Module 6 presentation

Breaking Down the Barriers Module 6: Intercultural Communication Presentation

Section 1: The impact of body language and ways of speaking and listening Module 5 has looked at how to communicate across a language barrier. But communication with someone from a different cultural background is about more than translating words or ensuring your words are understood. When we communicate we also use and interpret body language and conventions for speaking, listening and showing politeness.

1.1 Automatic judgements Every culture develops conventions for self-presentation and interaction with other people. When we meet a person, we unconsciously and automatically make judgements about them based on their appearance, their choice of clothes and their smell. We also take note of whether the person conforms to our own conventions of body language and speech. We generally feel comfortable interacting with someone who stands the ‘right’ distance away from us, gives us the amount of eye contact we find normal and polite, and speaks at a volume and pace we would use ourselves. We are likely to feel less comfortable with people who do not do these things. We may judge them rude and aggressive if they stand too close, stare and talk loudly or fast, or we may assume they are withdrawn and uninterested if they stand too far away, do not look at us and talk too softly or slowly. The other person may be making the inverse judgements about us, applying their own convention of what is “normal”.

1.2 The scope for misunderstanding Most of us assume that our own conventions are universal. This applies to clients just as much as health professionals. There is therefore considerable scope for mutual misunderstanding when a health professional interacts with a person from a different cultural background. For example, you may: give offence unknowingly; communicate an unintended message that contradicts what you say in words; feel offended if you apply your own conventions to interpreting a client’s behaviour or speech. Migrant women will themselves be in the process of learning the cultural conventions of behaviour and communication in the UK so that they can make themselves understood effectively and avoid giving offence. However, this process takes time, and it may be very difficult for women who do not speak English. This means that recent migrants, and women who have lived in the UK in communities that strongly maintain their traditions, may have had only limited opportunities to develop their own awareness of what is expected in the UK.

1.3 Basic principles of communicating across cultural barriers When you are involved in the care of women and families from a wide range of cultural backgrounds, it is not practical to become an expert on all the variations in communication conventions, although you may well become very comfortable with those you encounter most often. You can, however: develop your awareness of the cultural variations and be curious and open- minded about differences; be mindful that what you have learnt about the communication style of one person from a culture does not necessarily apply to another person from the same culture; be aware of the importance of checking that you really understand the other person and that she really understands you.

Improving your skills at communicating with people from different cultural backgrounds is a dynamic but straightforward and rewarding process. Fundamentally it requires an open mind, an awareness that many aspects of your own communication style are not universal, a non-judgemental acceptance of cultural differences, curiosity about other cultures, and a willingness to learn from individual encounters. Section 2: Improving intercultural communication skills Photo: Vasant Dave

2.1 The learning process The learning journey may be thought of as a sequence of steps, each building on the last:

This process of learning can also be understood as the four stages from unconscious incompetence to unconscious competence:

2.2 Actions towards improved intercultural communication skills In practice, the actions you could take include: Find out about other cultures. Be conscious of your body language. Avoid ambiguous gestures. Ask the individual woman what a gesture means, if you do not understand her. Do not make assumptions about any individual. Check you understand her: paraphrase back to her what you think she has communicated. Check she has understood you: ask her to paraphrase back to you what she thinks you have communicated. Reassure her: if she reacts in an unexpected way, she may be drawing a mistaken conclusion about what you are ‘really’ saying to her. Start with the presumption that she is not trying to give offence. Avoid ‘closed’ questions that can be answered with ‘yes’ or ‘no’.

Section 3: Body language, gestures and ways of speaking and listening This section looks at some of the aspects of communication, both verbal and non-verbal, in which cultures differ. It is intended to help you consider the impact on people from other cultures of your customary ways of communicating, and the possibility of mutual misunderstanding or inadvertent offence. However, it is essential to remember that any individual may not share the predominant cultural conventions of her country of origin. 3.1 Body language conventions 3.1.1 Interpersonal distance in different cultures Cultures have conventions for the appropriate distance apart for two people to stand while conversing. In White British culture the usual distance for conversation is approximately arm’s length, 2-3 feet, and anyone approaching nearer may be seen as aggressive. People from southern Europe, Turkey, Arabic countries and Latin America expect to stand closer and may interpret a White British person’s preferred distance as cold or arrogant.

3.1.2 Touch in different cultures Each culture has clear rules about who may touch who in different circumstances. In some cultures, touching in public is only acceptable between people of the same sex. In some cultures touching in public is only acceptable between people of opposite sexes. In some cultures high levels of touch are normal (e.g. Latin American, southern European and Arab). In some cultures (e.g. Japan) public touching is extremely unusual. In White British culture, public touching is normally confined to a greeting handshake, but touching as an expression of sympathy may be acceptable. Some cultures have specific prohibitions on touching. For example: In South East Asia, people may regard the head as the seat of the soul and not to be touched. In South Asia and Arabic countries, the left hand is regarded as unclean and it is insulting to touch a person with the left hand or to hand something to them from the left hand. In Orthodox Judaism, a husband is forbidden to touch his wife while she has any vaginal blood loss.

3.1.3 Eye contact in different cultures The amount of eye contact regarded as acceptable or necessary in different situations is culturally specific. For example: Culture Convention Arab A lot of eye contact: too little could be disrespectful, but unrelated men and women may avoid eye contact with each other as this could be seen as flirtatious. White British The speaker makes eye contact but periodically looks away to avoid ‘staring’; a speaker who does not make eye contact may be seen as untrustworthy. A listener is expected to look at the speaker: not to do so is seen as disrespectful, or implies the person is not listening. South Asian Direct eye contact can be seen as aggressive and disrespectful. Japanese and Chinese Direct eye contact for more than a couple of seconds is disrespectful, especially towards people seen as social ‘superiors’. Afro-Caribbean The speaker looks at the listener and the listener looks away: looking at the speaker may imply challenge and disrespect.

3.2 Meaning of gestures However, hand gestures may carry quite different meanings in other cultures. For example: A thumbs up sign, used in White British culture to mean ‘that’s right’ or ‘it’s good’, is an obscenely offensive sign in some west African and Middle Eastern cultures. Making a circle between thumb and index/middle finger, used in White British culture to mean ‘perfect’, is an offensive or obscene gesture in some south European and south American cultures, and has a variety of other meanings in different countries. Beckoning someone by holding your palm face up, curling in fingers and thumb, and curling the index finger back and forth, used in White British culture to mean ‘come here’, is in some Far Eastern cultures reserved for animals and could be insulting when used to adults. In some parts of South America the same gesture is highly flirtatious. (In both of those cultures, they beckon by holding a hand out palm down, and making a scratching motion with the fingers together). Many of us use hand gestures to emphasise what we are saying. We may unconsciously use more hand gestures than normal when communicating with someone whose first language is not English, in order to make it ‘easier’ for them to understand us.

3.3 Ways of speaking and listening The way that a person speaks is often assumed to reflect their emotional state and intentions. You may draw automatic inferences about the other person based on how they speak and listen. However, the speaking and listening conventions of different cultures vary widely and this includes: the normal speed and volume of speech the meaning of emphasis given to particular words the meaning of intonations how to indicate it is the other person’s turn to speak how to show you are listening the meaning of nodding or shaking the head how to structure the content of speech.

3.3.1 British English standard speech conventions British English uses emphasis to indicate particularly important or new information within a sentence, or to show excitement or anger. Speaking loudly can also indicate anger and excitement. A statement can be turned into a question by raising the tone at the end of the sentence (“She’s only just arrived at the hospital” turns into “She’s only just arrived at the hospital?”) A listener from a different cultural background will not necessarily understand these implications. In a polite exchange between speakers of British English, only one person speaks at a time, and the speaker pauses when they have finished to show the other person that it is their turn to speak. The listener nods and makes brief comments (‘Yes’, ‘I see’, ‘Really?’) to show their interest. Listeners appreciate clarity, directness, and linear thought, and expect the speaker to make their most important point first. Other cultures apply different conventions.

3.3.2 Speed and emphasis In some languages a person speaks more slowly to show that the information is important, and in other languages a person speaks more quickly to convey importance. 3.3.3 Intonation Many languages use a much wider range of intonation than British English. Some languages such as Chinese are tonal, and the meaning of individual words is changed by changing the intonation. A speaker of British English may assume that a person who is uses a large tonal range is angry or over-excited, while that person may assume that the speaker of British English (with their limited tonal range) is uninterested. A speaker of British English may turn a statement into a question by raising the tone of the end of a sentence, but this may not be understood as a question by speakers of other languages.

3.3.4 Volume There is a wide variation in the ‘normal’ volume of speech, and therefore in the perceived meaning of ‘louder’ or ‘quieter’ speech than the listener uses as a baseline. For example: A speaker of British English may believe a person is angry or over-excited if they speak at what is, for them, a normal volume, but which is louder than that commonly used in British English. A person from Latin America, where normal speech is quieter than British English, may think a speaker of British English is speaking angrily to them, and may in turn be perceived as shy and withdrawn. Photo: Demian Saborio

3.3.5 Taking turns Cultures vary in how they show it is someone else’s turn to speak. In some cultures, a speaker stops talking to show it is the other person’s turn, and it is rude for the other person to begin until the first person has stopped. In some cultures, a speaker may show that she has finished by speaking more slowly and quietly, or may begin to repeat herself. In some cultures, talking at the same time as someone else is polite and friendly. Photo: Andrew C

3.3.6 Listening A person may demonstrate that they are listening in a range of ways. For example, In some cultures a listener is not expected to give any audible or visible sign of listening. In White British culture a listener is expected to look at the speaker, and to respond with facial expressions, nods and brief comments. A Japanese person may close their eyes to show they are listening carefully. In some cultures, it is respectful not to look at the person who is talking to you (see ‘Eye contact’ above). Photo: Mario Alberto Magallanes Trejo

3.3.7 Nodding and shaking the head In most cultures nodding the head means ‘yes’ or ‘I am listening’, but in others (e.g. Bulgaria) it means ‘no’. In some cultures shaking the head means ‘no’, in others it means ‘yes’ or ‘alright’. There are many other cultural variations for indicating ‘yes’ and ‘no’. For example, people from the Indian subcontinent may bobble the head from side to side to show agreement. 3.3.8 Smiling In some cultures, smiling indicates happiness, or is used by a listener to encourage the speaker and to show attention. In some Far Eastern cultures, smiling may be used in situations of happiness, anger, embarrassment, sadness or apology.

3.3.9 Structure Cultures vary in whether they expect a conversation to be discursive or direct. Many cultures have a non-linear style of conversation. Speakers may start with generalities or examples before building up to the main point. This may be perceived by a speaker of British English as long winded or evasive. The logical and direct style of conversation used in British English may be perceived as abrupt and unfriendly by someone used to a non-linear style. Photo:Tony Corkovic

3.3.10 Direct/indirect style In some cultures, the context of the conversation is a highly important part of its meaning, and much is implied without being said. It is very important to maintain harmony and that no one should be embarrassed (‘lose face’). Listeners from this type of culture may pay as much attention to the speaker’s body language, facial expression, and the amount of time given to the conversation as to the actual words used to understand what the speaker is ‘really’ trying to say. In some cultures, the meaning of a conversation is straightforwardly contained in the words, and listeners are not expected to attach significance to the context. Some cultures lie in the middle: there may be situations where a certain amount is implied rather than stated openly, and others where a direct style is used.

Section 4: Politeness conventions All cultures have ways of indicating politeness and respect both through speech and body language. Most people apply their familiar conventions to an interaction with a health professional, as they will usually be trying to avoid giving offence, and often regard the health professional as a ‘high status’ person. Unfortunately they may easily be misunderstood if these conventions differ from those familiar to the health professional. For example, a person may seek to show politeness and respect by: not making eye contact not expressing negative emotions smiling giving no sign that he or she is listening.

4.1 Acting with deference Some cultures have strongly hierarchical attitudes, while others are more egalitarian. If a person from a hierarchical culture (such as many Asian and African cultures) perceives a health professional as a social ‘superior’, she may: behave deferentially try to avoid saying ‘no’ show only positive emotions, and not express her true feelings smile a lot to show politeness and compliance be very concerned to avoid annoying or creating work for the health professional. Photo: D.J. Jones

4.2 Saying ‘no’, saying ‘yes’ In hierarchical cultures it may be rude to say ‘no’ to a higher status person, but these cultures have ways to express ‘no’ without saying it directly. These may not translate readily into English, so a person may resort to ‘yes’ without meaning it literally. In some situations a person may refuse a treatment or pain relief because they do not want to give the impression that they believe they are worth the health professional taking the trouble to help them. They may need to be reassured and asked again before feeling able to accept gracefully.

4.3 Accepting praise European cultures tend to be straightforward in giving and accepting praise and compliments, and it may be a natural part of an interaction to encourage a woman in labour through praise, or to admire her baby. In some cultures that value modesty (e.g. Chinese culture), praise may be met by a denial or silence. In some cultures, parents may be very concerned to avoid attracting the attention of evil spirits to their baby and may become upset if a health professional compliments them on their baby. For the same reason, they may also avoid praising or paying much attention to their own child. Photo: Benjamin Earwicker

4.3 ‘Please’ and ‘thank you’ British English uses ‘please’ and ‘thank you’ to frame polite requests: without ‘please’ (or an equivalent softener such as ‘would you mind...’), a request becomes an order. Some languages do not use a separate word ‘please’, but incorporate politeness into the request by using a different form of the verb or pronoun. When a person from such a linguistic background (e.g. Urdu) speaks in English, he or she may omit ‘please’ without any intention to sound arrogant or demanding. In some languages, ‘please’ and ‘thank you’ are reserved for situations of particular kindness and gratitude, and not expected where a person is doing their ordinary work. How rude! Who does she think she is? Hold my baby!

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