1. Pace of Conversation
Allow brief periods of silence or pauses in the conversation to enable the patient to process information that may be occurring in the native language (Tagalog), especially for those with limited English proficiency.
2. Physical Distance
Maintain a reasonable personal space of 1 to 2 feet. Take height into consideration. A seated position for interaction is highly recommended.
3. Eye Contact
Sit at eye level with the patient for the interview; make brief and frequent eye contact, even though the patient’s eye contact is of shorter duration than the clinician’s. Older patients may look down or look away most of the time as a sign of respect to an authority figure, a professional, or someone who is of a higher social class. Prolonged eye contact between an older Filipino male patient and a younger female clinician may be flirtatious.
4. Emotional Responsiveness
Filipino Americans’ emotional responsiveness and affect may be misleading. Look for changes in facial expression—older adults may smile or chuckle inappropriately, which could be a sign of nervousness or embarrassment or may be simply a personal mannerism. Explore the meaning of flat affect and downcast eyes during the interview.
5. Body Movement
Frequent hand gestures may be used by Filipino Americans for emphasis:
- • They may cover their mouths with one hand when making conversation or smiling as an expression of shyness or embarrassment.
- • The common American gesture for “come here”, i.e., moving the pointed upward index finger forward and back, is an insulting gesture to less acculturated Filipino Americans. An acceptable gesture is to extend one hand towards the person with palm facing down and then flex and extend the four fingers (with no thumb) several times.
- • Head wagging or nodding (unconscious movement of one’s head) has many meanings and should not be confused with shaking one’s head in agreement.
- • Head movement can also mean “Yes I’ll cooperate” or “I hear you” even though the person does not understand you. This is mostly the case among Filipino immigrants who are less educated and have minimal acculturation experience.
Young female service providers should practice discretion when touching older Filipino male patients in situations such as laying a hand on the patient’s hand or shoulder to give comfort in moments of distress. Elderly Filipino women have a heightened sense of modesty, and show reservation in subjecting themselves to physical examinations involving female body parts. Health care providers should ask permission before performing this kind of examination and should avoid rushing through the procedure.
A male provider should always be accompanied by a female staff member when examining an elderly female’s private areas. Elderly Filipino women may spontaneously touch a hand or arm or hug a service provider to express appreciation for services rendered.