Providing Culturally Competent Care

First, approach the appointment from the view point of culture. Cultural competence is defined as a set of interpersonal skills that enables clinicians to work effectively in cross–cultural situations. It is used to increase the quality of services to produce better outcomes and patient satisfaction. Cultural awareness is critical to understand the expectations and preferences of patients to increase maximum effectiveness. Special considerations may arise between a Western clinician and a Middle Eastern patient, and the appointment should be carefully thought-out before beginning treatment. Though there is much ethnic variety among Middle Easterners, this group typically shares a value set that may include high value on family and affiliation and common beliefs regarding health.¹ Cultural assignment of gender roles may also significantly impact health care.² One of the greatest obstacles to successful treatment is limited proficiency in English. Scheduling appointments, procuring transportation, filling out forms, communicating with the office and medical staff, and following prescription instructions are just a few examples of challenges that await the non-English speaker within a Western medical/dental office. Medical interpreters can be used to provide accurate and culturally sensitive exchanges of information. These interpreters should not be children or family members, ensuring that the translation is accurate and unbiased.³ A certified medical interpreter can be found through the International Medical Interpreters Association directory at: imiaweb.org/corporate/find.asp. When a medical interpreter is not present, the use of simple, nonidiomatic language, pictures, or drawings may help to increase understanding. Additionally, limiting the amount of information given at once and repeating information are helpful strategies.⁴ Oral health professionals should also note that Arabic is often repetitive and indirect in nature; consequently, increased social courtesies can be helpful when establishing a new patient relationship. Furthermore, asking open-ended questions and the use of the third person when describing negative consequences will help establish the rapport inherent to personal relationships, while being sensitive to the sense of "shame" found within many Middle Eastern cultures.² It may also be helpful to let the patient know the cost of treatment up front. Reducing anxiety is key to each of these methods. Clinicians should be mindful of strict gender roles often found within Middle Eastern cultures. Standards of modesty are high for both women and men. Though not common in the United States, a man may be wearing a keffiyah (a scarf draped over the head and shoulders), which may impede access to the face and mouth. An open discussion of what the appointment will entail, and an explanation of its importance should help gain the patient's consent.⁵ This is especially important when such care is entirely new to the patient. Other considerations may include eye contact; distance; touch, such as the extraoral exam or handshake; and hand gestures with variable interpretations, such as a thumbs up. Basic research of the specific culture in question may help ensure an appropriate interaction between the provider and patient. Unmet expectations may confuse or frustrate any patient, particularly when cross-cultural barriers are present. Carefully discerning patient expectations (through an interpreter when possible), clearly articulating the what and why of an appointment, and developing a basic understanding of the patient's cultural background will help ensure effective care.

REFERENCES

1. Lipson JG, Meleis AI. Issues in health care of Middle Eastern patients. West J Med. 1983;183:854–861.
2. Hammoud MM, White CB, Fetters MD. Opening cultural doors: providing culturally sensitive healthcare to Arab American and American Muslim patients. Am J Obstet Gynecol. 2005;193:1307–1311.
3. Mann NK, Hayes, MJ. Deliver culturally competent care. Dimensions of Dental Hygiene. 2015;13(1):62-65.
4. Mann NK. Providing care to Hmong patients. Dimensions of Dental Hygiene. 2013;11(12):76.
5. Darwish S. The management of the Muslim dental patient. Brit Dent J. 2005;199:503–504.