Cultural Competency - Questions to Ask Your Patients
- Enhancing Your Cultural Communication Skills
- Cross-Cultural Interviewing Skills
- Communication Interviewing Tools
- ESFT Model
Enhancing Your Cultural Communication Skills
The following questions may assist clinicians in assessing patients and families from culturally diverse backgrounds.
So that I might be aware of and respect your cultural beliefs ...
- Can you tell me what languages are spoken in your home and the languages that you understand and speak?
- Please describe your usual diet. Also, are there times during the year when you change your diet in celebration of religious and other ethnic holidays?
- Can you tell me about beliefs and practices including special events such as birth, marriage and death that you feel I should know?
- Can you tell me about your experiences with health care providers in your native country? How often each year did you see a health care provider before you arrived in the U.S.? Have you noticed any differences between the type of care you received in your native country and the type you receive here? If yes, could you tell me about those differences?
- Is there anything else you would like to know? Do you have any questions for me? (Encourage two-way communication)
- Do you use any traditional health remedies to improve your health?
- Is there someone, in addition to yourself, with whom you want us to discuss your medical condition?
- Are there certain health care procedures and tests which your culture prohibits?
- Are there any other cultural considerations I should know about to serve your health needs?
Cross-Cultural Interviewing Skills
Definition of culture: The sum of socially learned beliefs, values, and traditions that influence patterns of behavior, including beliefs about health and illness.
What is cross-cultural communication? Any communication that occurs across cultures.
Fundamental skills of cross-cultural communication: Demonstrating curiosity and respect for patients and their beliefs through:
- Active listening
- Eliciting patient beliefs & information
- Understanding the patient's social context
- Negotiation skills
Communication Interviewing Tools - Eliciting Patient Information and Negotiating
Exploring the Meaning of the Illness
Explanatory Model Explanatory Model
- What do you think has caused your problem? What do you call it?
- Why do you think it started when it did?
- How does it affect your life?
- How severe is it? What worries you the most?
- What kind of treatment do you think would work?
The Patient's Agenda
- How can I be most helpful to you?
- What is most important for you?
Illness Behavior
- Have you seen anyone else about this problem besides a physician?
- Have you used nonmedical remedies or treatments for your problem?
- Who advises you about your health?
Social Context "Review of Systems"
Control Over Environment
- Is money a big problem in your life? Are you ever short of food or clothing?
- How do you keep track of appointments? Are you more
concerned about how your health affects you right
now or how it
might affect you in the future?
Change in Environment
- Where are you from?
- What made you decide to come to this country (city, town)? When did you come?
- How have you found life here compared
to life in your country (city, town)? What was medical care like there compared with here?
Social Stressors and Support Network
- What is causing the most difficulty or stress in your life? How do you deal with this?
- Do you have friends or relatives that you can call on for help? Who are they? Do they live close to you?
- Are you very involved in a religious or social group? Do you feel that God (or a higher power) provides a strong source of support in your life?
Literacy and Language
- Do you have trouble reading your medication bottles or appointment slips?
- What language do you speak at home? Do you ever
feel that you have difficulty communicating everything
you want to
say to the doctor or staff?
Negotiation
Negotiating Explanatory Models
- Explore patient's explanatory model
- Determine how the explanatory model differs from the biomedical model and how strongly the patient adheres to it
- Describe that biomedical explanatory model in understandable
terms, using
as much of the patient's terminology and conceptualization as necessary - Determine the patient's degree of understanding and acceptance of the biomedical model as it is described
- If conflict remains, reevaluate core
cultural issues and social context
Negotiating for Management Options
- Describe specific management options (tests, treatments, or procedures) in understandable terms
- Prioritize management options
- Determine the patient's priorities
- Present a reasonable management plan
- Determine the patient's level of acceptance of this plan (do not assume acceptance - inquire directly)
- If conflict remains, focus negotiation on higher priorities
Adapted from:
Carillo J.E., Green A.R., Betancourt J.R. "Cross Cultural
Primary Care: a Patient-Based Approach." Ann Intern Med.
1999;130:829-34.
ESFT Model
The ESFT model guides clinicians in understanding a patient's explanatory model, social and enviornmental factors, fears, and concerns and in contracting for therapeutic approaches.
Explanatory Model of Health and Illness
- What do you think caused your problem?
- Why do you think it started when it did?
- How does it affect you?
- What worries you most?
- What kind of treatment do you think you should receive?
Social and Environmental Factors
- How do you get your medications?
- Are they difficult to afford?
- do you have time to pick them up?
- How quickly do you get them?
- Do you have help getting them if you need it?
Fears and Concerns
- Does this medication sound okay to you?
- Are youconcerned with the dosage?
- Have you heard anything about this medication?
- Are you worried about the side effects?
Therapeutic Contracting (Treatment)
- Do you understand how to take the mediation?
- Can you tell me how you'll take it?
ESFT Model: Betancourt, J.R., Carrillo, J. E., & Green, A. R. (1999).
Hypertension in multicultural and minority populations:
linking communication to compliance. Curr Hypertens
Rep, 1(6), 482-488.
Table: The QIO Facilitator’s Guide: Companion to A Family Physician’s Practical Guide to Culturally Competent Care. Think Cultural Health Web Site. Available at http://www.thinkculturalhealth.org. Accessed September 12, 2006).
