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HISTORY: Communication Challenges

Cultural Competence
line line Building rapport to facilitate an accurate history may hinge on the provider being respectful and sensitive to communication cues. Interpreting statements and findings appropriately may depend on knowing racial, ethnic, or religious practices. The Cultural Interpretations table below contrasts aspects of communication that may be problematic due to differing interpretations.

Cultural Interpretations
Aspect Meaning in Dominant American Culture Meaning in Other Cultures
Silence Discomfort, stubbornness, resistance -Agreement or respect
-Acknowledgement listener has heard speaker
-If a direct no would be rude, may mean no
Nodding Agreement, understanding, or empathy May not indicate understanding or agreement
Conversation style -Blunt and to the point
-Social amenities excluded due to perception of time
-Often more comfortable to talk as strangers
-Indirect or through stories
-Social amenities important because they lessen embarrassment
-Information shared is useful to understanding the etiology of disease
Voice -Loud voice often seen as aggressive
-Soft voice may signal lack of self-respect, embarrassment, dishonesty
-Loud voice and repetitions may be for emphasis
-Soft voice may be sign of respect
Eye contact Positive self-concept, openness, honesty, interest -Persistent, direct eye contact considered intrusive, confrontational, or harmful
-Avoiding direct eye contact may be sign of respect or appropriate behavior between a man and a woman
Personal space Deference to personal boundaries and personal space:
-Intimate zone: 0-18 inches
-Personal zone: 18 inches to 3 feet
-Public zone: 3-6 feet
-Many cultures have considerably smaller zones
-Physical closeness common
-Standing "too close" may not be aggressive
Touch -Touching others is minimized
-Need permission to touch strangers
-Touch is a way to help and heal
-In some cultures associated with protection and "magical" healing

Asking Appropriate Questions
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The purpose of asking questions about the abuse is to assess the type, manner, and intensity of the abuse; the source(s) of injury; and whether force was used.

The box below provides examples of appropriate specific questions.

Questions to Ask about Abuse
WHO was involved in the abuse?
Was it a stranger, acquaintance, neighbor, relative, friend?
Is the person still nearby?
Does he/she have continued access to the child/adolescent?
Were there witnesses or other victims?

WHEN did the abuse occur?
How long did the abuse incident last?
How many times did the abuse happen?
When were these other times?

WHERE did the abuse occur?
Was it a public place, a home, the home of the child/adolescent?

WHAT happened? HOW did the abuse occur?
Were there factors that may have aggravated the occurrence (e.g., the abuser was drunk or on drugs)?

Avoid asking "why" questions because they may imply that the child/adolescent is somehow guilty.

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History: Overview   History: Taking Steps  History: Communication Challenges  History: Taking a History from the Parent/Caregiver  History: Taking the History from the Child/Adolescent  History: Responding to the Disclosure of Abuse  History: Additional Resources 

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Cultural Competence
Asking Appropriate Questions