Guidelines and Tools

There are three more tabs located on this page:

• Engaging with Asian families
• Culture and Health-belief Assessment Tool (CHAT)
• CALD Cultural Assessment Tool (CALD Toolkit)

Guidelines for engaging with Asian families

Communication

(Waitemata DHB, 2016f)

Many Asian gestures and greetings differ significantly from Western ones. To develop good rapport and show respect, here are some essentials for greetings and communication.

• Ask clients if they wish to be addressed using a title and surname, especially at the initial engagement (premature familiarity may be considered disrespectful eg they may also address the health practitioner as Dr, Madam, Sir to show their respect).
• A nod or slight bow is customary.
• Older people should be greeted first and last before leaving.
• Avoid prolonged or direct eye contact.
• Over-familiar touch is not appreciated.
• It is acceptable to shake hands with men.
• Muslim women may refrain from shaking hands with men.
• Preferably use customary greetings with women.
• When in doubt, a smile and a slight bow of the head will always be appreciated.
• Using hand gestures to summon someone is considered insulting.
• In most Asian cultures it is disrespectful to touch another’s head (except for medical examination).
• Many Asians will avoid saying ‘no’ as it is considered impolite, so ‘yes’ may be ambiguous and may indicate that the listener is paying attention; it does not necessarily indicate agreement.
• Showing respect, especially for elders, is appreciated (eg greeting the elders first, the practitioner being on time for appointments and greeting them in their traditional way)
• Showing an interest in the culture and practices will likely enhance the relationship with the practitioner, and compliance
• Health practitioners are usually highly regarded and clients may not ask questions, and may not answer in the negative as it is considered disrespectful. It would be helpful to invite the client and their family to ask questions, especially when working through an interpreter.
• In most Asian cultures ‘Saving Face’ is a strong principle and will be used over confrontation or questioning of those in authority. It is also important not to put a person in a position where they will be seen to ‘lose face’.
• Ask clients about their expectations of the service. Some migrant families may expect medications, injections, practical help, and solutions rather than just a visit/consultation. For some migrants discussion alone may be seen as a waste of time.
• Explain the treatment process and timeframe, immediately after diagnosis. Some Asian clients are distressed by uncertainty and may choose to return to their home country for treatment if they are anxious.
• Explain confidentiality and privacy especially when using interpreters. Confidentiality becomes an issue in smaller communities or recently arrived groups. Migrants may be reluctant to use an interpreter because he/she knows the interpreter and/or fears that details of the matter will be made public. At the beginning of the interview, reassure the patients that you and the interpreter will respect his/her rights to confidentiality (unless there are serious safety concerns).
• Explain your services and roles clearly and provide information in client’s language.Many migrants are not familiar with New Zealand health and social services, legal rightsand policies eg New Zealand definition of child neglect or family violence or “no smacking” law, and they don’t know what services are free of charge eg interpreting service etc. They don’t know what they don’t know. Newcomers are not familiar with the routine and practical details of New Zealand health and disability services. They may not understand peoples’ roles and who is responsible for what on the ward or in community health and social services. It is most important to provide interpreters or support people to explain what is happening, to answer questions and to discuss any fears or worries with parents/grandparents.
• Assess health literacy and English language proficiency.Do not assume someone who can respond with Yes or No answers understands English or comprehends medical terminology or information. Also do not assume someone can read in English or in their own native language.
• Use professional interpreters where practical: Avoid using a family member or a child to interpret. NB Many Asian families refuse the use of interpreting services because they are not aware that it is free of charge, and are not aware of the roles, responsibilities and confidentiality of the interpreters. They may expect interpreters to provide additional support or transport for them. It is important to explain the roles of interpreters to avoid misunderstanding.
• Give instructions in a clear, logical sequence so that families understand eg providing step-by-step instructions or using pictures/visual information.

Culture and Health-belief Assessment Tool (CHAT)

The CHAT tool can be used in a wide variety of clinical settings, with patients from any cultural background. The questions listed in CHAT are intended to stimulate discussion, giving the physician a greater understanding of the patient’s health-belief model, health practices and expectations for treatment.

• What do you think caused your illness?
• Why do you think your illness started when it did?
• What does your illness do to you? How does your illness work?
• How bad (severe) do you think your illness is? Do you think it will last a long time, or will it be better soon, in your opinion?
• What do you fear most about your illness?
• What are the chief problems that your illness has caused for you?
• When you have a problem, to whom do you turn for help?
• For your future care, who would you like to be involved?
• What have you done to treat your illness?
• What kind of treatment do you think you should receive?
• What are the most important results that you hope to receive from treatment?
• Is there anything that might conflict with your treatment regimen?
• Are you feeling uncomfortable or uncertain about what we have decided?

(Adapted from Kleinman et al., 1978)

CALD Toolkit

The following Cultural Assessment Tool may be adapted in a variety of clinical settings with children and families from Asian backgrounds.

• How long have you lived here? Do you have many New Zealand friends?
• Did you go to school here? What social activities do you do? (To determine level of acculturation).
• What do you think caused this illness?
• How do people from _____ usually treat this illness?
• What have you done already to cope with / treat this illness?
• What other medications are you taking?
• Who prescribes your other medications?
• What do you do when you run out of medication?
• Can you access similar source/s of help here in New Zealand?
• Tell me about your life in ______? (To determine socioeconomic status in country of origin).

(Waitemata DHB, eCALD® Services, 2016b)