Intercultural Dynamics

Importance of Cultural Factors in Health Care Encounters and Settings

  • Culture of the health care organizations
  • Diversity among organizations
  • Diversity among older patients

Acculturation Continuum

The degree to which older adults from particular ethnic backgrounds have incorporated the cultural attributes (e.g. values, beliefs, language, skills) of the mainstream culture. Providers should be aware of the vast range in acculturation found among older adults within each ethnic population.

There are different domains of culture; one person may differ in the degree to which s/he is acculturated in the different domains affecting health care, such as:

  • Belief in existence of non-biomedical illnesses or in the efficacy of scientific treatments
  • Importance of family decision making
  • Respect/deference to medical professionals
  • Knowledge of bureaucracies and skills in navigating them

Levels of Culture and their Expression in a Health Care Encounter

The health care encounter takes place within numerous levels of cultures and subcultures. Examples of influences of those levels include the following:

  1. Community: the norms, values, traditions of the community in which the encounter takes place
  2. Health care system: the roles and hierarchy of different staff and providers within the bureaucratic organization, the norms of making and keeping appointments, the emphasis on time, the overarching value of science and an antiseptic environment.
  3. Ethnic group: the customs of the cultural group, expected roles of family members, and norms of behavior toward health care professionals
  4. Personal:
    • Unique to individual provider
    • Unique to individual older patient
    • Different parts of one’s culture may be expressed or not expressed in different situations and different times
    • Some of culture is implicit, embedded, and unrecognized by the individual
  5. Intercultural dynamics of the patient/provider interaction within the health care system and community