Introduction to Culture

• Course Title: Communications: Cultural and Community Context
• Lecture Title: Introduction to Culture
• Lecturer: Dr. Anthony Friel
• Date: 28-01/02/2024

Learning Outcomes

• Define culture
• Distinguish between values and beliefs
• Recognise hidden and unhidden cultural dimensions
• Understand the importance of cultural influences in intercultural communications

RCSI – Patient Centred Services

• Patient-centered services prioritise individual needs and values
• Patients are actively involved in making their health and treatment plans
• Services are designed to be culturally sensitive, recognising diverse backgrounds and needs

Defining Culture

• Culture encompasses shared beliefs, values, customs, behaviors, and artifacts of a group
• Culture includes ideas, customs, and social behavior of a society or people
• Culture is the shared attitudes, values, goals, and practices that characterise a society

The Iceberg Model of Culture

• Culture is like an iceberg
• The visible part represents immediately noticeable aspects: food, clothing etc
• The submerged part includes less obvious elements: values, beliefs, attitudes, and norms

Culture Discussion Points

• Consider culture in contexts such as family structure, socialising, relationships, rituals, and art
• Cultural differences can be challenging to understand
• Personal experiences where cultural differences were encountered should be discussed

Culture as a Framework

• Culture provides individuals with a framework for interpreting experiences
• Individuals from the same culture share interconnected ideas, assumptions, beliefs, values, and unwritten rules
• Certain words and gestures can have different meanings in different cultural contexts

Cultural Facts Around the World

• In Nicaragua, pointing with the lips is common
• In some Asian countries, slurping soup loudly expresses appreciation
• In Japan, blowing your nose loudly is considered rude
• In Greece, wedding guests may symbolically spit on the bride and groom for good luck
• In Malaysia and Indonesia, pointing with the index finger is considered rude

Cultural Difference: Class Activity

• Reflect on the influence of culture on personal thoughts, actions, and beliefs
• Consider whether "your way" of doing things is always the best or right way
• Reflect on any frustrations experienced when working with individuals from different countries

Definitions of Culture

• Culture is the complex whole including knowledge, belief, art, morals, law, custom, and habits acquired as a member of society
• Culture is the collective programming of the human mind distinguishing members of one group from another
• Culture is a social system of learned behaviours, artistic traditions, technological achievements, and religious beliefs
• Culture relates to behaviours, values, beliefs, and attitudes that bind individuals into communities
• Culture is how we view and do things in a group
• In simplest terms, culture is a shared way of seeing, thinking, and doing
• Culture is an historically transmitted system of symbols, meanings and norms

Cultural Awareness

• Cultural awareness can influence the way we decode things
• Age, income, nationality, education, interests, experience, religion, culture, gender and personality all play a part
• Cultural awareness and sensitivity are crucial in healthcare for compassionate and effective care
• Cultural differences often cause miscommunication and dissatisfaction
• Culture has a significant influence on patient outcomes
• Knowing "what sort of patient has the disease" is more important than knowing "what sort of disease the patient has”

Culture And Learning

• Culture is learned, shared, and transgenerational
• Hofstede believed that this shared culture is learned from a very early age

Beliefs

• Beliefs are acceptances that something is true, especially without proof
• Cultural beliefs are learned and shared by a group
• Beliefs can be based on fact, opinion, or assumption
• Belief systems are not always correct or accurate and beliefs can be unconsciously reinforced

Cultural Belief Examples

• Filial piety in Chinese culture emphasizes respect and care for elders
• Karma in Hinduism and Buddhism proposes actions have consequences
• Respect for nature is a belief in interconnectedness shared by various indigenous cultures

Medical Cultural Belief Examples

• Traditional medicine plays a role in many cultures with practices like herbal remedies
• The hot-cold theory of health is used in Latino or Asian cultures and suggests that balance is essential for health
• Cultural dietary preferences are deeply rooted and can affect restrictions during pregnancy
• Cultural beliefs can influence attitudes toward mental health and seeking help
• Cultural beliefs can influence gender-specific health practices
• Cultural perceptions of pain can vary, influencing communication with healthcare providers

Values

• Values are core beliefs and practices referring to principles of behaviour
• Cultural values are core principles that protect communities
• Examples of values are morals, rules, languages, beliefs, arts, literature, music, social roles, and customs

Cultural Value Examples

• Hierarchy values respect for authority and age
• Equality values egalitarianism and treating people with respect
• Family-centered values close family ties and loyalty
• Community-centered values the wellbeing of the community and shared responsibility
• Tradition emphasizes cultural heritage and customs
• Innovation values progress and creativity

Medical Cultural Value Examples

• Family involvement in decision-making is influenced by culture
• Cultural values related to privacy influence information disclosure
• Cultural values influence attitudes toward preventive care
• Cultural values play a role in how individuals perceive aging and end-of-life care

Norms

• Norms are rules specifying behaviour in situations
• Cultural norms are standards of behaviour that guide people within a social group
• Cultural norms are learned from parents, friends, and teachers

Norm Examples

• Greetings norms relating to physical contact vary across cultures
• Personal space norms dictate acceptable distances between people
• Eye contact norms vary across cultures with some seeing it as disrespectful
• Communication style norms influence the use of language and nonverbal cues
• Punctuality norms show that being on time varies across cultures

Norm Examples in Medicine

• Hierarchy norms influence perceptions of hierarchy in medical teams
• Communication style norms impact information conveyed
• Team collaboration norms influence teamwork dynamics
• Work-life balance norms affect expectations around working hours
• Professional attire and appearance norms influence expectations in medical settings

Attitudes

• Attitudes refer to emotions, beliefs, and behaviours
• Cultural attitudes relate to thinking based on a specific society
• Attitudes are how people see other cultures with conclusions that may not be correct

Cultural Attitude Examples

• Individualism prioritizes personal autonomy, while collectivism values group harmony
• Risk-taking encourages calculated risks, while caution values prudence
• Future orientation values planning, while present orientation values living in the moment
• Openness embraces change, while resistance prefers stability
• Respect for authority emphasizes deference, while questioning encourages challenging authority

Cultural Attitude Medical Examples

• Openness to alternative therapies is shown in some cultures, skepticism in others
• Gender preferences and patients based on gender are examples of gender and healthcare
• Fatalistic views attribute outcomes to fate, while empowerment emphasizes personal agency

How Cultures Differ

• The study of cultural differences compares beliefs, behaviour, norms, attitudes, and social institutions

Multicultural Communication

• Multicultural communication is complex
• Multicultural communication can be difficult to solve
• Awareness of difficulties and preconceptions aids intercultural communication
• Openness to learning and sharing knowledge improves communication

Intercultural Communication

• Intercultural Communication is interaction between members of differing cultures
• Value systems of interacting members may be so different that real understanding is difficult
• Intercultural communication is affected by non-verbal factors

Multicultural Medicine

• Multicultural health is culturally sensitive and based on cultural competence
• Individual values, beliefs, and behaviours about health are shaped by race, ethnicity, nationality, language and gender
• Cultural competence in health care is the ability to understand, integrate these factors into the delivery and structure of the health care system

Case Study: cultural communication problems

• In a case the doctor, nurse and patient did not culturally align causing a breakdown in communication
• The Mauritian patient understood "before tea" to mean "before each cup of tea"
• This misunderstanding led to elevated insulin levels for the patient
• The patient thought the medical team was thinking he was having dinner or supper, in turn his tea was just a cup of tea