key: cord-1028091-txuzleq2
authors: Ogbogu, Princess U.; Noroski, Lenora Mendoza; Arcoleo, Kimberly; Reese, Benjamin D.; Apter, Andrea J.
title: Methods for Cross Cultural Communication in Clinic Encounters
date: 2022-01-25
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2022.01.010
sha: 6d3cbf018d9c1b9f99fd60da19c6112495b8c84e
doc_id: 1028091
cord_uid: txuzleq2

Successful cross-cultural communication is critical for adequate exchange of ideas with our patients. Our communities have become more diverse and thus the necessity has increased. The murder of George Floyd and other atrocities have sparked recognition of the need to address social injustice and racism, and as we fight the ongoing COVID-19 pandemic. Allergist-immunologists are uniquely trained to explain the complex immunology of COVID-19 to patients, but have less experience discussing issues of health equity. Here, we explore critical components of patient-provider communication: communicating with those for whom English is a second language, advising patients with limited health literacy, and understanding non-biomedical views of health and wellness. Two barriers to communication are discussed: implicit bias, and structural racism. Finally, we consider how the recent innovations in technology, the electronic health record including its patient portal and the use of telemedicine have both impeded and improved communication. We offer suggestions of what we could do to address these in our own local communities that would insure better understanding and exchange of health information. This perspective grew out of an effort by the AAAAI Committee on the Underserved to provide training in cross-cultural communication.

The murder of George Floyd and other atrocities have sparked recognition of the need to 35 address social injustice and racism, and as we fight the ongoing COVID-19 pandemic. Allergist- 36 immunologists are uniquely trained to explain the complex immunology of COVID-19 to 37 patients, but have less experience discussing issues of health equity. Here, we explore critical 38 components of patient-provider communication: communicating with those for whom English 39 is a second language, advising patients with limited health literacy, and understanding non- providers of different backgrounds is nuanced, and requires deep understanding of the barriers 60 and a multilayered approach for success. In this review, we build upon efforts initially 61 undertaken by the AAAAI Committee on the Underserved to provide training on cross-cultural 62 communication, and we explore critical components of the patient-provider relationship 63 including English as a second language (ESL), health literacy, non-biomedical views of health 64 and wellness, implicit bias, structural racism, and communication considerations with respect to 65 technology. 66 Health Literacy and ESL 67 Inadequate health literacy is considered "the silent, hidden epidemic," intertwining the lack of 68 language understanding by the patient with the lack of awareness by healthcare providers. 1 69 J o u r n a l P r e -p r o o f Adequate health literacy "occurs when a society provides accurate health information and 70 services that people can easily find, understand, and use to inform their decisions and 71 actions." 2 Health literacy depends not only on reading and writing skills but also numeracy, 72 listening, and speaking. It relies on cultural interpretations, conceptual knowledge and 73 integration of complex concepts. 1 and acting upon health information, and are incapable of accurately integrating written text. 79 Up to 50% of people in developed countries are unable to sufficiently read, write, find and 80 comprehend the correct health information. 1 In the United States, up to one in five persons 81 speaks a non-English language at home with Spanish as the most common non-English 82 language; of these, 40% have limited English proficiency and nearly 10% are considered 83 "linguistically isolated. 1, 7 This public health literacy problem is grossly underestimated and far 84 more extreme across poor-resource populations globally, especially among the elderly, poor, 85 racial and ethnic minority patients, refugee and non-English speakers. 5

In addition to education, preconceived perceptions and learned behaviors are also a function of 87 health literacy. Although health literacy issues are more severe among the poor and racial and 88 ethnic minority communities, impaired health literacy can also be seen among educated 89 populations resulting in distorted interpretations or denial of medical and public health 90 messages. 1, 3, 4 Individual, community and cultural attitudes and beliefs play a critical role on 91 J o u r n a l P r e -p r o o f how people decide to accept information, where value may be placed on the source and the 92 sender of the information rather than the content of the information itself. The COVID19 93 pandemic is a potent example of how misinterpretation of evidence-based medical information 94 can be related to the sources of delivery of the information and individual and population 95 attitudes and beliefs. 8 illness identity, what caused the illness, whether or not it can be controlled, potential 165 consequences of the illness, illness duration, potential treatment/action plans, and finally, 166 appraisal of outcomes. 16 The CSM has also been used to understand a phenomenon known as cultural beliefs, is the belief that homeostasis in one's body is achieved by a balance of "hot" 195 and "cold" elements and illness is caused by an imbalance in these elements similar to "yin" 196 and "yang" in Chinese culture. 31 Health is restored when a condition considered as "hot" is To fully engage in patient-centered care and achieve optimal health outcomes, it is critical that 218 the individual and healthcare provider arrive at a shared management plan that acknowledges, 219 respects and, when feasible, integrates these cultural beliefs and practices. Doing so will 220 increase acceptance by patients of these management plans and potentially significantly 221 improve adherence to the treatment plan. These must be integrated into position descriptions, measured, and individuals and 313 departments must be held accountable. As long as we leave the work of ensuring racial justice, 314 and social justice more broadly, to those who "specialize in that practice" or have a certain title, 315 then the rest of us run the risk of simply reflecting on social determinants of health, passively 316 endorsing the efforts of the few with "titles", and in an unintended way, being complicit in 317 reinforcing systems and structures of racial inequities in healthcare. 318 Activism for racial and social justice must be the responsibility of all of us in healthcare.

The role of technology in communication 320 There is little research on the best methods to communicate across cultures and even less on 

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