.

Generalising

Generalising is grouping elements to form categories to make sense of a complex world.

We cannot respond to all of the isolated and disparate things we encounter or observe in our interactions with different groups and types of people so we group information into categories.

When observing different cultures we can make general observations based on our knowledge and experience. For example, we can generalise that:

  • '‘Western’ societies tend to be individualistic
  • Germans tend to value efficiency and formality
  • U.S. Americans readily praise personal achievement
  • Japanese society values discretion and politeness.

Stereotyping

But when we take these categorisations of general observation and apply them to whole groups of people, ignoring individual differences, we stereotype everyone in those groups. The stereotypical views of the above generalisations could be:

  • Australians are selfish
  • Germans are uptight
  • Americans are show-offs
  • Japanese never say what they really think.

Generalisations & Stereotypes

The key differences between generalising and stereotyping are:

Generalisations

Stereotypes

Retained consciously
Descriptive, not judgmental
Modified by subsequent experience

Retained unconsciously
Judgmental, not descriptive
Not modified by experience

 

Generalising can be a useful starting point for understanding - and then being open to modify our perceptions as new information about groups comes to us.

Stereotyping is not a useful starting point for understanding others or working with them.

Adapted from Culture from the Inside Out, Alan Cornes (1998)

 


 

Cultural differences across nations

Layers of culture

Every group of people carries a set of common mental programs that constitute its culture.

Almost everyone belongs to a number of different groups at the same time, so we have several layers of culture within ourselves, corresponding to the different levels of culture.  In particular each of us has a layer of culture at:

  • A national level – according to ones country (or countries for people who migrated during their lifetime).
  • A regional and/or ethnic and/or religious and/or linguistic affiliations as most nations are composed of culturally different regional and/or ethnic and/or religious and/or language groups
  • A gender level, according to whether a person was born as a girl or as a boy
  • A generation level, separating grandparents from parents from children
  • A social class level, associated with educational opportunities and with a person’s occupation or profession
  • For those employed, organisational, departmental and/or corporate levels, according to the way employees have been socialised by their work organisations.

The national level

We can use the national level as an example.

National cultures are different from one to the next.

To help us make sense of the diversity of national cultures it is useful to consider five dimensions of culture:

  1. Social inequality, including the relationship with authority: More equal than others

    For example in some societies children are more likely to treat parents and older relatives as equals and in other societies it is more likely that respect for parents and older relatives is a basic lifelong virtue. Sweeden is an example of the former and Russia of the latter.

  2. The relationship between the individual and the group: I, we they

    For example in some societies it is more likely that resources should be shared with relatives and in other societies it is more likely that there is individual ownership of resources, even for children. Indonesia is an example of the former and the United States is an example of the latter.

  3. Concepts of masculinity and femininity: He, She and (S)he

    For example in some societies it is more likely that both boys and girls are allowed to cry but neither should fight and in other societies it is more likely that girls cry, boys don't; boys should fight back, girls shouldn't fight at all. Ireland is an example of the former and Denmark is an example of the latter.

  4. Ways of dealing with uncertainty and ambiguity: What is different is dangerous

    For example in some societies it is more likely that people are comfortable in ambiguous situations and with unfamiliar risks and in other societies it is more likely that there is acceptance of familiar risks and fear of ambiguous situations and of unfamiliar risks China is an example of the former and Japan of the latter.

  5. Fostering of virtues oriented towards future rewards or oriented to past and present rewards: Yesterday, now or later.

    For example in some societies it is more likely that people have concern with social and status obligations and in other societies it is more likely that people have a willingness to subordinate oneself for a purpose Pakistan is an example of the former and China is an example of the latter.

Below is a more detailed description of each of these five dimensions, and lots more examples.

Questions

  • What is your culture like?
  • Where is your culture on each of these five dimensions?
  • What is your worker’s culture like?
  • Where is your worker's culture on each of these five dimensions?
  • What are the similarities and differences and their implications?
  • Are you talking about your respective cultures and how to understand each other better?

The examples below are about the national layer. There are of course all the other layers as well.

The key point is having conversations about what’s important – and recognising that the way people communicate from one culture to another is also different.

See also cross cultural communication on the next Tab.

1. More equal than others – “power distance”

1. More equal than others – “power distance”

Power distance is the extent to which the less powerful members of institutions and organisations within a country expect and accept that power is distributed unequally.

High (inequality)           Malaysia, Philippines, Russia, Serbia, Mexico
Mid                            Turkey, Peru, Thailand, Chile, Portugal
Low (inequality)           United States, Australia, Great Britain, Sweden, Ireland,

Small power distance
Low inequality

Large power distance
High inequality

Inequalities among people should be minimised. Inequalities among people are expected and desired.
Parents treat children as equals. Parents teach children obedience.
Children treat parents and older relatives as equals Respect for parents and older relatives is a basic lifelong virtue
Students treat teachers as equals. Students give teachers respect, even outside of class.
Teachers expect initiative from students in class Teachers should take all initiative in class.
Quality of learning depends on two-way communication and excellence of students Quality of learning depends on excellence of teacher.
Children play no role in old-age security of parents Children are a source of old-age security to parents.

 

Questions

The two descriptions are deliberately polarized. Most nations are somewhere on a continuum.

Where do you think you are on the continuum?
Where is your worker?
What are the implications?

2. I, we, they (Individualism and collectivism)

2. I, we, they (Individualism and collectivism)

Individualism refers to societies in which ties between individuals are loose: everyone is expected to look after himself or herself and his of her immediate family; collectivism refers to societies in which people  from birth onward are integrated into strong cohesive in-groups which throughout people’s lifetimes continue to protect them in exchange for unquestioning loyalty.

Collectivism       Taiwan, Peru, Indonesia, Pakistan, Colombia, Ecuador
Mid                    Spain, India, Argentina, Japan, Iran, Russia
Individualism     United states, Australia, Great Britain, Canada, Hungary, New Zealand

Collectivist

Individualist

People are born into extended families or other in-groups that continue protecting them in exchange for loyalty. Everyone grows up to look after him¬or herself and his or her immediate (nuclear) family only.
Children learn to think in terms of "we." Children learn to think in terms of "I."
Harmony should always be maintained and direct confrontations avoided. Speaking one's mind is a characteristic of an honest
Friendships are predetermined. Friendships are voluntary and should be fostered.
Resources should be shared with relatives Individual ownership of resources, even for children.
High-context communication Low-context communication

 

3. He, she and (s)he (Masculinity and femininity

3. He, she and (s)he (Masculinity and femininity

A society is called masculine when emotional gender roles are clearly distinct: men are supposed to be assertive, tough and focussed on material success whereas women are supposed to be more modest, tender, and concerned with the quality of life.

A society is called feminine when emotional gender roles overlap: both men and women are supposed to be concerned with the quality of life

Masculine:   Japan, Hungary, Italy, Mexico, Ireland, China (Australia 20)
Mid:            Canada Malaysia, Pakistan, Brazil, Singapore
Feminine:    Chile, Finland, Denmark, Netherlands, Norway, Sweden

Masculine

Feminine

Relationships and quality of life are important. Challenge, earnings, recognition, and advancement are important .
Both men and women should be modest. Men should be assertive, ambitious, and
Both men and women can be tender and focus on relationships Women are supposed to be tender
Both boys and girls are allowed to cry but neither should fight Girls cry, boys don't; boys should fight back, girls shouldn't fight at all.
Boys and girls play for the same reasons. Boys play to compete, girls to be together.

 

4. What is different is dangerous (uncertainty avoidance)

4. What is different is dangerous (uncertainty avoidance)

Uncertainty avoidance is the extent to which members of a culture feel threatened by ambiguous or unknown situations.

This feeling is, among other things, expressed through stress and in a need for predictability: a need for written and unwritten rules.

High:      Greece, Portugal, Russia, Salvador, Japan
Mid:       Brazil, Venezuela, Italy, Austria, Pakistan,
Low:       Great Britain, Ireland, China, Sweden, Denmark, Singapore

Low uncertainty avoidance

High uncertainty avoidance

Uncertainty is a normal feature of life, and each day is accepted as it comes. The uncertainty inherent in life is a continuous threat that must be fought.
Low stress and low anxiety High stress and high anxiety
Comfortable in ambiguous situations and with unfamiliar risks. Acceptance of familiar risks; fear of ambiguous situations and of unfamiliar risks.
Lenient rules for children on what is and taboo. Firm rules for children on what is and taboo.
What is different is curious What is different is dangerous

 

5. Yesterday, now or later

5. Yesterday, now or later

Long Term Orientation stands for fostering of virtues oriented towards future rewards, in particular perseverance and thrift. Short Term Orientation stands for fostering of virtues oriented to past and present - in particular, respect for tradition, preservation of "face" and fulfilling social obligations.

Long Term:   China, Hong Kong, Taiwan, Japan, Brazil
Mid:             Italy, Sweden, Poland, Austria, Australia
Short Term:  United States, Great Britain, Canada, Spain, Pakistan

Short Term Orientation

Long Term orientation

Efforts should produce quick results Perseverance, sustained efforts toward slow results.
Social pressure toward spending Thrift, being sparing with resources.
Respect for traditions. Respect for circumstances.
Concern with personal stability Concern with personal adaptiveness.
Concern with social and status obligations. Willingness to subordinate oneself for a purpose.
Concern with "face." Having a sense of shame.

 

 

 

 

 

 

 

Cross cultural communication

Cross-cultural communication is complex, but four elements are usually present, though one or two may stand out.

1. Verbal behaviour: What we say and how we say it.

This includes accents, tone of voice, volume, rate of speech and slang.

2. Non-verbal behaviour: What we say when we’re not talking.

This includes ‘body language’ such as eye contact and ways of showing respect, ‘object language’ such as dress codes and ornaments and ‘environmental language’ such as house and office design.

3. Communication style: How we prefer to express ourselves.

This includes ways of getting our point across, assumptions about ways of
speaking and interacting with each other.

4. Values, attitudes and prejudices: What we believe is right.

This element is the most complex and includes our deep beliefs and feelings about our own identity, about the world and how we judge other people.

Questions

  • What are some of the characteristics of your culture's communication style?
  • What are some of the characteristics of your worker’s culture's communication style?
  • What are the similarities and differences and their implications?
  • Are you talking about your respective cultures and how to best communicate with each other?

 

Verbal Behaviour

1. Verbal Behaviour

What we say and how we say it.

Accent

“I love your accent!” Why do we tend to like some accents and dislike others?
How much do we judge each other by our accents?

Tone of Voice

“Don’t take that tone of voice with me!” How does tone affect us? Vocal
expression varies greatly in different languages, high or low pitched, fast or
slow, rhythmic or clipped, hard or soft.

Volume

“Why do they have to talk so loudly?” Loudness or softness of speech is
culturally influenced. The softly-spoken may appear weak in a high-volume
country. Loudly-spoken people may appear pushy or rude where the majority
are quietly-spoken.

Rates of Speech

“Slow down! You’re not in the city anymore.” Just as country and city people
differ in their rates of speech in most cultures, so do people of different cultures.
Often, we judge people’s intelligence or emotional state by their rates of speech.

Jargon and Slang

“Wait till we get some runs on the board.” Each occupation and sector has its
own jargon such as “downsizing”, “consultative mechanisms” Slang is nonstandard
language such as “You little ripper!”, “ain’t”, “nope”, “bludger” and
many more.

Idioms and Metaphors

“Don’t beat around the bush.” Idioms are expressions peculiar to a language
such as “Keep your fingers crossed” and “Pull your socks up”. Metaphors are
figures of speech such as “a blanket of snow” or “a sea of troubles”.

Proverbs

“Too many cooks spoil the broth” and other popular sayings, long in use, carry a
culture’s core values. “A stitch in time saves nine” is not just about sewing!

Non-verbal behaviour

2. Non-Verbal Behaviour

What we say without talking. What we say with our dress, our objects, our buildings, our gestures, eyes and faces.

  • Body Language
  • Object Language
  • Environment Language

Body Language

Body language includes: movement, gestures, posture, distancing, gaze, eye contact, touch, facial expression, politeness, hygiene

Some Examples:

Distancing: The comfortable distance between people talking varies between
cultures. In different cultures, there are different views and conventions regarding:
Intruding, noise, privacy, use of space, neighbour relationships and public places.

Gaze: The degree to which people give eye contact or look at other people varies.

Gestures: While most human gestures are easily read across cultures, important
variations include ways of pointing, beckoning, shaking hands, kissing or bowing.
Descriptive, praising or insulting gestures such as those for complicated, good,
expensive, crazy or stupid can vary widely.

Touching: The degrees to which people touch each other in social interactions varies
across cultures and levels of relationship.

Touch Cultures: Middle East, Italy, Greece, Spain, Portugal, Russia
Non-Touch Cultures: Japan, United States, Canada, England, Australia, Scandinavia
"Middle Ground" France, China, Ireland, India.

Object Language

Objects can carry different meanings in different cultures. For example, a sign of wealth
in one culture can be interpreted as a sign of vulgarity in another.

Some examples:

Signs: Symbols, crucifixes, swastikas, signs of power, class, occupation
Artefacts: Religious objects, gifts, utensils, heritage items, tools, technology
Adornments: hair styles, beards, make-up, jewellery, tattoos, shaven heads
Designs: tattoos, designs of signage, language of signage,
Clothing: Ties, suits, “Business casual”, hijab, beards, modesty, fashion
Accessories: Watches, handbags, Akubra hats, uniforms, gold chains,piercings

Environmental language

The look and feel of the social environment in different countries and cultures and within
countries sends a wide range of non-verbal messages. For example, solid barriers of
counters and windows between customers and staff in a government services office
can be seen as appropriate demarcations or as signs of inaccessibility and bureaucratic
intimidation.

Some examples:

Colours: “Institutional green”, “Royal yellow”, khaki, house colours
Architecture: skyscraper, villa, police station, hotel, house design, open or closed frontages, privacy, proximity to other structures.
Natural surrounds: topiary hedges, garden design, parks, tree and landscapes, feng shui
Lighting: spotlights or candlelight, fluoro or natural light, direct or indirect
Use of Space: Office or factory layout, open or closed office doors, privacy, seating arrangements
Direction: Signage, positioning of walls and fences, design of public places, focus of attention

Communication style

3. Communication Style

How we prefer to communicate and express ourselves.

Different Cultural Assumptions

We have different assumptions about what is appropriate, who takes which role, how much ‘give and take’ is expected in a communication, how much silence is appropriate. When does “Yes” mean “Yes”? What is or isn’t funny?

Different Ways of Making a Point

We have different views of how to sound logical, whether to use direct or indirect language. Discussion moves from the general to the particular, or vice versa. Emotion may be stronger than logic.

Different Ways of Speaking

We speak differently (our verbal behaviour) and have different conventions about such things as turn-taking, politeness formulas, facial expressions and gestures (our non-verbal behaviours). Even when we’re not conscious of the differences between our own and others’ communication styles they can still affect us deeply.

Taking turns in conversation

In Anglo-Celtic cultures, two or more speakers will often overlap each other, coming in just before the other person has finished. In Latin cultures, there is often a much higher level of overlap, with seemingly two or three conversations going on at once. In Asian cultures, it is considered polite to let the other person finish and not to speak immediately, but to pause briefly, considering
what has been said and what they will say in reply.

Tolerance of silence

Many Australians dislike silence in conversation - it's uncomfortable. Other cultures value silences as showing thoughtfulness and respect.

Use of humour and irony

Humour often does not 'travel' well. Australian humour tends to rely on forms of criticism, 'stirring' and irony, which can sometimes puzzle or offend newcomers.

Speech rules

Expressing politeness in English relies heavily on formulas such as ‘please’, ‘excuse me’ or ‘would you mind’. Other languages do not use such politeness formulas, instead relying on honorifics or titles showing respect.

Rules of politeness

The rules that say who can speak to whom; who initiates conversation. In Australia, there are few restrictions on who speaks first. In many cultures, particularly older ones, there are firm rules, such as not speaking first to someone older or a superior.

Different meanings of Yes and No

When does Yes mean No, Maybe or Yes? In English convention, we are expected to mean 'yes' or 'no'. In other cultures, 'Yes' may only mean 'I hear what you say' and people may be reluctant to give a direct 'No' for fear of offending.

Structuring information

Direct versus indirect methods of making a point.
Australians generally believe one should 'get to the point' quickly. Some
cultures may believe it is better to lead up to the point. See below.

Rules of stating your case: linear or circular

While Western cultures tend to be linear - going from A to B in a direct line, members of other cultures prefer to circle around and spiral in to the point of stating their case.

Views of what is logical

In stating cases or seeking solutions to problems, people from different cultures may think it is more important to express the emotional side than the factual side.

Values and attitudes

The values, attitudes and prejudices held by a culture embody the way a group of people sees the world. Some examples of these differences are the five dimensions on the previous tab:

  1. Social inequality, including the relationship with authority: More equal than others

    For example in some societies children are more likely to treat parents and older relatives as equals and in other societies it is more likely that respect for parents and older relatives is a basic lifelong virtue. Sweden is an example of the former and Russia of the latter.

  2. The relationship between the individual and the group: I, we they

    For example in some societies it is more likely that resources should be shared with relatives and in other societies it is more likely that there is individual ownership of resources, even for children. Indonesia is an example of the former and the United States is an example of the latter.

  3. Concepts of masculinity and femininity: He, She and (S)he

    For example in some societies it is more likely that both boys and girls are allowed to cry but neither should fight and in other societies it is more likely that girls cry, boys don't; boys should fight back, girls shouldn't fight at all. Ireland is an example of the former and Denmark is an example of the latter.

  4. Ways of dealing with uncertainty and ambiguity: What is different is dangerous

    For example in some societies it is more likely that people are comfortable in ambiguous situations and with unfamiliar risks and in other societies it is more likely that there is acceptance of familiar risks and fear of ambiguous situations and of unfamiliar risks China is an example of the former and Japan of the latter.

  5. Fostering of virtues oriented towards future rewards or oriented to past and present rewards: Yesterday, now or later.

    For example in some societies it is more likely that people have concern with social and status obligations and in other societies it is more likely that people have a willingness to subordinate oneself for a purpose Pakistan is an example of the former and China is an example of the latter.

 

 

Knowledge of particular cultures

Diversicare have published a range of profiles to provide an overview of various cultures which support service providers in delivering culturally sensitive care.

Austrian Profile
Bhutanese Profile
Chinese Profile
Croatian Profile
Dutch Profile
Fijian Profile
Finnish Profile
German Profile
Greek Profile
Indonesian Profile
Lao Profile
Papua New Guinean Profile
Philippino Profile
Polish Profile
Russian Profile
Samoan Profile
Swiss Profile
Tokelauan Profile
Vietnamese Profile

If the cultural profile you are looking for is not listed above do a web search for the particular cultural profile. There are many cultural profiles available on the Internet.

 

Definitions

Cultural Knowledge

Cultural Knowledge is familiarization with selected cultural characteristics, history, values, belief systems, and behaviours of the members of another ethnic group (Adams, 1995)

Cultural Awareness

Cultural Awareness is developing sensitivity and understanding of another ethnic group. Awareness extends to special foods, manners of dress, language, religious preferences and observances, and differences in communication styles. As an example, in some cultures it is impolite to make eye contact, especially with someone you do not know well. Cultural Awareness also involves changes in attitudes and values and reflects an openness and flexibility in working with others of another culture.

Cultural Sensitivity

Cultural Sensitivity is recognizing and knowing that both cultural differences as well as similarities exist, and not making value judgments of good or bad, better or worse, right or wrong (Texas Department of Health, National Maternal and Child Health Resource Center on Cultural Competency, 1997). It is important to be familiar with and sensitive to special events, activities, meaning of holidays, and other ethnic celebrations and the special foods that are served at these times.

Cultural Competence

Cultural Competence is a set of congruent behaviours, attitudes, and policies that come together in a system, agency, or among professionals that enables that system, agency, or those professionals to work effectively in cross-cultural situations (Cross, Bazron, Dennis, and Isaacs, 1989). Cultural competence also refers to a set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community in developing targeted interventions, communications, and other supports.