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I am starting a new position with a practice that includes a large proportion of Hmong people—some of whom do not speak English—in its patient population. Do you have any
advice to help me communicate effectively with non English speakers?

QUESTION: I am starting a new position with a practice that includes a large proportion of Hmong people—some of whom do not speak English—in its patient population. Do you have any advice to help me communicate effectively with nonEnglish speakers?

ANSWER: Hmong people are of Asian ethnicity and originate from the mountains of China, Vietnam, Laos, and Thailand, where they have traditionally practiced subsistence agriculture. The largest concentration of Hmong people living outside of Asia resides in the United States. Most groups of Hmong have settled in California, Minnesota, Wisconsin, Washington, Pennsylvania, and North Carolina. While Hmong people have their own language with many dialects, most speak what is called “White” or “Green” Hmong. There are societal distinctions based on the style of clothing, dialect, and rituals that separate Hmong into White and Green divisions.

Hmong was not a written language until the late 1960s and includes few medical terms. Older Hmong adults sometimes speak using metaphors. Fear and lack of trust may hinder the clinician-patient relationship. Following are some strategies to help you communicate effectively with this patient population.

Verbal communication: Repeat questions to help ensure understanding; do not rush a response. If Hmong patients feel pressured, they may say “OK” or “yes” when they actually mean “no.” Older Hmong listen attentively to health professionals, but will avoid direct eye contact because it is  considered rude. Women are not addressed by their first name, but rather by Ms. or Mrs.

Time: Traditionally, Hmong farmers organized their activities around the sun. Recent immigrants are not accustomed to doing things at a specific time. As a result, information about appointment times needs to be provided in writing and carefully explained.

Cultural sensitivity: Touching the top of an adult’s head is considered insulting and disrespectful. This idea is related to the Buddhist belief that higher parts of the body (and buildings) are more sacred than lower parts. When a Hmong patient’s head needs to be examined, the clinician must ask permission first and explain why it is necessary.

Dental care: Due to language barriers, cultural attitudes, and reduced access to care, the Hmong population is at high risk of tooth loss. Professional oral health care, as well as simple oral hygiene aids, were most likely unavailable to this rural-based population in their countries of origin.

Resources: I highly recommend reading Anne Fadiman’s book The Spirit Catches You and You Fall Down to improve your understanding of theHm ong culture. The movie Gran Torino is also a helpful resource for learning about Hmong culture. Patient fact sheets that discuss various oral health topics in Hmong and other languages are available on the California Dental Association website at: The paper “Strategies for Providing Cultural Competent Health Care for Hmong Americans” by Tory Cobb, PA-C, from the March 2010 issue of the Journal of Cultural Diversity is also a helpful resource.

Communicating with nonEnglish-speaking Hmong: The best option is to provide a Hmong interpreter. Do not rely on a child or other family member to translate, as a qualified interpreter must act as a neutral party. A certified medical interpreter can be found through the International Medical Interpreters Association membership directory at When speaking to any patient whose second language is English, avoid idiomatic phrases and slang. Speak clearly and more slowly, but not more loudly. Increased volume does not improve the patient’s ability to understand instructions. The use of contractions (eg, isn’t for is not) should be avoided. Remove your mask when speaking, so listeners can watch your lips as you pronounce words. Use photos and/or mouth models for demonstration. Following these strategies should help you complete successful appointments with Hmong patients.

From Dimensions of Dental Hygiene. December 2013;11(12):76.

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