6 Intercultural Communication

Watch or Listen to the Following Media Clip

Media 6.1 Cultural Sensitivity [Video]. CC-BY-NC-SA 2021. Conestoga College.

Introduction

The following chapter will explore cultural communication styles with diverse cultures, including Anglo-Saxon-Western, Black-African, Chinese, Filipino, Indigenous, LGBTQ2S+, and South Asian. These cultures were selected based on Ontario demographics and are alphabetical to avoid any hierarchy of importance. Finally, trauma-informed communication will be discussed. The HCA should be aware that cultures can change over time when persons are exposed to new knowledge, beliefs and norms, so the cultural norms discussed in this chapter may change over time. It is not possible to cover all the various and wonderful cultures that make up our world. We invite you to explore, investigate, and add to the cultures discussed in this chapter.

Assessing What You Already Know

Thanks to global access to travel and the high potential for requiring health care while in other countries. A Health Care Administrator should consider their day-to-day interactions with others from differing cultures or communities. Cultural competencies will decrease misunderstanding in health and studies support the need for cultural competence to increase a person’s successful health outcome.

Cross-Cultural Communication

Many diverse aspects of multicultural communications can include usage, use of words and phrases that may be interpreted differently and non-verbal communication such as facial expressions, gestures, seating arrangements, personal distance, and sense of time may vary. When interacting with patients, their families and other health care professionals, it is important to consider the following guidelines.

As a professional HCA learn some generalizations about other cultures but does not use those beliefs to stereotype the individual one is communicating with, ask questions to confirm and learn. Individuals are multi-faceted human beings. Do not assume that there is one right way (yours!) to communicate. Self-awareness and self-reflection will assist one with multi-cultural skill development. It is important to be aware of one’s gestures, body language or postures that indicate receptivity in one culture might indicate aggressiveness in another.

The HCA should listen actively and empathetically by putting themself in the other person’s shoes. At times, it is best to acknowledge potential historical events that have occurred and remain open to learning more about them. Truthful acknowledgement of oppression and the mistreatment that has taken place on the basis of cultural differences is crucial for successful communications.

HCA’s should be aware of power imbalances such as those between health care workers and clients, between those of client’s families and health care workers, and the various levels of health care disciplines.

Remember that cultural norms may not apply to the behaviour of any particular individual. Persons are influenced by one’s ethnic background, family, education, personality and life experience; much more than cultural norms (Tuazon, 2021). To develop an understanding of cultural communications, consider the following list as it explores cultural communication techniques that include language, gestures and positionality when interacting with clients from differing cultures.

One way to enhance diverse understanding is to provide patients with easy-to-understand instructions, including directions to appointments. It is essential to provide enough time for patients to express and share their concerns and listen carefully to patients when they are speaking. Patients should always be included in decision-making and care plan development. Patients should be encouraged to access their Personal Health records to illicit an awareness and demonstrate the acceptance of being a part of their health care plan.

If required, offer assistance to clients when filling out forms or performing tasks they may not have done before, such as scheduling appointments, making a referral, going to the lab for bloodwork or x-rays. Always communicate with patients through their preferred communication method (phone, mail, secure messaging) (Shepherd et al., 2019).

Anglo-Saxon Western Cultural Communications

An Anglo-Saxon person speaks English. A Westerner is a person who comes from a country in the western part of the world, particularly North America. The Western medicine system includes medical and healthcare professionals such as doctors, nurses, therapists, and pharmacists who manage and treat disease using conventional, evidence-based practices such as drugs, surgery, lifestyle changes or treatment protocols.

The assumptions in Western health care systems include a patient-centred approach where the individual needs have priority over their needs and decision making. The literal meanings of medical words are essential and should be explained; for example, the term palliative. Many health uncertainties in life can be managed with the correct diagnosis, medication treatment, or medical interventions.

Persons from western cultures tend to have an explicit and direct communication style. Therefore, the clients become a part of their health care plans and often will communicate the need to be involved. It is an expectation in western culture to make informed decisions, and thus the client may ask for clarification from any health care professional. Westerners are accustomed to seeking second medical opinions, which should not be conveyed as an insult to the professional as clients are involved with their health care plans and decision-making.

Clients from western cultures generally follow medical advice, particularly if they understand it. Clients will ask many healthcare professionals questions to obtain answers, as they have a right to know and transparency is key to their decision-making. The client learns by detailed inquiry extensive or questioning of the physical examination or laboratory results.  Clients coming into a health care facility may appear anxious. As institutional rules restrict their privacy and actions, communicating with the client may appear to be a challenge when you deal with the person in the sick role who believes they are powerless due to institutional limitations such as meal times and visitors.

Typically elderly clients should be addressed with their prefix Mr., Ms., Mrs., Dr., Miss., and surname. However, clients may prefer to be addressed by their first name. It is essential to ask the client how they prefer to be addressed.

Black- African Cultural Communications

Language barriers may limit the HCA’s ability to communicate efficiently when communicating with Black immigrant populations. Between African and Caribbean immigrants, the populations speak over 2,100 languages and dialects (Komen, 2020). As a language translator is preferred practice, it is essential to get a professional who speaks the language and the dialect.

Many Black immigrants come from cultures with power distance, meaning some members have higher status than others. People of perceived lower status do not direct eye contact to people of higher status (Neuliep, 2014). Before looking a client directly in the eye, step back and perceive how the person interacts with you and act accordingly.

Non-Verbal Communication with Black Immigrants

The following recommendations may not apply to all black immigrants. It is essential to know what culture the client accepts or feels connected to, to provide culturally sensitive and culturally competent care as many practices will be individualized (Shepherd et al., 2019). Such as, in Black Muslim cultures, men and women may not wish to shake hands with the opposite sex. Be mindful of the cultural gender roles.

However, in some African cultures, the HCA should avoid pointing with their index finger, as this gesture may be considered offensive. The HCA should use an open hand with their palm facing down when offering direction to the client room or diagnostic centres.

In some African cultures, the left hand is considered unclean; therefore, the HCA should pass paperwork or pamphlets to the client using the right hand.

Some Black immigrant cultures like to be in closer proximity when speaking. Although the HCA should speak quietly for privacy reasons, they should avoid whispering. In some African cultures, whispering can be viewed as gossiping.

Chinese Cultural Communications

Being late for an appointment is considered an insult in Chinese business culture so make sure you are on time. This can be challenging in busy clinics. As well, when scheduling client appointments, be sensitive to Chinese holidays such as the Chinese New Year, which changes yearly, as many other institutions may be closed.

In Chinese culture, there is a strong emphasis on familial hierarchy.  For example, following Chinese business protocol, people are expected to enter the meeting room in hierarchical order. This may apply to families coming for a clinic visit. As an initial greeting traditional Chinese person may nod or bow slightly.  Handshakes are also common greeting practice; however, wait for your client to initiate the gesture. Handshaking is done with a rather gentle grip because a very firm handshake suggests aggression (Shepherd et al., 2019). People from China will often pause after something has been said to show respect and contemplate a good response.

When speaking, people from China do not use many gestures or demonstrative expressions and will become annoyed with someone who does. Emotion is often repressed, and humility is a virtue. When you need to point, use your whole hand. Avoid using any excessively demonstrative behaviour or gesture. Do not raise your voice too loud or snap your fingers, wink, or whistle when speaking. Maintaining good eye contact is appropriate. People from China are taught to avert their eyes to avoid intimidation. It is unacceptable to blow your nose in a handkerchief or tissue and then put it in your pocket or handbag. This is considered unsanitary. Gentlemen — do not cross your legs with your foot resting on your knee. It is considered disrespectful, and you may inadvertently point the sole of your shoe at someone – an absolute insult!

Indigenous Cultural Communications

All persons are to be treated as individuals within their cultures. Some people may self-select to follow some practices and add others, particularly with language and communication styles. Indigenous populations are unique as well. Those living in remote communities may have low proficiency in the English language, with English being the second or third language spoken within their community. The following information will provide a provide overview for communicating with the population.

Health care administrators need to have or develop an understanding of the historical context of Aboriginal people as there may be cross-cultural misunderstandings or a  lack of recognition of Aboriginal beliefs and “ways of doing things”. Remember, there are complex centralized health systems or restrictions and potential logistical challenges in accessing health services.

Cultural Perceptions of Health and Wellness

First Nations Health Authority’s health model represents a fluid and holistic concept of health and wellness. The model centres on the individual human being. There is a focus and importance of a healthy and balanced life’s mental, emotional, spiritual, and physical facets. The Indigenous values supporting wellness include respect, wisdom, responsibility and relationships (First Nations Health Authority, 2021). It is essential that the HCA has a cultural awareness of the Indigenous health care approaches.

Traditionally, indigenous peoples learn things through prayer, visions, dreams or divination—extensive or brief divination, prayers or supplication, by entering into a trance state (Ball & Bernhardt, 2008). The practices emphasize communication with spirit beings and direct requests for healing. This communication occurs through prayer, song and ceremony. Additionally, one looks for areas of disharmony and imbalance within the external community, within the community of one’s mind, and in the relationship with our bodies, the earth, the plant people, the animal people and all of creation. Healing is through achieving balance and harmony in our many relationships. The approach to each person is different because each person is unique and has their own set of imbalances. By contrast, biomedicine generally looks for the one treatment that will benefit the highest number of people with a particular disease.

Develop an Awareness of Aboriginal English Language Patterns

In Canada, Aboriginal English speakers may omit a subject pronoun. Pronouns include I, you, she, he, it, we, they. The use of double negatives is every day in many dialects of Aboriginal English. How comments are stated can hold meaning. Such as reading intonation, the ups and downs of the voice pause between speakers, the use of gestures and facial expressions contribute to the meaning of the words used.

Based on historical experiences, understand that Indigenous peoples may not immediately trust the health care administrator (HCA) or the health care system. Native American patients are reluctant to tell health care providers about a hallucination or dream experience due to the risk of labelling the client negatively or the concern that the dream could indicate psychosis (Fadden, 2016).  In order for this reluctance to be overcome trust must be established with the client. One way that health care workers can build trust with clients from indigenous communities is by following through on the agreements or decisions.

Health Care Administrator Communication Approaches

First and foremost, the use of Indigenous translators, patient navigators, or Indigenous health workers should always be considered to enhance Indigenous peoples’ understanding of health or assist in seeking healthcare services (Ball et al., 2006). The HCA must learn about the Indigenous communities in the area of residence and work. Health care is a sensitive matter to the indigenous and should not be asked about directly. Also, always seek permission and explain to the client why one needs to touch them, such as taking their blood pressure. Establishing rapport and mutual respect first may allow the client to feel more comfortable in the health care setting.

When calling a client, use formal addresses with older people and Elders and ask them how they wish to be acknowledged. During the interaction, recognize that extended silence during conversations is considered the ‘norm’ and is valued in some Indigenous cultures. The meaning of the silence may vary. It can be used as a show of respect, contemplation, disagreement, a time of reflection, or considering what has been said. Listen and wait your turn to speak without speaking over the client. Verbal and physical interactions should be mirrored to the pace of the individual. Consider the choice of vocabulary, delivery rate, clarity and logical ordering of ideas during a verbal interaction; building trust is the goal of assisting the client. Consider the following in your approaches. If a client appears to be struggling with reading or writing, sensitively offer assistance. Do not ask clients whether or not they can read or write, as this may can shame and embarrassment. Do not speak loudly or in a patronizing manner; offer professional assistance.

The HCA should not assume that an accent indicates a lack of education or sophistication. However, if an interpreter is available, this may assist with cultural sensitivities and learning for the health care professional. During conversations, be careful with the use of humour, as it can be misunderstood or misinterpreted.

Speakers of English may use eye contact to convey or assess sincerity and attentiveness, and if a client does not look the professional in the eye, the assumption may be that they are being untruthful, deceptive or uncooperative. Too much eye contact is awkward, and in the worst case, rude and possibly confrontational. As well, it may not be customary in some communities to maintain eye contact with authority figures.

The HCA should never hesitate to seek the translator’s expertise or the indigenous support available within your institution.

LGBTQ2S+ Cultural Communications

In LGBTQ2S+ populations, there are some specific communication skills, awareness and language to be utilized by the Health Care Administrator.  Interactions with the LGBTQ2S+ persons are no different than the procedures we follow with any patient, other than language and a developed understanding of their cultures. As with many cultures, language, beliefs and approaches are fluid and can change over time and, most importantly, differ between individuals (Rowe, 2020). The equality issues and acceptance of transgender and nonbinary people can be demonstrated by the correct use of terms and language.

The proper use of gender identity terms, including pronouns, can signal courtesy and acceptance. “Pronouns are basically how we identify ourselves apart from our name. It’s how someone refers to you in conversation,” says Mary Emily O’Hara, a communications officer at the American Gay and Lesbian Alliance Against Defamation (GLAAD) “and when you’re speaking to people, it’s a really simple way to affirm their identity” (Walmsley, 2021). Everyone uses pronouns when referring to themselves. The primary way of understanding and knowing the correct pronoun is to ask the client. When introducing yourself say, “My name is George, I am the Health Administrator, I use he/him pronouns, What about you?” Utilizing the correct pronoun reaffirms to the client that they are accepted and worthy. Using correct pronouns to demonstrate respect is also essential because of the extensive history of discrimination and barriers that LGBTQ2S+ persons have been subjected to over time, particularly when seeking health care (Table,  et al., 2021).

The HCA should use the terms that the client uses to describe themselves and their partners. For example, if the client calls themself “gay,” do not use the term “homosexual.” If a woman refers to her “wife,” then say “your wife” when referring to her. The HCA’s primary focus has to be on making all patients comfortable. When taking a medical history, do not use words that assume people have an opposite-sex partner or spouse, ask “Are you in a relationship?”. Gender-neutral and non-biased language assists in open and honest dialogue.

The use of accepted language and terms can change. Some of the terms currently used are different from those used in the past to describe similar ideas, identities, and experiences. Moreover, some terms are acceptable to use by specific populations yet not accepted by some people to use as labels (Nett, 2021). The HCA is to recognize and respect all people as individuals.

Vanessa Goes to the Doctor

The video is an excellent demonstration of correct and incorrect communications with a person from the trans community. Remember if you make a mistake when dealing with a client, politely apologize and learn from your error. The HCA’s role is one of continuous learning and improvement of client service.

Media 1.1 Vanessa goes to the doctor [Video]. From Margolies, 2015.

The guidelines for communication from chapter two apply to all individuals. As language is an essential element for Health Care Administrators, the use of a glossary is helpful to demonstrate further respectful, informed, and accurate interactions.   The following further reading will list the current accepted terms and definitions as used by GLAAD, Center for Transgender Equality, the Trans Journalists Association, NLGJA: The Association of LGBTQ Journalists, Human Rights Campaign, InterAct and the American Psychological Association, and Egale Canada Human Rights Trust.

Further Reading: LGBTQ2S+ Terminology

Wamsley, L. (2021, June 2). A guide to understanding gender identity terms. NPR.

Egale Canada Human Rights Trust. (2020, June 1). 2SLGBTQI glossary of terms. EGALE.

Egale Canada Human Rights Trust. (2022). Pronoun usage guide. EGALE.

Philippino Cultural Communications

Cultural Interactions with Persons from the Philippines

The Philippines represents a variety of cultures. It is located in the heart of South-East Asia, though the culture is heavily influenced by non-Asians from Spain, Mexico, and the United States. The Catholic Church is very influential in the Philippines culture.

Communication Style

The Philippine style of communication is indirect and takes into consideration the perception of the recipient.  In order to save face and remain courteous, Filipinos rarely give a direct answer of ‘no’ and will avoid disagreement, rejection and confrontational behaviour, especially when a superior is involved.  The word ‘yes’ is often used to disguise more negative responses and avoid causing embarrassment or offence. ‘Yes’ may mean ‘maybe’ or ‘I’ll think about it’ or even an outright ‘no’.  A healthcare professional will have to be more alert to the subtle cues hidden in conversation, such as nonverbal communication, to help decipher meaning.  This ambiguity in response means that it can take longer to get a firm negative answer.

Language

Because of the years of U.S. military presence in the Philippines, most westernized gestures and communication styles are recognized and understood. As well, English is the language of most interactions in the Philippines.

Gender

Women are accepted in business circles. However, they should avoid acting domineeringly with male colleagues. Women managers are expected to be highly competent and assert their authority in a professional, restrained manner. Although there are social inequalities in the Philippines, Filipinos believe that everyone must be treated with respect, and they behave with modesty and graciousness, especially in their dealings with the poor or less fortunate.

Greetings

In the Philippines, showing respect for one’s elders is a tradition that has been preserved for generations. The ‘honouring-gesture’ called pagmamano involves a younger person asking for an elder’s hand and gently touching their own forehead with it while bowing. The practice is common whenever someone visits relatives or meets their godparents (Engson, 2021).

It is common for most people in the Philippines to shake hands as a way of greeting.  This can occur between men and women, but there are some boundaries.  Even though most parts of the Philippines find it acceptable to shake hands between men and women, the touching of women is a very sensitive issue.  In some areas, men and women do not shake hands because it involves touching.  In every part of the Philippines, any touching of women in public is deemed inappropriate.  Filipinos are widely regarded as needing a little more personal space than people from western culture.

Approach

Most Filipino people expect pretty constant eye contact, and it is a sign of self-confidence.  Also, when introducing yourself, it is proper to use academic and professional titles.  In addition to formal titles, it is customary to introduce yourself to the eldest or most important person first (Shepherd et al., 2019).

 ‘Small talk’ is an integral part of establishing relationships with Filipinos. Be aware that embarrassing someone, or reprimanding them in front of others, can cause them to “lose face”, trust or loss reputation, and this has very negative consequences in this culture. Maintaining cordial relationships is essential in the Philippines. Keep your comments as positive as possible (Engson, 2021).

Nonverbal Cultural Communication

Hold your hand out, palm downward, and make a scratching motion with the fingers to beckon someone. Beckoning someone with the palm up and wagging one finger can be interpreted as an insult. Pointing at someone or something can be perceived as an insulting gesture. Filipinos typically point at objects using an open hand. They may use a glance with a slight nod or purse their lips to signify which way to provide directions. Consider some of the following when communicating with people from the Filipino culture. When counting indicating ‘two’ with the fingers is done by holding up the ring and little finger, not the forefinger and middle finger. The thumb is not used to count numbers in the Philippines (Engson, 2021).

As far as body language, do not put your hands on your hips when conversing, and this gesture can be misinterpreted as a challenge to another person. However, nodding and raising eyebrows with a smile is one way of how Filipinos greet each other casually and quickly, acknowledging that you saw that person. A friendly tap sometimes follows this gesture on the shoulder if they are within reach.

People from the Philippines may be pointing their lips at someone or something. Instead of lifting their finger or arm, Filipinos commonly use their lips to point to an object or another person, and this gesture is called nguso (Tuazon, 2021).

Positioning ones’ arms extended while lowering the head is commonly done when passing in front of two people talking to each other or crossing a room when someone is watching a TV. Followed by an “excuse me,” this gesture is seen as a sign of courtesy and respect.

If Filipinos do not understand a question, they open their mouths. Raised eyebrows signify recognition and agreement. Laughter may convey pleasure or embarrassment; it is commonly used to relieve tension. Raising one’s voice is unacceptable in the Filipino culture. It is crucial for the HCA professional to maintain a low, controlled tone of voice at all times (Tuazon, 2021).

When you are about to pass in between two people talking, you do not need to say ‘excuse me’ or ‘pardon me.’ Doing so will only interrupt their conversation. Lower your head and extend your arm downwards before going in between them. Without saying anything, this gesture instantly indicates politeness and respect for the two people conversing.

Verbal Communication

Filipino people are known for being very comforting. They do not regularly discuss politics or religion.  It is acceptable to make light of social, political and economic issues, but it is not acceptable for foreigners to discuss politics with the Filipino people. Raising one’s voice is unacceptable in the Filipino culture. It is crucial to maintain a low, controlled tone of voice at all times (Tuazon, 2021)

South Asian, India Communications Interactions

India is home to over a billion people, with tremendous cultural diversity between languages, geographic regions, religious traditions and social structures. The following health communications are not intended to represent every Indian person. However, there are common themes and principles. Most Indians tend to have a strong sense of pride in their culture. Persons from India are from South Asia; therefore, the terms Indians or South Asians will be used interchangeably in this text. 

When interacting with clients from India, it is essential to understand and have an awareness of India’s historical and current cultural and social influences. Although this is changing, the caste system remains one of the most critical influences in Indian society. The caste system encompasses a complex ordering of social groups based on ritual purity, creating a social and religious hierarchy that may continue to thrive among Indians abroad. A person’s caste identity is inherent in their surnames (most times, but not always). Technically there is human equality under the law; however, inequality still exists between the castes and is an accepted reality of Indian life (South Asian Caste System, 2021).

How does the caste system impact health communications or interactions? Persons of a higher caste may expect to be serviced before someone of a lower caste. A person in a higher caste may appear more demanding; however, it is essential to communicate with all clients with trust, respect and equity. As well clients should be reminded that they are triaged based on health needs and urgency.

Many persons’ from India’s health care beliefs are rooted in spirituality and preventative practices, particularly in yoga practice. Some clients may perceive disease and illness as a punishment from god due to actions in one’s past life, and those good or bad personal circumstances are deserved.

Gender will also influence who a health care professional addresses first (Shepherd et al., 2019). Typically, a male family member will be in charge of the health care of other family members; therefore, the male person may be participating in the health care decisions, and their presence should be addressed alongside the client.

Gender may also play a role in regards to the health care professional. Due to the modest nature of the female body, women clients may prefer or expect a female health care practitioner. When scheduling appointments, it is recommended to advise the client of the gender of the health care professional providing their assessment or examinations.

When registering an infant, the administrative professions should be aware that the naming of newborns often occurs after hospital discharge. The baby is taken to their religious institution, where the leader will provide a letter to guide the family in naming the newborn. Hence, babies may be labelled as ‘baby boy’ or ‘baby girl’ until this ceremony. 

Verbal Communication with South Asian Populations

The communication style of Indian South Asians tends to be polite and indirect. Whereas direct communication is used with relationships with a high level of trust or crucial situations, such as during health care crises. Direct refusals, such as stating ‘no’, may be considered to be too harsh. Therefore, Indians may give evasive refusals and provide indirect disagreement. Indians tend to use the phrases ‘maybe’ or ‘I will do my best as a way to express ‘no’. Sometimes clients will remain silent versus providing a verbalized ‘no’. Pay attention to what is not being said, as the absence of agreement may be an expression of disagreement (Kaur, 2021).

The term ‘yes’ has various connotations that differ from the word’s usage in Western cultures. South Asians may say ‘yes’ to indicate that they are listening to the health care professional in contrast to their disagreement or refusal through their body language (discussed below). Cultural politeness and modesty can sometimes mean that some Indians automatically answer ‘yes’ to direct questions that require a yes or no answer. One way to address any ambiguity is to check for clarification several times using open-ended questions. For example, rather than asking, “Is the appointment time suitable?” it is better to ask, “Which day and time works for you?”.

Non-Verbal Communications with South Asian Populations

Consider the following norms in South Asian cultures.  To beckon a client to come forward, hold one’s hand out, palm downward, and make a scooping motion with the fingers. Beckoning someone with the palm up or wagging one finger is perceived as an insult. Pointing with your finger is considered accusatory or rude. Indians may prefer to point with their chin.

South Asians prefer minimal eye contact or may avert their eyes, particularly from the opposite gender. Women may avoid eye contact altogether. Direct eye contact is generally appropriate as long as one diverts their gaze every so often. 

South Asians may tilt their head to the side or shake them to both sides to indicate agreement and understanding. This head movement is comparable to the Western gesture indicating “I do not know” with a tilting one’s head to the side or a shrug of the shoulders. Out of politeness, Indians will often nod to acknowledge what is said out; however, this does not always mean they understand or agree.  Touching anyone on the top of the head is deemed to be insensitive and offensive, as the head is considered the holiest part of one’s body (Kaur, 2021). 

Check Your Understanding

Summary

In this chapter you have:

• Explored the health communication between various cultures.
• Developed a level of understanding of various cultures.
• Developed the awareness of health care communications and interactions between health care administrators and diverse client populations.
• Enhanced self-awareness when communicating with diverse populations.

Key Terms

Ambiguity: Something that does not have a clear meaning. (Merriam-Webster, n.d)

Avert: Avoid. (Merriam-Webster, n.d)

Conventional: Something that is usual. (Merriam-Webster, n.d)

Dialect: A  language distinguished by vocabulary, grammar, and pronunciation using other regional types and creating a single language. (Merriam-Webster, n.d)

Domineeringly: Overbearing control over other individual. (Merriam-Webster, n.d)

Elder: An identified and respected member of an Aboriginal community. Elders have ley information about their community and are often sought for guidance and support. Often they may be called ‘aunty’ or ‘uncle’ as a sign of respect, even if they are not related.

Equality: The quality of having the same rights. (Merriam-Webster, n.d)

Gestures: A movement of the body that emphasizes an idea. (Merriam-Webster, n.d)

Gossip: Rumour about others. (Merriam-Webster, n.d)

Graciousness: Kindness and politeness. (Merriam-Webster, n.d)

Hierarchy: A system in which people are placed by levels with different importance. (Merriam-Webster, n.d)

Holiest: Something that has a divine quality. (Merriam-Webster, n.d)

Mirrored: Adjective of something that gives an accurate representation. (Merriam-Webster, n.d)

Positionality: The position that your race, gender, sexuality, and ability position your identity in society (Merriam Webster, n.d).

Powerless: Lacking the capacity to act. (Merriam-Webster, n.d)

Proficiency: Advancement in any knowledge. (Merriam-Webster, n.d)

Pride: A feeling that you deserve to be respected (Merriam-Webster, n.d)

Rapport: A relationship that is harmonious. (Merriam-Webster, n.d)

Reluctance: State of feeling aversion. (Merriam-Webster, n.d)

Restrained: Not excessive. (Merriam-Webster, n.d)

Subtle: Something that is hard to notice. (Merriam-Webster, n.d)

Supplication: Humility

Transparency: Obvious or easy to understand. (Merriam-Webster, n.d)

Trauma: A very difficult experience that causes mental or emotional problems, usually for a long time. (Merriam-Webster, n.d)

Uncertainties: Uncertain things. (Merriam-Webster, n.d)

Whispering: Soft speech to avoid being overheard. (Merriam-Webster, n.d)

Wisdom: The knowledge that is gained by experiences in life. (Merriam-Webster, n.d)

Worthy: Having value. (Merriam-Webster, n.d)

References

Ball, J. and Bernhardt, B. M. (2008). First Nations English dialects in Canada: Implications for speech-language pathology. Clinical Linguistics & Phonetics, 22(8): 570–588. https://doi.org/10.1080/02699200802221620

Ball, J., Bernhardt, B., and Deby, J. (2006). First Nations English dialects: Exploratory project proceedings. Unpublished monograph, First Nations English Dialect Project.

Engson, J., (2021). Communicating with persons from Philippines. Personal Communication, October 21, 2021.

Fadden, L. (2016). Communicating effectively with Indigenous clients: An Aboriginal Legal Services publication. Aboriginal Legal Services. https://aboriginallegal.ca/downloads/communicating-with-indigenous-clients.pdf [opens a PDF file].

First Nations Health Authority. (2021). Perspectives on health and wellness. https://www.fnha.ca/wellness/wellness-for-first-nations/first-nations-perspective-on-health-and-wellness

Kaur, J., (2021). Communicating with Persons from South Asian populations. Personal                               Communication, November 10, 2021.

Komen, S., (2020). Education toolkit: Cultural-responsive communications with the Black immigrant community.  Susan G. Komen Toolkits. https://komentoolkits.org/wp-content/uploads/2015/03/Culturally-Responsive-Communication-B-AA-Comm.pdf [opens a PDF file].

Margolies, L. (2015, March 12). Vanessa goes to the doctor [Video]. YouTube. https://www.youtube.com/watch?v=S3eDKf3PFRo

Nett, B. (2021, June 2). A guide to gender identity terms. NPR. https://www.npr.org/2021/06/02/996319297/gender-identity-pronouns-expression-guide-lgbtq 

Neuliep, J.W. (2014). Intercultural communication: A contextual approach (6th ed.). Los Angeles: SAGE Publications.

Rowe, K. (2020). Improving provider confidence and partnership with LGBT patients through inclusivity and education. Doctor of Nursing Practice Projects, 5. https://scholarworks.seattleu.edu/dnp-projects/5

Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019). The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Services Research, 19(1), 1-11. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-3959-7

South Asian Caste System. (2021). https://www.britannica.com/topic/race-human/Indias-caste-system

Table, B., Tronstad, L. D., & Kearns, K. (2021). ‘Anything is helpful’: Examining tensions and barriers towards a more LGBT-inclusive healthcare organization in the United States. Journal of Applied Communication Research: 1-20. https://dx.doi.org/10.1080/00909882.2021.1991582

Tuazon, N. (2021). People of Filipino Heritage. In L.D. Purnell & E.A. Fenkl (Eds.), Textbook for Transcultural Health Care: A Population Approach (pp. 365-394). Springer Nature.

Walmsley, L. (2021, June 2). A guide to gender identity terms. WFDD. https://www.wfdd.org/story/guide-gender-identity-terms