Module 4: Building Conversations

4.2 Keys to Good Communication

ConversationBe Culturally Aware

  • Respect personal space. When you first sit down to speak with clients, ask them to sit where they feel the most comfortable or let them tell you where to sit. Allow people to choose the distance that feels right to them — for example, Hispanics tend to feel comfortable at a closer distance than do Native Americans or Asian Americans.
  • Learn the cultural rules about touching. Find out the cultural rules regarding touch for the ethnic groups with whom you work — including differences based on gender. In some Asian cultures, the head should not be touched because it is the seat of wisdom. In many Hispanic cultures, the head of a child should be touched when you admire the child. A vigorous handshake may be considered a sign of aggression by Native Americans.
  • Establish rapport. Take time to establish common ground through sharing experiences and exchanging information.
  • Ask questions. Do not be afraid to ask someone about something with which you are unfamiliar or uncomfortable. Be sure your questions are open-ended (as we reviewed in Module 3) and show an interest in the person, a respect for his culture, and a willingness to learn.
  • Listen to the answers. Really listen. Do not interrupt your client or try to put words in her mouth. Let her tell her own story.
  • Appreciate and use silence. Observe your client to get a feel for how he or she uses silence. Do not feel that silence has to be filled in with small talk. Give people a chance to formulate their thoughts, especially if they are trying to speak in a language that is not their native tongue. Cultures that value silence learn to distinguish varying qualities of silence, which may be hard for others to discern. “Pause time” is different for different cultures.
  • Notice eye contact. Notice the kind of eye contact your client is making with family members or your coworkers. Many cultures consider it impolite to look directly at the person speaking. Lowered eyes or side glances may be seen as respectful, especially if the speaker is older or in a position of authority.
  • Pay attention to body movements. Movements such as upturned palms of the hands, waving one’s hand, and pointing with fingers or feet convey varying messages. Observe your clients for clues. Ask them to tell you what gestures should be avoided.
  • Note client responses. Note that a “yes” response does not necessarily indicate that a client has understood or is willing to do what is being discussed. It may simply be an offering of respect for the MCH professional’s status. Native Americans, among others, may not ask questions because this would indicate a lack of clear communication by the provider. In some cultures, smiling and laughing may mask other emotions or prevent conflict.
  • Check for understanding and provide reinforcement. Try to assess what the client thinks or feels about what has been discussed. Ask some questions to find out whether you have communicated the intended message. This provides an opportunity to review the concept and discuss any barriers. Use this time to build the client’s confidence by reinforcing the client’s understanding of the concept.

Listen and Observe Carefully

Listening and observation skills are essential. You’ll find that you can break down barriers by listening to people and letting them know that you are interested in what they have to say.

Nonverbal communication is just as important as the spoken word. When you are faced with a family whose culture is initially unfamiliar to you, you can learn a lot just by being a good observer. Nonverbal cues can offer clues to appropriate behavior.

These nonverbal cues can have different meanings in different cultures:

  • Facial expressions
  • Gestures
  • Body movements
  • Interactions among family members
  • Silence

Nonverbal Behaviors

  • Nod in agreement
  • With children, sit at their level and make eye contact
  • Interact with or play with the child
  • Show expression, attention, concern, or interest
  • Convey understanding and empathy
  • Touch client (if appropriate)
  • Draw pictures to clarify
  • Demonstrate techniques

Verbal Behaviors

  • Allow client to state concerns without interruption
  • Encourage questions and answer them completely
  • Clarify statements with follow-up questions
  • Ask about feelings
  • Acknowledge stress or difficulties
  • Allow sufficient time for a response (wait time >3 seconds)
  • Offer supportive comments
  • Restate in the client’s words
  • Offer information or explanations