The influence of cultural differences on communication in addition to, or independently of, language differences has been extensively investigated (e.g. Clyne, 1994).
In the context of renal services, Devitt and McMasters (1998) have described the communication problem between Indigenous renal patients and carers in Central Australia as 'one that resulted from a deep cultural gap, both profound and pervasive'(p.164).
The influence of such contrasting ideologies or paradigms, in terms of ontology (ideas about the nature of reality), epistemology (theories of knowledge including concepts of time, space and causality) and methodology (in terms of how we construct knowledge) on communication between Aboriginal and non-Aboriginal people have been explored in a number of studies (e.g. Cook,1998; Christie,1994).
Aboriginal patients arrive at their first encounter with the western theory of renal function, renal failure and treatment options with their own theories of life, of the body, of health, and the relation of health to their history, their spirituality, and the politics of their family and community lives. The health practitioners also arrive with their biomedical model of renal function, disease and treatment.
Assumptions by health staff that Western biomedical beliefs are universal 'truths' are common - and normal. The extent to which their beliefs and practices are culturally specific - and not necessarily shared by others - is often invisible to members of any group.
To achieve effective communication it is necessary for health staff to
critically analyse the nature of the biomedical model, and the ways in
which this structures their communication.. and to identify ways of working
that model together with other models.
Most of the participants in this study had some awareness - but little in-depth understanding - of the actual level of risk for miscommunication which is inherent in interactions between people from such different cultural and linguistic backgrounds. Most were unaware how little cultural knowledge they shared with the other person - or how culturally specific their own discourse systems are.
An understanding of how perceptions - both biomedical and Yolŋu - of health and sickness are culturally constructed is essential to ensure effective clinical and educational interactions.
Beliefs about causation are just one cultural feature that can critically influence health communication (eg. Berndt, 1982; Weeramanthri, 1996), particularly the way in which information is interpreted.
Cultural and linguistic distance is not simply a matter of ethnicity, however. There is considerable variation between the Yolŋu participants in terms of their familiarity with Western cultural constructs depending on their experience of Western health services and their educational background. Such differences in cultural knowledge between Yolngu participants in the encounters were also a source of miscommunication.
It is impossible to become an expert in the culture and language of everyone you need to communication with - and every individual and every situation will be different - the key to success is skill in collaborative practice - the more effectively staff, patients and families work together the better the outcomes will be - for everyone..
Click here for more information about 'working together'.