Supporting Cultural Diversity

What is Culture?

As a healthcare professional, you will work with many people – those accessing services, their whānau/family and your co-workers – whose cultures may differ from yours.

A person’s culture can affect so many things about how they see and experience the world we all live in. These include their approach to health, their views and expectations of getting, understanding, and accepting healthcare, and how they communicate and express themselves to others. Your ability to see when a person’s culture differs from your own and then choose how you will work with them and their whānau can make a big difference to their health and wellbeing. Understanding how to work well with different cultures in a health or wellbeing setting is important to doing your job well.

Watch

Watch the following video about Cultural Competence and reflect on your own feelings and knowledge of culture.

Defining culture

The Oxford Dictionary defines culture as “the ideas, customs, and social behaviour of a particular people or society”.

Many people think culture is about ‘race’ and ‘ethnicity’, but culture is much more than just which part of the world someone comes from. Culture also affects many other aspects of a person's identity, including age, abilities or disabilities, gender, sexual orientation, group affiliations and connections. Culture is about how people see themselves, think about things and behave.

The people you work with and support in a health setting may differ from you in many ways including:

• age
• gender
• ability
• spirituality
• sexual orientation
• immigrant status
• disability
• socio-economic status or employment
• ethnicity.

Groups might also have distinct cultures, setting them apart from other groups. These groups can consist of individuals with different ethnicities, ages and other diverse characteristics, however, they will share at least one common aspect that binds them together.

For example:

• Retirees - They may be Māori, Pasifika, Pakeha or Asian. They could be single, married or divorced, they could identify as Takatāpui or LGBTIQIA+. The characteristic they share is that they are all above 65 years old.

Further reading

If you are interested in finding out more, read this information about diversity and inclusion.

Diversity is a difficult concept to define. Think for a moment about what the word ‘diversity’ means to you. Can you write your own definition?

Diversity refers to differences and variations which exist within a group, and is often used when talking about people who are from different cultural backgrounds. In fact, diversity refers to many characteristics.

Diversity parameters

Diversity can apply to many different aspects of New Zealand society and can mean different things to different people. Some parameters of diversity are described below, click on each heading to learn more:

Reflection Point

Consider the following questions and reflect on problems and solutions.

1. Were you able to identify the groups’ shared characteristics just by looking at them?
2. What possible problems might there be with doing this?
3. What potential problems could arise between people of different groups?
4. Why do these problems occur and how can we prevent or minimise this?

Cultural identity is defined as the distinct identity of people or groups. We are often born into our cultural identities. Categories that make up cultural identities include age, sexual orientation, ethnicity, gender, religion or spirituality beliefs, social class, occupation, disability, immigrant or refugee status, or region. Culture also reflects group values, norms, and behaviours. Cultural preferences include food, music, clothing, communication, customs, and celebrations. 

Activity - Reflection

What are some of the things that make up your own culture? Some different features of culture are listed in the table below. Next to each one, reflect on how your own cultural identity expresses that feature. There are no right or wrong answers – just be honest with yourself and be willing to explore and reflect upon your own values, beliefs and attitudes.

Evolving cultures

Cultures do not stay the same; they are constantly evolving and changing. These changes happen as different generations of people grow up within a culture and adapt it to suit the world around them. Sometimes this can cause conflict or challenge, within families and in the broader community. People who have grown up in one country and then moved to New Zealand may feel differently from their children who were born here. In turn, their children may have experiences and feelings which are quite different to those of their parents.

In the heart of providing exceptional care to our diverse aging population in New Zealand lies the essential principles of cultural competence and cultural safety. As our society becomes increasingly multicultural, the role of aged care workers goes beyond just caregiving. It involves having an understanding and appreciation of the various cultural backgrounds, traditions, and values that shape the lives of those we care for. Cultural competence goes beyond the surface and considers empathy, respect, and effective communication, while cultural safety ensures an environment where individuals feel secure and respected within their unique identities.

Activity: Forum

This website contains valuable information about cultural safety and cultural competence for healthcare providers. Be sure to watch the videos explaining how cultural safety differs from cultural competence and consider ways you can incorporate cultural safety into your role with aged care clients. Spend 60 minutes navigating the website and taking notes for your own records.

Reflection: What information from healthy.nz on cultural safety did you find important? Write your thoughts in the cultural safety forum thread and read what your classmates found important. 

Employers, workers and clients all have particular rights and responsibilities in the workplace. In the areas of diversity relating to culture, age, disability, sexuality and gender, there are many different rights and responsibilities which apply. For example, an employer has a responsibility to provide a non discriminatory workplace and a community services worker has a right to be treated with dignity and respect during a home visit.

Examples of rights in relation to diversity include:

• The right to be listened to and treated with respect and dignity.
• The right to work and be in a workplace that accepts and values people as individuals.
• The right to a strong system of policies and procedures that are communicated and enforced.
• The right to appeal decisions, and have complaints heard and acted upon.
• The right to work in a place that is free from bullying, harassment and intimidation.
• The right to receive education and training regarding diversity and culture.
• The right to attend to the requirements of cultural and religious practices.

Examples of responsibilities in relation to diversity include:

• The responsibility to follow and comply with legislation, policies, procedures and directions from managers or supervisors.
• The responsibility to behave and interact in a way that is polite, respectful and appropriate.
• The responsibility to learn about the cultural and linguistic needs of a client and their family.
• The responsibility to follow lawful instructions provided by a manager or supervisor.
• The responsibility to work with clients in a way that is fair, equitable and respectful.

Discrimination

Discrimination means making an unfair decision made based on a characteristic of a person, such as having a disability or being from a particular race or gender. In New Zealand, discrimination is against the law. In a workplace, it is important that everyone understands discrimination laws and how they protect people from discrimination.

Direct discrimination is easy to identify and often involves clear statements which show bias or preference for one group of people or individual over another.

Indirect discrimination is more challenging to identify. Indirect discrimination relates to systemic, large-scale mechanisms that make it more likely that a particular person or group of people will be favoured over another. For example, indirect discrimination occurs when a person who has dyslexia is unable to respond effectively to a job advertisement that has been written in overly complex and abstract language rather than in straightforward, easy-to-read Plain English.

Indirect discrimination still infringes on the rights of people in the workplace, and it should always be addressed.

Making changes in the workplace

Workplaces can use many different tools to reduce discrimination or bullying. These include:

• Policies – clear statements which identify appropriate and inappropriate behaviours and the position of the workplace as a whole, as well as who is responsible for actions.
• Procedures – clear action statements about what to do in a situation.
• Vision statements – overall direction and values of the organisation so that policies and procedures can link with what the organisation values.
• Training – training and guidance to build skills and knowledge in areas where rights may be infringed or to increase awareness of the responsibilities of individuals and work teams.
• Mentoring – support from a more experienced worker to provide guidance and direction to a newer worker while they are first learning their job.
• Induction – the time when a new worker is learning about the workplace, where documents, policy frameworks and responsibility and accountability can be explained.

Example

Melanie has just begun working for a disability support agency as an in-home worker. She attends an induction program to learn about the policies and procedures of her job. She works alongside another, more experienced worker for the first week so she can learn ‘on the job’ skills before she begins visiting clients on her own.

Becoming aware of your own limitations is a good starting point for working effectively with others. It is important to not make assumptions or pre-judge someone. Always remember that each individual has their own cultural background, and we must be cautious of the natural tendency to judge another person’s behaviours and beliefs according to the standards of own culture.

A critical step towards developing cultural competence is understanding your own cultural pre-conceptions. One of our main cultural preconceptions is that our cultural group is ‘normal’ and that people who are different from us are ‘abnormal’. Furthermore, we usually perceive those from our own cultural group as having individual features while at the same time grouping all individuals from different cultural groups as conforming to a particular stereotype. In other words, by categorising a person as a member of a specific group we tend to deem them as conforming to the shared features of that group (e.g., Chinese, elderly, homeless, etc.). We place on them our perceptions of the characteristics of members of such a group – we stereotype them. When we interact with an individual from a different background to us, we have a tendency to categorise the person, lumping them in with stereotypes that might even be tinged with bias, racism, and prejudice.

It is only by examining our own pre-conceptions and views of different cultures that we can begin to understand the influence that these pre-conceptions have on our interpersonal communication. People often unknowingly display negative attitudes and behaviours toward those of different cultural backgrounds. This might be expressed via physical action (e.g., facial expression or body language), verbal expression (such as saying something culturally inappropriate), or via suggesting an activity that is contradictory to another’s beliefs.

The process of looking inward and considering your own beliefs and values, and how they have been influenced by your culture and personal experiences, is known as self-reflection or reflexivity. When working with people who are different from yourself, you should stop to reflect on any assumptions that you are making.

We cannot overemphasize the point that if you are aware of your own values you are less likely to impose them indirectly on others. Exposing clients to different value systems may be helpful; imposing values on clients is not helpful. Becoming aware of other people’s value systems will help you understand, appreciate, and accept differences between your value system and others’

(Okun & Kantrowitz, 2014, p.31) 

In order for successful cross-cultural communication to occur, workers must develop skills that will help them communicate constructively with others, in conjunction with the flexibility to adapt their strategies to suit the individual’s cultural needs. Apart from continually developing awareness of your own and your clients’ worldviews, some important skills for cross-cultural communication include:

• Monitor for own reactions during communication for any anxiety or defensiveness.
• Use a range of verbal and nonverbal behaviour responses or approaches to suit the client’s cultural context.
• Identify when a language barrier exists and be prepared to adapt strategies and/or seek assistance to meet the person’s communication needs.
• Recognise and be open about your own limitations and seek support where necessary.
• Demonstrate genuine respect for clients’ cultural beliefs, values, and identities.

It is vital that you demonstrate cultural competence in all communications with clients, their families, your co-workers, and anyone else you may come into contact with. Respect must be demonstrated in all aspects of communication including verbal, nonverbal (e.g., gestures, facial expressions, posture) and written communication (this includes all organisational communications as well as things such as signage in the work environment).

For effective cross-cultural communication, you will need to consider the following:

• What is the other party’s proficiency in your language?
• What is the other party’s preferred style of conversation?
• What impact is each of your non-verbal communication styles having on the conversation?
• How can you best integrate your and the other party’s diverse communication preferences?
• How can you demonstrate respect for the other party?

Being aware of how we communicate with others will go a long way to ensuring effective interactions. However, the differences that exist between people mean that communication is not always smooth and sometimes barriers to communication can exist.

One commonly occurring barrier is the presence of a language barrier. You want to be able to get your message across in a respectful way while ensuring that the person understands. Even when the other person speaks English, if English is their second language and you do not adapt your approach, problems can arise. As such, it is important to adapt your approach to communicating when a language barrier exists. The exact strategies you will use to alter your communication will depend upon the severity of the barrier. However, some strategies that you might like to use when communicating with someone who speaks English as a second language include:

• Speaking slowly and enunciating words clearly (however, it is important not to speak too slowly or treat the other party as though they are a child).
• Avoiding the use of jargon.
• Rephrasing any words that are not understood.
• Speaking in clear, simple and direct English (e.g., avoid long or difficult words).
• Speak in short rather than complex sentences.
• Pausing to check for understanding by seeking a response from the other party.
• Asking for clarification and seeking feedback if you are unsure of the other party’s message.
• Using appropriate gestures and facial expressions to support your verbal meaning.
• Using resources within your organisation such as bi-lingual colleagues and having commonly used resources printed in the common language of clients.
• The use of international signage and symbols.
• The use of interpreters.

A Note on Using Interpreters

If there is a significant language barrier it is important to use a professional interpreter. Sometimes it might not be immediately apparent that the client requires an interpreter because they have a basic level of English comprehension; however, you must always assess the level of the client’s language ability and act accordingly.

Remember that the interpreter does not necessarily have an understanding of your role and the work you are trying to achieve with a client. It is important to briefly introduce yourself and brief the interpreter on the purpose of the conversation and any important terminology or information. Be prepared, too, to allow more time for the session, or additional sessions where required to make sure information is communicated as accurately and efficiently as possible.

Another important aspect of effective cross-cultural communication is the ability to recognise when miscommunication occurs and resolve it sensitively with consideration of diversity factors.

Developing cultural competency requires ongoing reflection and learning – sometimes through situations of conflict. Particularly if culturally appropriate work practices are not used effectively, there is a potential for conflict, misunderstandings, or communication difficulties. As such, an important skill relevant to working with diverse people is conflict resolution. Where difficulties or misunderstandings occur, it is important to consider the impact that diversity factors might have in the conflict – though it may not be the only factor.

Activity - True or False

Potential diversity-related causes of conflict are outlined in the diagram below.

If you experience conflict with a client or co-worker, it is important to consider the possible impact of cultural factors in this conflict. If you believe cultural differences to be the cause of the conflict, then conflict resolution should be completed in a sensitive manner. If the conflict is a minor one, it can be best to be open and honest with the individual when the problem arises. Even stating the fact that you seem to be having a conflict (or difference of opinion) can prompt a frank and honest discussion of your differences and possibly resolve the issue before it becomes a larger problem.

Essentially, the steps involved in cross-cultural conflict resolution include:

1. Identify the presence of conflict. This involves using your basic communication and self-awareness skills to identify areas of emotional reaction, discomfort and conflict within interpersonal interactions.
2. Define the nature of the conflict. This involves having each party communicate their perspective on the issue. To resolve any miscommunication, all parties need to voice their perspective of the problem – just like communication, the resolution is not one-sided – instead both parties need to share their reactions and perspective on the situation in order to find a way forward. Ensure that each party gains an understanding of the other’s perspective.
3. Resolve the conflict. Once each party has an understanding of the other’s perspective and the true nature of the conflict, it is important to resolve the conflict. Depending upon the nature of the conflict there are a number of conflict resolution strategies that may be appropriate, such as:
   • Each party accepts their part in the conflict and offers apologies where appropriate.
   • Mutually deciding upon the best course of action in order to resolve the conflict as soon as possible.
   • The use of mediation to assist in negotiating a compromise or resolution to the conflict.
4. Implement strategies to prevent similar conflicts in the future. This involves learning from the conflict, sharing your insights with others, and making changes at both an individual and organisational level to ensure that similar conflicts do not reoccur.

In situations of extreme conflict, situations of heightened emotions, or situations where the individual parties cannot resolve the conflict themselves, it might be more appropriate to seek mediation in order to resolve the conflict.

Consider the following case study adapted from Arnott (2020, pp. 104-105) and the following reflective questions:

In this case study, Carol’s and John’s behaviours resembled their own cultural values, expectations, and worldview. Without awareness and consideration of these ‘differences’, Carol and John were prone to negatively interpret each other’s words and behaviours, and act accordingly. Fortunately for Carol and John, their manager Gerry was equipped with sufficient mediation skills and awareness of the cultural diversity at play. He made an effort to sensitively resolve the differences between Carol and John, taking into account the diversity factors.

It may not always be straightforward to resolve cross-cultural misunderstandings. However, there are resources to assist you. It will be your responsibility to seek appropriate help to meet the client’s needs, to meet your responsibilities as a practitioner or work colleague, to develop your cultural competency, and to contribute to a workplace that accepts and reflects cultural diversity. Some options available to you include:

• Access local organisations that are a cultural match to your client or colleague in order to learn more about that culture.
• Engage in the services of a professional language or cultural interpreter.
• Speak to more experienced colleagues and managers in your workplace.
• Speak to your professional supervisor.
• Undertake training that will help develop your cultural competency.

If you experience conflict with a client or co-worker, it is important to consider the possible impact of cultural factors in this conflict. If you believe cultural differences to be the cause of the conflict, then conflict resolution should be completed in a sensitive manner. If the conflict is a minor one, it can be best to be open and honest with the individual when the problem arises. Even stating the fact that you seem to be having a conflict (or difference of opinion) can prompt a frank and honest discussion of your differences and possibly resolve the issue before it becomes a larger problem. Essentially, the steps involved in cross-cultural conflict resolution include:

1. Identify the presence of conflict. This involves using your basic communication and self-awareness skills to identify areas of emotional reaction, discomfort and conflict within interpersonal interactions.
2. Define the nature of the conflict. This involves having each party communicate their perspective on the issue. To resolve any miscommunication, all parties need to voice their perspective of the problem – just like communication, resolution is not one-sided – instead, both parties need to share their reactions and perspective on the situation in order to find a way forward. Ensure that each party gains an understanding of the other’s perspective.
3. Resolve the conflict. Once each party has an understanding of the other’s perspective and the true nature of the conflict, it is important to resolve the conflict. Depending upon the nature of the conflict there are a number of conflict resolution strategies that may be appropriate, such as:
   • Each party accepts their part in the conflict and offers apologies where appropriate.
   • Mutually deciding upon the best course of action in order to resolve the conflict as soon as possible.
   • The use of mediation to assist in negotiating a compromise or resolution to the conflict.
4. Implement strategies to prevent similar conflicts in the future. This involves learning from the conflict, sharing your insights with others, and making individual and organisational changes to ensure that similar conflicts do not reoccur.

Activity - Reflection

1. Go online and see if you can research your local area and find out how many cultural and ethnic groups there are.
2. Reflect and consider what diversity means to you.
3. How might you learn about another person's culture?