Getting Communication Right in First Nations Healthcare

Videos

Working with ALOs

 

ASH patient journeys and ALO roles

Printable Resources

Links to Posters and Brochures to be added soon

Key points:

• Do you speak the patient’s language? Do you share their cultural background? If not, call an ALO/Interpreter
• Engage with the right ALO/Interpreter from the beginning for the best outcomes
• Arrange a briefing with the ALO/Interpreter before you talk with the patient
• Explain clearly – don’t oversimplify or use ‘broken English’
• Listen to the patient – an ALO/Interpreter can help you understand what the patient wants/needs you to know
• Take time to achieve effective communication – it will save time later
• De-briefing is also important; consider the emotional impact on Aboriginal staff when they have a close connection with patients and their families
• Recognise that the job of the ALO/Interpreter does not stop after hours

Resource videos:

1. Plain English Part 1 | New information
2. Plain English Part 2 | Implicit information
3. Plain English Part 3 | Order of events
4. Plain English Part 4 | Abstract nouns
5. Plain English Part 5 | Passive voice
6. Cultural differences in visual literacy
7. Idioms and metaphors - key challenges in intercultural communication

Key points: 

Be aware of the worldview of those you are working with

• Look for new information: Is there anything new to the people you are communicating with?
• Look for implicit information (not described directly) that may not be clear cross-culturally. Have you included all the steps of the story?
• Order of events. Put the events in the order that they happened – or will happen.
• Beware of ‘because’ and beware of ‘before’ or ‘after’ - these words can create confusion and change the order of events. Put the first thing first.
• Look for abstract nouns – words that name things/concepts that are not concrete (i.e. cannot be seen). Avoid abstract nouns. Rewrite/rephrase using the verb they came from.
• Look for passive sentences and change them to active sentences. Australian languages do not use passive voice.
  Passive sentence: I was bitten (by the dog.)
  Active sentence: The dog bit me.

Printable Resources

Resource video:

Cultural way of using questions

Key points: 

• In Aboriginal societies, it is not good manners to ask too many questions.
• Within Aboriginal cultures, questioning is not usually a teaching technique.
• When you ask a question, you may be answered with silence – just be patient and wait. But consider possible reasons for no response – topic, who is asking, right to answer, time and place.
• In English, if we ask a question, the responsibility is on the questioner to assess whether it is a reasonable request before we ask it. 
• In Aboriginal societies, the onus is on the one who is questioned to decide if it is a reasonable request with which she/he is happy to comply. 
  It can be extremely bad manners to reply to a request in the negative - learn the art of refusal.
• A lot of information is “owned”, so it’s not our right to ask for it.
• Some questions might be acceptable and help to make a connection with the patient – e.g. questions about family, country, ways of doing things
• Hypothetical questions are rarely used.
• Alternative questions (using ‘or’) can be a problem.
• Direct verbal confrontation can be very bad manners in Aboriginal society – so people might give you the answer they think you want to hear.

Printable Resources

Resource video:

Forming questions across cultures

Key points: 

• In Aboriginal languages, a yes/no question is often the same as a statement – only the intonation changes to show it’s a question e.g. you went to the shop?
• Word order is more flexible in Aboriginal languages than in English.
• Adding a tag question to a statement can work well – and be more likely to be answered e.g. ‘You did (something), didn’t you?’
• When asking for information (a content question), giving a clue to the type of information you seek can help.
• Questions that contain no, not, never, etc., can be very confusing – and are best avoided. e.g. Didn’t you go to the shop? might be answered ‘Yes (meaning I didn’t go..)
• Rhetorical questions are used in Aboriginal languages the same way as they are used in English.

Printable Resources

In all interactions with Aboriginal patients - with and without an ALO/Interpreter consider the following:

• talk to the patient, not the interpreter, and encourage the patient to talk directly to you (arrange seating to facilitate this)
• do not speak too quickly (or too slowly)
• keep your sentences short: one idea or question at a time
• pause frequently: allow sufficient time for the interpreter to think about the best translation
• fully explain terms and processes in plain English - don't oversimplify or use 'broken' English: detailed explanations are essential if the patient/family are to make genuinely informed choices about their health care (with the assistance of an interpreter, this can be achieved much more effectively)
• repeat the same information in different ways
• use pictures and diagrams wherever possible to illustrate your explanation (but check with local language experts to make sure these are meaningful – visual literacy is different across cultures)
• think carefully about how your own communication style and content are influenced by your culture - are they appropriate/meaningful to the interpreter and patient?
• avoid metaphors and concepts that are culturally specific, e.g. clock and calendar references to time, quantification in terms of percentages, grams or litres, etc., cannot be translated into languages that use different measures of time and quantity
• encourage the interpreter to interrupt when clarification or repetition of information is needed
• avoid questions that require a yes/no response - the patient may give the response they think you want to hear because this is appropriate in some cultures
• provide opportunities for the patient/family to use their preferred communication style, e.g. ask them to tell their story rather than using question-and-answer routines, which can be uncomfortable/unfamiliar/ineffective.

WAIT: pause times are very different across cultures; some people might need a few minutes before they are ready to respond to a request or question or to continue a story… just be patient - this takes practice.

Pause frequently to check the message has been understood - both ways:

• never assume communication has been effective – CHECK
• asking 'Do you understand?' is not a valid way to assess comprehension
• summarise what you think the patient has told you and check if your understanding is accurate (with the assistance of the ALO/interpreter)
• ask the patient to tell you what they think you have told them in their own words.

Always check your attempts to use an Aboriginal language with a speaker of that language

The same words can carry different meanings across cultures, for example:

• use of the term ‘last’ in any context can be interpreted as implying that the person will pass away and cause distress
• words that sound the same can also be misinterpreted e.g. dye / die

Beliefs about the power of language can also be different across cultures, for example:

• speaking about an illness (diagnosis) can cause it to become real
• predicting what will happen (prognosis) can be perceived as a threat