Additional Guidelines

The following are suggested approaches to developing trust and rapport with CALD women and their families:

• Greet women and family members with a warm smile, a slight bow/nod to show respect especially at the initial engagement.
• Acknowledge the woman’s status, by addressing her using a formal title and surname, especially at the initial engagement (and ask if she and other family members are happy with being addressed in this way), do not assume.
• Show an interest in the woman’s cultural heritage.
• Explore the woman and her family’s cultural orientation or level of acculturation.
• Assess English fluency (spoken and written).
• Use a professional interpreter when required (ensuring a gender-matched interpreter, where appropriate).
• Understand the family structure and relationships.
• Understand the woman’s attitude towards sensitive issues (eg giving bad news).
• Find out about the woman’s religious and spiritual belief systems and the role they play in pregnancy, birth and care.
• Do not assume the woman understands the New Zealand health system; or health professional roles and in particular the Lead Maternity Carer (LMC) roles.
• Involve families if they are available.
• Explore the locus of decision-making.
  Explore the woman’s understanding of confidentiality.

The following are suggested considerations when communicating with CALD women and their families:

• Be aware of differences in communication patterns (formal versus informal; direct versus indirect; non-verbal and gestures).
• Use simple language, speaking clearly, avoid using jargon.
• Use open ended questions to avoid a “Yes” or a “No” answer to prevent misunderstanding.
• Assess the woman’s ability to comprehend or speak in English especially when requiring consent or decisions to be made. This can be done by:
  • Asking open ended questions.
  • Asking the woman to repeat a statement in her own words.
• Access a professionally trained interpreter for women with limited or no-English language ability instead of using a family member.
• Learn how to work with interpreters effectively (See CALD 4 training ‘Working with interpreters” at www.ecald.com).
• Provide information to non-English speaking women and their families in their own language. However, it is important not to assume all CALD women can read written information in English or their own language. Assessing literacy is important by asking and not assuming.

Before the session: Pre-brief the interpreter:

• Allocate extra time for the interpreting process.
• Provide a brief introduction of your role and service.
• Explain the objectives / purpose of the session.
• Obtain cultural background information or ensure that appropriate cultural greetings and etiquette are followed.
• Establish the mode of interpreting - consecutive or simultaneous.
• Confirm the use of the first person throughout the session.
• Clarify any specific terminology to be used and ask the interpreter if they understand it.
• Prepare the interpreter for difficult issues or tense topics.
• Inform the interpreter if you plan to talk about a sensitive or controversial issue and advise them that you will inform the woman through the interpreter that what is said is not the opinion of the interpreter but your own.
• Remind the interpreter of the confidentiality protocol.

At the start of the session (Briefing): Setting ground rules with the woman and family:

• Greet and direct the woman (and family members) to a pre-arranged seating arrangement.
• Introduce yourself and explain the roles of the professionals present.
• Introduce the interpreter and her/his role (ie she/he will be interpreting for both you and the woman and family members, and that the interpreter will not be expected to give her/his opinion during the session).
• Assure the woman of confidentiality. It can be helpful to the woman to know that both professionals are bound by a clause of confidentiality under a Code of Ethics. Conditions under which confidentiality cannot be maintained (for clinical safety) can also be explained at this time.
• Establish with the woman that everything said in the session by all parties will be interpreted.
• Familiarise the woman with the mode of interpreting (ie consecutive or simultaneous) to be used. Ask the woman (and family members) to pause after three short sentences for the interpreter to interpret.
• Explain that if the session involves sensitive or controversial issues, the opinion given is yours rather than that of the interpreter.

During the session (Communicating):

• Do not enter into direct conversation with the interpreter.
• Do not ask the interpreter for their opinion.
• Use short sentences.
• Pause at regular intervals for the interpreter to assimilate and interpret.
• Allow the interpreter to interpret after every 3-5 sentences.
• Allow enough time for the interpreter to convey information.

After the session (De-brief):

Clinicians can ask for a de-briefing with the interpreter to clarify any cultural issues, interpretation of words or concepts.