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History : Communication Challenges

Cultural

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 table below contrasts aspects of communication that may be problematic due to differing interpretations. 

Cultural Comparisons and 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 healing

Asking Appropriate Questions

Asking questions about the abuse should assist in the assessment of the type, manner, and intensity of the abuse; the source(s) of injury; if any threats were made; potential for future abuse (safety); and, in cases of suspected sexual abuse, the perception of 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 they 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?
    • What body parts were involved (on the child/adolescent)?
    • 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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