During the assessment process, it is important to elicit relevant information about the patient/client’s situation or condition in the context of the patient/client’s culture.  The basic premise of a cultural assessment is that patient/clients have a right to their cultural beliefs, values, and practices and that these and other cultural factors should be respected, understood, and taken into consideration when delivering services.

A successful cultural assessment takes cultural factors into account.  For example:

▶ If you are interviewing a Hispanic/Latino patient/client, it is helpful to understand certain cultural concepts such as simpatia (the quality of being friendly and acting humble -- the opposite of being formal and acting superior); respeto (the ability of the helping professional to convey genuine respect); and familismo (the reliance upon the family network for social support).

▶  With Asian patient/clients, you should be aware of the cultural inclination to keep personal matters secret; the need to save face; and, frequently, the willingness to defer to the authority of helping professionals (especially doctors and nurses) because they are seen as experts.

▶ In the Native American community, a helping professional is likely to gain credibility and acceptance based not upon training, credentials, or an impressive job title but upon a friendly, unpretentious style and the ability to offer caring and concrete help.

▶ African American patient/clients may rely upon religion and spirituality as a primary source of strength and social support. Since African American culture tends to be communal, patient/clients may take notice of your eye contact, facial expressions, touch, and your willingness to engage in dialogue and build a relationship.

Depending on the cultural group you are serving, certain cultural factors may arise that could be relevant to the cultural assessment.   For example:

▶  Family members may come to the interview but communicate through a spokesperson.  Don’t press everyone to participate (as you might in an American classroom or support group).  Find out the family’s preference.

Consider:  How have you (or how would you) facilitate this kind of session?

▶  “Clock time” may be less important to some patient/clients than it is to you.  If you must adhere to a strict schedule, explain this to your patient/client in advance or, if possible, try to arrange for a more open-ended session.

Consider:  Within the parameters of your agency’s or clinic’s policies and procedures, how have you accommodated) or how could you accommodate people with a different time orientation?

▶  Non-verbal cues – such as body language and facial expressions -- may take on added significance if your patient/client’s first language is different from yours.  Use body language that communicates your interest and concern; but respect the patient/client’s space.  Don’t stand or sit too close; don’t talk too loud or too fast; don’t touch (don’t even shake hands) unless you are certain that your patient/client is comfortable with touch.

Consider:  How do you know how to read your patient/client’s non-verbal cues?  What adjustments have you made (or could you make) to accommodate your patient/client’s style?  What kinds of misunderstandings or mistakes could occur as a result of misreading, or failing to read, non-verbal cues?

▶ In a cultural assessment, your patient/clients may be assessing you as much as you are assessing them.

Consider:  Have you ever sensed that a patient/client was assessing you?  What are the clues?  How should we handle that kind of situation?

▶ Your patient/clients may ask you personal questions.  Don’t be disconcerted by these questions.  They need to know you’re human.  They may also be testing whether you’re willing to disclose the kind of information you’re asking them to share.  Don’t hesitate to offer some information about yourself, but do try to keep the focus on the patient/client’s situation.

Consider:  How has (or how could) sharing personal information helped you connect with a patient/client?  How can you answer personal questions without divulging more than you want to, or allowing the focus of the interview to shift too much?

▶  Your patient/client may need for you to engage in casual conversation – or “small talk” -- in order to build rapport and establish a human connection.

Consider:  What are some acceptable topics for small talk?  How can you initiate small talk?

▶  There may be pauses and silences during the interview.  Know that these silences are normal and vary from culture to culture.  Let the silence last as long as the patient/client needs.

Consider:  How do you handle the silences?

▶ Things may be said that you do not understand or that may even shock you.  Be careful not to impose your personal values or pass judgment.  But do ask for clarification if you don’t understand.  For example, you might say something like, “I need some help to understand what caused you to leave your parents’ home.”

Consider:  Can you think of any examples where a patient/client said anything that confused or even surprised you?  How have you handled (or how could you handle) such a curveball?

▶ Some people may be uncomfortable if you take a lot of notes during the interview.  Of course, some note taking may be necessary, but try not to write incessantly.  Doing so tends to create a distance between you and the patient/client.  Also, due to historic mistrust, some patient/clients may be worried or suspicious about what you’re writing.  It may be helpful to explain why you are taking notes and how you will use them.  Offer to share your notes with the patient/client.

Consider:  How do you explain the need to take notes (or how do you capture the information you need without constant note-taking)?

▶ Some patient/clients may engage in alternative or traditional health care practices.  To learn about their beliefs and practices, you might ask, “Do you ever seek advice from folk healers, friends, or other people who are not doctors or nurses?”  Demonstrate your respect and support by incorporating your patient/client’s beliefs into the discussion of options or interventions.  The intervention may incorporate alternative treatments, spirituality, healers, and other cultural practices (such as prayer, special foods, sweat lodges, and so on).

Consider:  How have you found out (or how could you find out) about your patient/client’s beliefs and practices?  How have you incorporated (or how could you incorporate) these beliefs and practices into the treatment plan?

Sample Questions to Considering Culture in Assessment

The following questions may help you to assess your patient/client’s culture and may also serve to create a respectful and positive atmosphere for recognizing and addressing cultural issues openly.

Questions about cultural background:

▶ How would you describe yourself ethnically or culturally?

▶ How would you describe your cultural background?

Questions about family:

▶ How do you define family?  Who are your family members?

▶ Would you like for any of your family members to be involved in your treatment/exam/counseling/assessment?

Questions about language:

▶  What language do you speak in your home?

▶ What language are you most comfortable speaking?

Questions about religion and spirituality:

▶ Is religion or spirituality important in your life?  Are you comfortable talking about your beliefs with me?

▶ Do you have any preferred forms of healing that are connected with your spiritual or religious beliefs (i.e., herbal remedies, traditional healing practices)?

Questions about support systems:

▶ Besides your family or people you have already mentioned, who do you rely on for support – either emotional support or other help?

▶ Do you know what kinds of supports and resources are available to you?

Questions about discrimination:

▶ Do you think your cultural background or beliefs have had any effect on how people have treated you at work, in your neighborhood, or in other social settings?

▶  Have you experienced any forms of social, religious or political intolerance that you may want me to know about?