--- module: 100-02 language: en chapter: 100 title: "Social Psychology, Communication, Culture, and the Behaviour of Health" module_title: "Culture, language, stigma, and clinical communication" source_sha256: 06a9ecb477e6246f3be8ce11e834cc2263ef849fec44f615ab5bc7067de608e2 --- # Culture, language, stigma, and communication ## Culture and explanatory models ### Culture is dynamic, not traits of ethnicity ### Multiple cultures, identification shifts with context ### Cultural humility, not mastery #### Curiosity, self-reflection, attention to power ### Illness experience versus disease account ### Explanatory models may differ #### Ask name, fear, cause, expected help ## Coexisting practices and structures ### Prayer, diet, herbs, family advice, medicine ### Dismissal drives practices underground ### Uncritical acceptance misses toxicity, delay ### Respect the person, test the claims ### Structural competence: housing, labour, transport #### Constrained behaviour is not preference #### Document barriers, connect resources ### Culture must not conceal deprivation ## Language access and interpreters ### Discordance affects accuracy, consent, safety ### Trained interpreter conveys pragmatic meaning ### Family may filter or be inappropriate #### Children should not interpret key information ### Automated translation for limited tasks only ### Face the patient, first person, short segments ### Brief the interpreter, state uncertainty ### Longer translation is not inaccuracy ### Record involvement; interpreter does not consent ## Health literacy and clear explanation ### Relational capacity within a task and system #### Fear, pain, unfamiliar language impair anyone ### Universal precautions avoid shaming tests ### Few actionable ideas, numbers linked to decisions ### Teach-back tests the explanation #### Neutral prompt makes repair safer ### Return demonstration for devices, injections ### Written material reinforces dialogue ## Nonverbal communication ### Gaze, posture, distance, touch, tone ### One sign should not be overinterpreted ### Averted gaze may reflect respect, pain, trauma ### Note word-affect mismatch, ask openly ### Same level, fewer interruptions ## Stigma, language, and bias ### Labelling, separation, status loss, discrimination ### Public, anticipated, experienced, internalised #### Anticipated judgement delays care ### Person-first versus identity-first #### Ask or follow the person's language ### Polite words cannot offset discriminatory care ### Implicit bias affects pain, credibility, referral ### Awareness training alone has limited effect #### Standard criteria, audited support, time ### Algorithms can automate disparity ## Trauma-informed care ### Trauma shapes safety, trust, control ### Disclosure not required ### Predictability, explanation before touch, choice ### Difficult behaviour may be protective ### Compatible with firm limits and urgent action ## Interviewing, empathy, and bad news ### Open questions invite narrative ### Closed questions clarify detail ### Reflection and summaries allow correction ### Move deliberately and signal transitions ### Empathy without shared feeling or agreement ### Validation without confirming false belief ### Premature reassurance feels dismissive ### Bad news: privacy, time, support, facts #### Assess understanding, warn, speak directly #### Euphemism confuses, excess detail not retained ## Conflict, confidentiality, and purpose ### Conflict reflects unmet needs, fear, prior harm ### De-escalation: calm, space, limits, choices #### Safety first when violence is imminent ### Apology before technical explanation ### Explain limits of confidentiality ### Shared background does not guarantee trust ### Communication improves epistemic quality