Canada is a nation of profound cultural diversity. Heavy immigration over the past two centuries has made Canada one of the most multicultural of all industrial nations. Every year 200,000 immigrants from all parts of the globe continue to choose Canada as their home (Canadian Heritage, 2008). In a nation as large and diverse as Canada, of course, few cultural values and beliefs are shared by everyone. Thus, cultural values can be inconsistent and even conflicting, leading to miscommunication and the formation of barriers. Communication is an essential aspect of our profession; thus, it is important to embrace diversity of people and educate ourselves in order to serve the client to the best of our abilities (Rayman, 2007). To establish a good rapport and to ensure client compliance we must be proactive in learning about how different cultures view health and health care in general, their beliefs, values, and the unique aspects of nonverbal communication. By respecting these elements we can come up with strategies so that we can accommodate these clients in a professional manner.
Medicine is the practice of healing that has developed from the cultural perception about mind, body and health. In Canada, health professionals use principles of Western medicine to assess, diagnose, and treat clients based on the scientific research. The vast majority of the world’s population do not use Western methods (Darby, 2003). Thus, we as health care professionals should familiarize ourselves with aspects of other healthcare methods. In Asian cultures most principle assessments are derived from extended conversations. Asian, Arab, and African societies are some of the many cultures utilize traditional herbal remedies to cure illness. Health care professionals must, therefore, consider interactions between prescribed medication and herbal remedies the client may already be taking. Many Arabs place high value on Western medicine since much of it originated from Arabic medicine. They place high value in hygiene, especially in oral cleanliness (HRSA, 2005). To honour their religious beliefs, Arabs fast for one month every year. Thus, a health professional must take this into consideration while prescribing medications, or administering dental injections (HRSA, 2005). European and African cultures avoid health care until there is an emergency, indicating that they place low value on oral health maintenance. In Hispanic culture disease is viewed as an imbalance between hot and cold principles; health is maintained by balancing the temperatures. Cultures not only differ in their aspects of medicine and health, but also in their communication styles.
Several non-verbal aspects of communication we should be aware about such as: types of greetings, handshake, eye contact and gestures. When it comes to greetings, Asian client may bow in greeting; however, the bows are different. Cambodian and Laotian cultures bow with both hands together in front of their chest like they are praying. People from Japan will also bow, and the depth of the bow indicates the level of respect they have for the other person. Koreans usually bow as well, but if they shake hands, the left hand supports the wrist of the other person’s right hand to show respect. Instead of bowing, Taiwanese usually nod their head in acknowledgement. It is important to note that most of the world does not greet by shaking hands (Dunn, 2004). A smile may not indicate a friendly greeting to everyone. In the Japanese culture, people may smile when they are confused or angry. In other Asian cultures, it is an indication of embarrassment. It is important to not judge clients as unfriendly because they do not smile, or smile at seemingly inappropriate times (Haynes, 2004). Eye contact is another cultural difference that dental team should be aware about. In North America, not making eye contact makes one appear untrustworthy, Arab cultures consider too little eye contact as disrespectful, while South Asian cultures, direct eye contact is considered as rude and aggressive. As hygienists, we need to be respectful of our clients’ comfort level regarding eye contact, in order to avoid an unintentional message (Bibikova, 2008).
In addition, to eye contact very few gestures are understood and interpreted in the same way. For instance, the gesture symbolizing “OK” in North America means “money” in Japan, “zero” or “worthless” in France and Russia, and is an insult in Brazil and Germany (Bibikova, 2008). Pointing with the index finger is impolite in the Middle and Far Eastern cultures; it is better to use the thumb or open hand instead. Making a “V” with the index and middle finger to indicate “two” will mean “shove it” to most people from Europe if the palm if facing away from the client. In Bulgaria, a nod means “no” and shaking the head means “yes” (Haynes, 2004).
Passing a Japanese client a toothbrush with one hand is seen as very rude—it must be passed with two hands. Similarly, in many Middle and Far Eastern cultures it is rude to pass something with the left hand since it is regarded as “unclean” (Haynes, 2004).
As a health professional, there are many strategies that can be used to better deal with a clientele of different cultures. For instance, displaying an accepting, nonjudgmental demeanor when presented with a client of diverse beliefs and practices is essential to build trust in a respectful manner (Darby, 2003). In a culture full of technology, it is very easy to attain numerous sources of educational information to provide our clients with at dental appointments. These sources could prove to be very valuable in times when language is a barrier. Lastly, it is essential to become a lifelong student of other cultures, particularly the cultures in your community (Darby, 2003). As dental hygienists living in a multicultural society we are fortunate enough to be able to work with clients of diverse backgrounds. Becoming aware and knowledgeable of these diverse cultures allows us to effectively manage differing practices, perceptions, and beliefs of oral health (Donate-Bartfield, 2002).
In the end, cultural sensitivity proves to be both advantageous to both the oral health care professionals and client; cultural competence allows health care professionals to feel that they have accomplished bettering the oral health of individuals to the best of their abilities, plus it allows the client to obtain the full benefits of receiving optimal oral health care. As author, Brian Dyson aptly wrote, “It is because we are different that each of us is special.”
Bibikova , A. & Kotelnikov, V. (2008). Managing Cross-Cultural Differences. Retrieved June 29, 2008, from http://www.1000ventures.com/business_guide/crosscuttings/cross-cultural_differences.html
Canadian Heritage (2008).Multiculturalism-Canadian diversity: Respecting our diversity.Retrieved July, 01, 2008 from http://www.pch.gc.ca/progs/multi/respect_e.cfm
Darby, M. L., & Walsh, M. M. (2003). Dental Hygiene: Theory and Practice. St. Louis: Saunders.
Donate-Bartfield, E. & Lausten, L. (2002). Why Practice Culturally Sensitive Care? Integrating Ethics and Behavioral Science. Journal of Dental Education, 66(9), 1006-1010.
Dunn, S. (2004). 10 multicultural differences in greetings you can learn from. Retrieved June 29, 2008, from http://www.enchantedspirit.org/ReadingRoom/475.php
Haynes, J. (2004). Communicating with gestures. Retrieved June 29, 2008, from http://www.everythingesl.net/inservices/body_language.php
HRSA Office of Minority Health and Bureau of Primary Health Care (2005).Providers guide to the Quality and Culture. Retrieved June 20, 2008, from http://erc.msh.org/aapi/cc4.html
Rayman, S. & Almas, K. (2007). Transcultural Barriers and Cultural Competence in Dental Hygiene Practice. Journal of Contemporary Dental Practice,8(4), 1-9. St. ThomasUniversity. (2005). International Students. Retrieved June 13, 2008, from http://w3.stu.ca/stu/future_students/basics/international/international.aspx