CULTURAL ASSESSMENT

• Culture may be defined as a

shared system of values,
beliefs, and learned patterns
of behavior
• The particular culture defines
values (learned beliefs about
what is held to be good or
bad) and norms (learned
behaviors that are perceived
to be appropriate or
inappropriate).

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• Cultural Beliefs and Values

• • Beliefs about human nature
• • Beliefs about relationship with nature
• • Beliefs about purpose of life
• • Beliefs about health, illness, and healing
• • Beliefs about what causes disease
• • Beliefs about health
• • Beliefs about who serves in the role of healer or
what practices bring about healing

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• Verbal communication can have many

variations based on both language
differences and usual tone of voice.
• For instance, a harsh tone of voice may be
normal in some cultures and thought to be
rude in others.

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• Nonverbal communication has the most

often misinterpreted variations.
• These variations include patterns of space,
eye contact, body language and hand
gestures, silence, and touch.

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• A. TIME:
• Cultural groups tend to value time in the
past, present, or future.
• Those focused on past value practices that
are unchanged from ancestors and are
often resistant to new ways.
• Those focused on the present put what is
going on in the present above what will
occur in the future.

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• Those who are future oriented place value

on deferring pleasure for a later gain.
• They are the ones who will value the care
and treatment in expectation of
improvement (this reflects Western values).

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• B. SPACE:
• Asians and Americans tend to keep more
space between themselves when speaking.

• Latins, both Mediterranean and Latin

American, stay closer to each other; and

• Middle Easterners move in the closest.

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• C. Eye Contact and Face Positioning
• Americans expect people talking to each
other to maintain a fairly high level of eye
contact.
• Those looking away and not giving “good
eye contact” are thought to be rude or
inattentive.
• But people from Eastern countries and
Native Americans tend to look down to
show respect to the person talking.

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• C. Eye Contact and Face Positioning (cont)

• Also, some African Americans look away
when being talked to, but give a very high
level of eye contact when speaking.
• Another variation is whether the persons
face each other or stand with the face
slightly to the side.

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• D. Body Language and Hand Gestures

• The way Americans sign OK
by making a circle with the
thumb and forefinger is a
definite and serious insult in
many cultures around the world.

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• E. Silence
• There are two types of silence.
• One is simply remaining silent for long
periods; the other is used to space talking
between two people carrying on a
conversation.
• In Eastern cultures there is a pause after
each person speaks before the other does.
• The pause is thought to show respect and to
allow for consideration of what has been
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• E. Silence (cont)
• Other cultures, such as Latin cultures, it is
common for speakers to interrupt one
another in conversation.
• This provides for overlap in speech.
• Within the culture, this indicates that the
persons are deeply engaged in the
conversation, but it is perceived to be rude
by other cultures.

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• F. Touch
• Touch is very culturally based.
• Touch of females by males in many of these
cultures is restricted to male family members
and may also be restricted among them.
• Even male physicians are not allowed to
treat a female patient.

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• F. Touch (cont)
• In some religions, there are prohibitions on
touching people considered to be unclean.
• There are prohibitions about touching parts
of the body, especially the head, or
touching children in some cultures because
touch is a way to “give the evil eye” to
another.

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• G. Autonomy
• Autonomy is assumed to be a right of all
health care consumers in the United States,
meaning that an individual has the right to
know about the diagnosis and treatment
plans and to make decisions for himself or
herself.
• However, autonomy is not an accepted
value in many societies.

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• G. Autonomy (cont)
• In paternalistic or patriarchal societies, the
father or the family is expected to be told of
diagnoses and to make decisions about
treatment.
• In many societies, women are not decision
makers. Do not assume that the client
expects autonomy; clarify with the client
and family.

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