Caring for Patients in Cross-Cultural Settings

The nature of this violent conflict between the Lakota Sioux, Northern Cheyenne and Arapaho Indians and the US government and military is an example of what my entire research and teaching career has focused on— minority-dominant relations. The significance of this research is that the seven tribal bands of the Lakota nation and their allies were the last loose ends that needed to be tied up by the US government and military to complete the continuous expansion of manifest destiny. The Lakota Sioux had long dominated the American interior northern territories, impeding Western migration with discerning negotiation, brutal intimidation and absolute power. A fierce and effective resistance emerges in the North central US, led by the Lakota Sioux and Cheyenne. This dramatic confrontation features men like Sitting Bull, Red Cloud, John Grass, Gall, Crazy Horse and military icons like George Custer. Gruesome violence, massacre, mutilation and removal are tragic and continuous in this saga. This research is relevant because many of the methods of decimation and control used against the indigenous plains Indians—racial and cultural genocide, forced assimilation, disproportionate use of violence, broken treaties, territorial colonization, suppression of religion and language, and reeducation schools—are the same weapons used today by dominant cultural groups against their own citizens, ethnic minority groups —by China against Uyghur Muslims and by the military coup in Myanmar against Rohingya Muslims. US deplorable treatment and nativist policies regarding African slaves, those of Mexican descent, Asian immigrants and indigenous Americans have provided a ghastly template for genocide and other human rights violations for nations around the globe.

As the rapid development of internationalization in Chinese higher education, the number and scale of international scholars working in China has significantly increased. However, few studies have focused on international scholars’ cross-cultural encounters in the Chinese academic context. Based on 21 in-depth interviews, this article investigates international scholars’ subjective experiences in a cross-cultural setting through Bourdieu’s conceptual lens. After presenting an overview of participants’ major motivations for working in China, we find their vague and idealistic expectations engendered “false anticipation” of their possible career future in China, which left some of them unprepared to experience a sense of misfit when entering the new field of Chinese academia. Moreover, we identify the dual habitus–field disjunctures emerging from participants’ perceptions of misfit in the cross-cultural scenario, namely explicit disjuncture and implicit disjuncture, which reveal the underlying reasons for mismatch between international scholars’ previously generated habitus and the new field of Chinese universities.

Given the current increase of global migration movements and its implications for healthcare
\nsystems (Carballo et al. 2017), it is important to better understand how patients with migration
\nbackground and healthcare professionals experience their shared clinical encounters and the
\nspecific factors that can influence communication and interaction between them. Here,
\nreflections on ‘culture’ and biases as well as the topics of language barriers and mutually
\nperceived problem areas have proved to be fruitful. Furthermore ethical aspects surrounding the
\nperceived issues have to be explored. If not addressed, language barriers can affect
\ncommunication and interaction in cross-cultural clinical encounters and quality of care
\nnegatively. Although the need to address language barriers is widely acknowledged, little is
\nknown about how linguistic complexities shape decision-making for or against the use of
\ninterpreter services in everyday cross-cultural encounters. Also, it is crucial to explore the
\nproblem areas patients with migration background and healthcare professionals identify, and to
\nreflect connected ethical aspects. Using an ethnographic approach, 32 migrant patients (16 of
\nAlbanian and Turkish origin, respectively) have been accompanied during their medical
\nencounters at two outpatient clinics (using participant observation and semi-structured
\ninterviews with patients and healthcare professionals). Overall, 94 interviews with patients and
\nhealthcare professionals on how they perceived communication and interaction in their crosscultural
\nclinical encounter were conducted. Perspectives of patients and physicians on their
\nshared clinical encounters were triangulated regarding the topics ‘getting-by with limited
\nlanguage proficiency’ as well as ‘difficulties and challenges’. In one case a patient’s, a physician’s
\nand the researcher’s perspective have been compared. Results show that reflecting on ‘culture’
\nand one’s own biases is an essential tool promoting insights about what can be relevant in a
\ncross-cultural clinical encounter. In the context of language barriers, the assessment of the
\nlanguage situation, the involvement of interpreters, and dealing with conversational limits are
\nimportant topics to physicians and patients shaping decision-making for or against the use of
\ninterpreter services. Furthermore, patients and physicians identified the topics of ‘patient
\nbehaviour in relation to doctors’ advice’ and ‘relationship issues’ as meaningful problem areas in
\ntheir encounters. What makes perceived issues relevant from a medical ethics perspective is that
\npotential ethical implications of perceived difficulties (e.g. regarding how shared decisionmaking
\ncan be made in the context of relationship issues or questions of responsibility in the
\ncontext of the social embeddedness of health) were not identified during clinical routine.
\nA deeper understanding of cross-cultural clinical encounters and ethical aspects of everyday
\ncross-cultural clinical routine is provided by presenting patients’ and physicians’ perspectives on
\ntheir shared encounters focusing on the interplay between ‘culture’, stance and biases, the
\ncomplexities of decision-making in the context of language barriers and difficulties and
\nchallenges that can arise in cross-cultural settings.

Trends of overcoming traditional oppositions „high culture“ / „low culture“, „big culture“ / „small culture“ and the significant expansion of the scope of concept of culture in the direction within which culture means forms of everyday life but also the so-called „popular culture“ have been a way of seeing culture in the recent decades. This is especially intensified with UNES-CO's commitment to overcoming the Eurocentric concept of culture in the direction of its broader, global understanding and relativization in the relation of dominant vs. subordinate cultural groups and forms. In accordance with the openness of the contemporary idea of culture, the so-called „small cultures“ and related „small languages“, as well as other cultural practices through which such cultures are becoming more visible and more recognizable in the global cultural network, are coming to the scene of global culture legitimately and in accordance with their own capacities. The paper, in a new and innovative way, questions the role and potentials of the current cultural environment, mediated more and more by the so-called social media, such as wikis, blogs, virtual worlds, social networks and other web technology tools in general. The role of participatory cultural platforms that transform culture in the direction of the so-called participatory culture is been analysed, as a result of the use of diverse social media to produce and share information in a way that is not conditioned by earlier, privileged power social positions. In this way, social media and participatory culture are argued as useful mechanisms of deinstitutionalized, direct inclusion of „small cultures“, „small languages“ and related cultural forms and practices in today's global culture. In doing so, special attention is paid to a critical analysis of the so-called amateur culture and public, collective wisdom impact on practicing culture today.

This chapter puts the spotlight on a community-initiated museum project of the Tsonga people that is located deep in the rural settings of the Chiredzi South District. Tsonga people, as a minority ethnic group, have endured stigmatisation and marginalisation by other dominant cultural groups in the country. The museum challenges the historic and contemporary exclusions of Tsonga people in the national narratives. Activities at the community museum also strengthen cultural ties between Tsonga people who were separated by colonially invented national boundaries. The museum allows the Tsonga people to collect, document, and exhibit their artefacts as well as to author and censor their narratives. The museum has become an active place for civic engagement where communities also dissect topical issues that affect them daily. Here, Tsonga traditional leaders are involved in the participatory governance structures at the museum. Thus, the museum can be seen as a decolonial museum, a site where strategies for challenging the dominant groups in the national discourse are enacted and given a public existence.

The goal of this paper is two-fold. First, I begin by reviewing several of the major points of emphasis among health educators as they begin to incorporate multicultural issues into healthcare education. I then consider the role of moral relativism, which is currently being endorsed by some health educators, as the foundation for resolving cross-cultural conflicts in healthcare. I argue that moral relativism is ultimately inconsistent with the stated goals in multicultural curricular proposals and fails to provide an effective framework for considering moral conflicts in cross-cultural settings. Instead, I propose that those methods seeking to establish a common morality, built upon mutually shared values, offer the most promising means of resolving cross-cultural conflicts. This leads to my second goal, to compare recent work in moral pragmatism with what is now widely known in bioethics as moral "principlism." I argue that while proponents of principlism and pragmatism each seek to establish a common foundation for moral deliberation, they fail to appreciate significant similarities between their respective approaches. Instead of offering two completely unique and independent methods of moral deliberation, I suggest that principlism and pragmatism embrace common themes that point us in a positive direction, providing an effective framework useful for considering cross-cultural conflicts in healthcare.

This study examined the psychometric properties of the Social Connectedness in Mainstream Society (SCMN) and the Social Connectedness in the Ethnic Community (SCETH) Scales in two groups of ethnic minorities. We especially examined their theoretical/conceptual and empirical viability in relation to other established constructs of general social connectedness, acculturation, and enculturation. Analyses of two sets of survey data from 200 Mexican American students in California and 134 Asian international students in Minnesota supported (a) construct validity of the SCMN and the SCETH as related but distinct structures, (b) convergent and discriminant validity in relation to acculturation and enculturation, and (c) high reliability. The examination of incremental validity in predicting subjective well-being further supported their distinctive utility in addition to other established constructs of general social connectedness, acculturation, enculturation, ethnic identity, and other group orientation. Implications for future research and practice are discussed.

During the pandemic, people have spent a lot of time online negotiating their responses to rapidly changing conditions during COVID-19. Reactions to the pandemic varied wildly, and while the issue might have seemed bipartisan, responses were often split along political lines. Online polarization is not a new phenomenon, but the pandemic provided scholars with new material to better understand the ways that arguments about policy ultimately filter down into polarized discussions of identity. This project argues that polarization online, particularly on the website Reddit.com, is exacerbated by features that hierarchically rank user submissions based on popularity, lending a populist slant to users’ experience of content. Using two case studies from the Reddit website, this thesis project uses rhetorical analysis to demonstrate that the use of memes as artifacts of identity aids in the polarization of online discourse by allowing modes of engagement based on judgment and tribalism. The introductory chapter describes the stakes of the project, summarizing the existing literature on polarization, memes, and identity. Next, Chapter 1 provides a rhetorical analysis of the Reddit platform, using medium theory to explicate the ways that fixed features of the website contribute to polarization. Then, Chapter 2 uses modal rhetorical analysis of memes to present a case study based on a group identity unified positively around a shared culture. The next chapter (3) uses modal rhetorical analysis to demonstrate the opposite – that is, memes in a group unified by their shared opposition to and disdain for a particular out-group. The concluding chapter uses the rhetorical analysis of Reddit as well as the findings from the case studies to theorize a Selfish Rhetoric that describes the conditions under which the success of a message is defined by its mass reach, its recognizability, and its replicability in ways that produce ideological profit.

Children and young people with cross-cultural backgrounds are significantly influenced by multiple cultures during their upbringing. They face the ambivalence and challenges of regularly dealing with multiple cultural frames of reference, norms and expectations, and often experience particular identity challenges. One might say that much of the ambivalence of modern intercultural societies may show up as internalized ambivalence in these “children of migration”. This article explores cross-cultural identity development. The aim is to further our understanding of how the identities of cross-cultural children and young people can be supported and their resources activated. This can both strengthen their resilience and well- being, and be of great value to society at large. Psychosocial/cultural interventions and creative projects in cross-cultural settings are potential arenas for this type of cultural health promotion. One example is the multicultural music project Fargespill (‘Kaleidoscope’). In a case study of Kaleidoscope, I describe and discuss how these participatory creative activities work, and ask how they may foster the development of constructive cross-cultural identities. Participant observation was conducted in Kaleidoscope throughout a year. In the light of theoretical perspectives from social and cultural psychology, the article analyzes identity issues and possibilities within this empirical context. Supporting cross-cultural identity development in a constructive manner is here operationalized as allowing, increasing and acknowledging identity complexity. The findings are categorized under the headings of resources, vulnerability and creativity. The project leaders make an effort to establish trust and a safe, supportive space. They apply a participatory method, in which the participants are seen as resources and their strengths and contributions are emphasized. In some situations, the vulnerability that may be caused by potentially being stereotyped is apparent, and identity definitions and complexities need to be negotiated. There are explicit expectations concerning creativity in the Kaleidoscope process, and the crossing of different cultural expressions, old and sometimes new, leads to the final creative product of the performance. To summarize, identity complexity is given space to play out, relating to both origins and current participation in culture in construction here in Norwegian society. Thus, at its best, Kaleidoscope sets the stage for a flexible and playful performance of identity. This may be one path towards appreciated and integrated intercultural identities.

Theories of cultural planning and sustainability highlight cultural capacity building as the fourth pillar of sustainability, alongside social, economic, and environmental aims, and integration as a new framework for combining these four pillars. Seeing cultural participation as the core of the complex puzzle, we regard the digitization of art and media as an engine for changing the dynamics of participatory culture. Further, digitization rearticulates the power relations between cultural infrastructures (production) and cultural access and participation (consumption). This chapter examines the dynamics of online digital cultural participation by ethnic minority (EM) youth in Hong Kong. By analyzing a questionnaire survey data set of EM youth in Hong Kong (N = 561), we demonstrate the various capacities and aspirations of cultural activities online among ethnic minority youth. The data were collected via local community networks of social workers and social enterprises. The sample covers diverse ethnic minority groups in Hong Kong, such as Indonesians, Filipinos, Indians, Pakistanis, Nepalese, and others. A typology of digital cultural capacity will be attempted using a descriptive analysis to show the EM youth’s access and participation in cultural, arts, and leisure activities on the Internet, controlled by demographic background variables such as gender, age, and class. Our core argument is that baseline digital capacity established above is complicated by EM youth’s Community Capacity, i.e. education/information attainment; capacity of engaging social agencies that hold power; Social Capital, i.e. resources and networks embodied in life domains such as school, family, friendship, work, and ethnic community cohesion; and Cultural Identity, i.e. self-recognition/respect and intra- and inter-ethnic identity negotiation and development. Our discussion, with these tiers of indicators, provides critical insights into EM youth’s participation in online cultural activities and the barriers to their inter-cultural integration.

This additional issue of Culture, Health & Sexuality brings together a selection of papers that examine contemporary sexual and reproductive norms and practices amongst minority ethnic communities in South-East Asia and Bhutan. The result of a collaboration with the Medical Committee Netherlands Vietnam and the Royal Tropical Institute in Amsterdam, this special issue includes the perspectives of both researchers and development practitioners working with minority ethnic groups. A growing body of work examines the dramatic changes in sexual and reproductive health behaviour, gender roles and identities among dominant ethnic and cultural groups in the region. Yet little research has been published on these topics in relation to minority and indigenous peoples. Conducting fieldwork research among such population groups is extremely challenging in many South East Asian countries (Turner 2010). Obtaining official clearance can be a lengthy process and qualitative social science approaches, including medical anthropology, are only beginning to be applied in a number of countries. Minority ethnic group members themselves are not yet active in the South-East Asian social science research community, the papers included here are therefore inevitably reflections on the Other. We would like to thank all those who worked painstakingly to share their scholarship and the participating minority groups who made these studies possible. Two recurrent themes emerge from this collected body of work: the side-effects of national modernization policies and the impacts of migration and increasing mobility, including new sexual networks and opportunities for transactional sex, with an associated vulnerability to HIV.

To assess the adequacy of cross cultural adaptations of survey questions on self reported tobacco and alcohol consumption in the United Kingdom. Assessment of consistency of data between studies identified through literature review. Studies evaluated with 12 guidelines developed from the research literature on achieving cross cultural comparability. The literature review identified 18 key studies, five of them on national samples. Survey instruments were obtained for 15 of these. The comparison of prevalence data in national surveys showed some important discrepancies, greater for tobacco than for alcohol. For example, prevalence of cigarette smoking in Bangladeshi women was 6% in a national survey in 1994 and 1% in a national survey in 1999; in Chinese men it was 31% in a survey in 1993-4 and 17% in one in 1999; in African-Caribbean men it was 29% in a 1992 survey and 42% in one in 1993-4. The most guidelines met by any study was three, although one study partly met a fourth. Two studies met no guidelines. Only four studies consulted with ethnic minority communities in developing the questionnaire, none checked each language version with all others, and two stated the questionnaire had not been validated. Surveys have not followed best practice in relation to measurement of risk factors in cross cultural settings. There is inconsistency in the prevalence data on smoking provided by different major national UK studies. Users of such data should be aware of their limitations. Research is needed to help achieve linguistic equivalence of survey questions in cross cultural research.

Objective To assess the adequacy of cross cultural adaptations of survey questions on self reported tobacco and alcohol consumption in the United Kingdom.Design Assessment of consistency of data between studies...

BackgroundMinor ethnic groups in Italy face unique challenges in accessing sexual health education and services due to cultural, linguistic, and social barriers contributing to disparities in STI and HIV outcomes....

The importance of corporate culture in a cross-cultural environment is considerable. Corporate culture serves as the "glue" that unites individuals with diverse mentalities, worldviews, values, traditions, and norms of behavior. The article summarizes notable cultural theories, including those by Geert Hofstede, Edward Hall, Florence Kluckhohn, Fred Strodtbeck, and Ronald Inglehart. Particular emphasis is placed on the model of cultural differences by Fons Trompenaars and Charles Hampden-Turner, based on seven dimensions. This model provides insights into national cultures, enabling organizations to analyze these dimensions and create a shared corporate culture for employees from various nationalities and ethnic groups. Key factors to consider when shaping corporate culture in a cross-cultural setting are identified based on analyzed theories. The significance of corporate culture in a cross-cultural environment for various target groups of influence is emphasized: business partners, employees, owners, consumers (clients) and governmental authorities. Using comparative, generalization, and evaluative methods, the article identifies the core functions of corporate culture in a cross-cultural setting: integrative, crisis-resistance, supportive, adaptive, informational, protective, motivational, and reputational. They emphasize the importance of corporate culture in a cross-cultural environment. All organizations, regardless of their type of activity, ownership form, purpose, or methods of operation, possess a corporate culture. This culture develops both consciously and unconsciously. However, deliberate efforts to shape corporate culture yield significantly better results, especially in organizations employing individuals of diverse nationalities or ethnic backgrounds. Taking into account the worldviews, traditions, attitudes, and relationships of such employees—through the application of analyzed cultural concepts and understanding the functions and significance of culture for different target groups—enables the creation and cultivation of a functional and effective corporate culture.