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Master of Advanced Studies in INTERCULTURAL COMMUNICATION

Case Studies in Intercultural Communication

Welcome to the MIC Case Studies page.

Case Studies Intercultural Communication

Here you will find more than fifty different case studies, developed by our former participants from the Master of Advanced Studies in Intercultural Communication. The richness of this material is that it contains real-life experiences in intercultural communication problems in various settings, such as war, family, negotiations, inter-religious conflicts, business, workplace, and others.

Cases also include renowned organizations and global institutions, such as the United Nations, Multinationals companies, Non-Governmental Organisations, Worldwide Events, European, African, Asian and North and South America Governments and others.

Intercultural situations are characterized by encounters, mutual respect and the valorization of diversity by individuals or groups of individuals identifying with different cultures. By making the most of the cultural differences, we can improve intercultural communication in civil society, in public institutions and the business world.

How can these Case Studies help you?

These case studies were made during the classes at the Master of Advanced Studies in Intercultural Communication. Therefore, they used the most updated skills, tools, theories and best practices available. They were created by participants working in the field of public administration; international organizations; non-governmental organizations; development and cooperation organizations; the business world (production, trade, tourism, etc.); the media; educational institutions; and religious institutions. Through these case studies, you will be able to learn through real-life stories, how practitioners apply intercultural communication skills in multicultural situations.

Why are we opening our "Treasure Chest" for you?

We believe that Intercultural Communication has a growing role in the lives of organizations, companies and governments relationship with the public, between and within organizations. There are many advanced tools available to access, analyze and practice intercultural communication at a professional level. Moreover, professionals are demanded to have an advanced cross-cultural background or experience to deal efficiently with their environment. International organizations are requiring workers who are competent, flexible, and able to adjust and apply their skills with the tact and sensitivity that will enhance business success internationally. Intercultural communication means the sharing of information across diverse cultures and social groups, comprising individuals with distinct religious, social, ethnic, and educational backgrounds. It attempts to understand the differences in how people from a diversity of cultures act, communicate and perceive the world around them. For this reason, we are sharing our knowledge chest with you, to improve and enlarge intercultural communication practice, awareness, and education.

We promise you that our case studies, which are now also yours, will delight, entertain, teach, and amaze you. It will reinforce or change the way you see intercultural communication practice, and how it can be part of your life today. Take your time to read them; you don't need to read all at once, they are rather small and very easy to read. The cases will always be here waiting for you. Therefore, we wish you an insightful and pleasant reading.

These cases represent the raw material developed by the students as part of their certification project. MIC master students are coming from all over the world and often had to write the case in a non-native language. No material can be reproduced without permission. © Master of Advanced Studies in Intercultural Communication , Università della Svizzera italiana, Switzerland.

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Cross-cultural Communication: Case Study

2017, © www.odayalnabhan.com

Cross-cultural communication is the process by which people from different cultures exchange, negotiate, and mediate their cultural differences through language, space relationships, and non-verbal gestures. In business, cross-cultural communication is a significant determinant of how a person will successfully carry out business with stakeholders and teams beyond their cultural boundary. Benefits such as increased bandwidth, competitive advantage and institutional knowledge are best realized when there is adequate and efficient communication (Bilets, & Serdyuk, 2016).

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In a world so diverse and culturally rich as the one we live in today; it would be a pity to waste the possibility to broaden our horizons and understand a little of what is distant from our everyday lives. Communication is the most powerful tool we have to connect with other human beings, not only to fulfil our social needs but also for business purposes. To be effective communicators, one is not only required to speak several languages: there is so much more than words can describe. Managers need to learn about other cultures’ traditions, body language, values, customs, and many more cultural aspects that deeply influence the way business is conducted around the world. This is why cross-cultural communication is such an important topic for business studies and has long been rightfully studied. The analysis of the concepts of culture and communication are the key to understanding such a complex theme.

Studies in Media and Communication

Maurice Odine

The paper addresses the foundation of cross-cultural communication and its relation to global business. Shina Neo (2015) states that, humans take for granted their communication with one another, stating, “In a multicultural organization, how employees communicate can set the tone.” Populations in North Africa and the Middle East believe in “external control” over destiny, meaning events are predetermined. In Japan, the productivity movement is based on respect for humanity, which is focused on cooperation. John-ren Chen and Christian Smekal (2004) argue that liberalizing international markets creates foreign capital and foreign investment. Concurring in support of global business are the European Union and African Union, Organization of American States and Caribbean Basin, plus the International Monetary Fund and World Bank. Furthering cross-cultural communication and global business is new information technology. Meanwhile, the latter has dismantled territorial boundaries. Nilufer...

Valeria Sjomina

IAEME Publication

In today’s changing business scenario increasing number of firms extends their business abroad. Effective communication with people of different cultures is especially challenging. Cultural awareness shapes how business firms behave in cross-culturally reflected international markets. It is broadly recognized that cultural factors act as invisible barriers in international business communications. Understanding cultural differences is one of the most significant skills for firms to develop in order to have a competitive advantage in international business. Organizations should focus on eliminating the cross cultural communication barriers. Understanding of cultural diversity is the key to effective cross-cultural communications. Firms which fail to understand the cross cultural communication barriers face several issues in many aspects of international business communication. It impacts free trade policies, localization and standardization strategy decisions, advertising, brand effectiveness, business relationships, international business management, international marketing, international negotiation, and consumer behavior, staffing, industrial relations, interpersonal relationships, negotiation, and teambuilding. Cross-cultural communication presents a fine opportunity to foster global peace and prosperity. It may also present unpleasant consequences if not well managed. Many problems arise in our workplace today as a result of the barriers cultural diversity imposes on cross cultural communication. Cross-cultural communication barriers such as anxiety, uncertainty, stereotyping, and ethnocentrism are caused by inadequate cultural knowledge and the lack of intercultural communicative skills. Adequate training in cross cultural communication and exposure to other cultures is essential in eliminating these barriers. This paper INTERNATIONAL JOURNAL OF MANAGEMENT (IJM) ISSN 0976-6502 (Print) ISSN 0976-6510 (Online) Volume 6, Issue 1, January (2015), pp. 348-351 © IAEME: http://www.iaeme.com/IJM.asp Journal Impact Factor (2014): 7.2230 (Calculated by GISI) IJM © I A E M E International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 6, Issue 1, January (2015), pp. 348-351 © IAEME 349 R. Delecta Jenifer and G. P. Raman, “Cross Cultural Communication Barriers in Workplace” – (ICAM 2015) concludes with a suggestion for the understanding of the effect of cross cultural communication barriers on international business.

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Communication competencies, culture and SDGs: effective processes to cross-cultural communication

Stella Aririguzoh 1

Humanities and Social Sciences Communications volume 9 , Article number: 96 ( 2022 ) Cite this article

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Business and management
Cultural and media studies

Globalization has made it necessary for people from different cultures and nations to interact and work together. Effective cross-cultural communication seeks to change how messages are packaged and sent to people from diverse cultural backgrounds. Cross-cultural communication competencies make it crucial to appreciate and respect noticeable cultural differences between senders and receivers of information, especially in line with the United Nations’ (UN) recognition of culture as an agent of sustainable development. Miscommunication and misunderstanding can result from poorly encrypted messages that the receiver may not correctly interpret. A culture-literate communicator can reduce miscommunication arising from a low appreciation of cultural differences so that a clement communication environment is created and sustained. This paper looks at the United Nations’ recognition of culture and how cultural differences shape interpersonal communication. It then proposes strategies to enhance cross-cultural communication at every communication step. It advocates that for the senders and receivers of messages to improve communication efficiency, they must be culture and media literates.

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Blerim Limani & Emira Limani

Public interest

The United Nations has recognized culture as a causal agent of sustainability and integrated it into the SDG goals. Culture reinforces the economic, social, and communal fabrics that regulate social cohesion. Communication helps to maintain social order. The message’s sender and the receiver’s culture significantly influence how they communicate and relate with other people outside their tribal communities. Globalization has compelled people from widely divergent cultural backgrounds to work together.

People unconsciously carry their cultural peculiarities and biases into their communication processes. Naturally, there have been miscommunications and misunderstandings because people judge others based on their cultural values. Our cultures influence our behaviour and expectations from other people.

Irrespective of our ethnicities, people want to communicate, understand, appreciate, and be respected by others. Culture literate communicators can help clear some of these challenges, create more tolerant communicators, and contribute to achieving global sustainable goals.

Introduction

The United Nations established 17 Sustainable Development Goals (SDGs) in 2015 to transform the world by 2030 through simultaneously promoting prosperity and protecting the earth. The global body recognizes that culture directly influences development. Thus, SDG Goal 4.7 promotes “… a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development.” Culture really matters (Seymour, 2007 ). Significantly, cultural cognition influences how people process information from different sources and suggests policies they may support or oppose (Rachlinski, 2021 ). Culture can drive sustainable development (United Nations, 2015 ; De Beukelaer and Freita, 2015 ; Kangas et al., 2017 ; Heckler, 2014 ; Dessein et al., 2015 ; and Hosagrahar, 2017 ).

UNESCO ( 2013 , p.iii ; 2017 , p.16; 2013a , p. 30) unequivocally states that “culture is a driver of development,” an “enabler of sustainable development and essential for achieving the 2030 Agenda” and as “an essential pillar for sustainable development.” These bold declarations have led to the growth of the cultural sector. The culture industry encourages economic growth through cultural tourism, handicraft production, creative industries, agriculture, food, medicine, and fisheries. Culture is learned social values, beliefs, and customs that some people accept and share collectively. It includes all the broad knowledge, beliefs, art, morals, law, customs, and other experiences and habits acquired by man as a member of a particular society. This seems to support Guiso, Paola and Luigi ( 2006 , p. 23) view of culture as “those customary beliefs and values that ethnic, religious, and social groups transmit fairly unchanged from generation to generation.” They assert that there is a causality between culture and economic outcomes. Bokova ( 2010 ) claims that “the links between culture and development are so strong that development cannot dispense with culture” and “that these links cannot be separated.” Culture includes customs and social behaviour. Causadias ( 2020 ) claims that culture is a structure that connects people, places, and practices. Ruane and Todd ( 2004 ) write that these connections are everyday matters like language, rituals, kingship, economic way of life, general lifestyle, and labour division. Field ( 2008 ) notes that even though all cultural identities are historically constructed, they still undergo changes, transformation, and mutation with time. Although Barth ( 1969 ) affirms that ethnicity is not culture, he points out that it helps define a group and its cultural stuff . The shared cultural stuff provides the basis for ethnic enclosure or exclusion.

The cultural identities of all men will never be the same because they come from distinctive social groups. Cultural identification sorts interactions into two compartments: individual or self-identification and identification with other people. Thus, Jenkins ( 2014 ) sees social identity as the interface between similarities and differences, the classification of others, and self-identification. He argues that people would not relate to each other in meaningful ways without it. People relate both as individuals and as members of society. Ethnicity is the “world of personal identity collectively ratified and publicly expressed” and “socially ratified personal identity‟ (Geertz, 1973 , p. 268, 309). However, the future of ethnicity has been questioned because culture is now seen as a commodity. Many tribal communities are packaging some aspects of their cultural inheritances to sell to other people who are not from their communities (Comaroff and Comaroff, 2009 ).

There is a relationship between culture and communication. People show others their identities through communication. Communication uses symbols, for example, words, to send messages to recipients. According to Kurylo ( 2013 ), symbols allow culture to be represented or constructed through verbal and nonverbal communication. Message receivers may come from different cultural backgrounds. They try to create meaning by interpreting the symbols used in communication. Miscommunication and misunderstanding may arise because symbols may not have the same meaning for both the sender and receiver of messages. If these are not efficiently handled, they may lead to stereotyping, prejudice, and discrimination. Monaghan ( 2020 ), Zhu ( 2016 ), Holmes ( 2017 ), Merkin ( 2017 ), and Samovar et al. ( 2012 ) observe that inter-cultural communication occurs between people from different cultural groups. It shows how people from different cultural backgrounds can effectively communicate by comparing, contrasting, and examining the consequences of the differences in their communication patterns. However, communicating with others from different cultural backgrounds can be full of challenges, surprises, and re-learning because languages, values, and protocols differ. Barriers, like language and noise, impede communication by distorting, blocking, or altering the meaning.

Communication patterns change from one nation to the next. It is not uncommon, for example, for an American, a Nigerian, a Japanese national, or citizens of other countries to work together on a single project in today’s multi-cultural workplace. These men and women represent different cultural heritages. Martinovski ( 2018 ) remarks that both humans and virtual agents interact in cross-cultural environments and need to correctly behave as demanded by their environment. Possibly too, they may learn how to avoid conflicts and live together. Indeed, García-Carbonell and Rising ( 2006 , p. 2) remark that “as the world becomes more integrated, bridging the gap in cultural conflicts through real communication is increasingly important to people in all realms of society.” Communication is used to co-ordinate the activities in an organization for it to achieve its goals. It is also used to signal and order those involved in the work process.

This paper argues that barriers to cross-cultural communication can be overcome or significantly reduced if the actors in the communication processes become culture literates and competent communicators.

Statement of the problem

The importance of creating and maintaining good communication in human society cannot be overemphasized. Effective communication binds and sustains the community. Cross-cultural communication problems usually arise from confusion caused by misconstruction, misperception, misunderstanding, and misvaluation of messages from different standpoints arising from differences in the cultures of the senders and receivers of messages. Divergences in cultural backgrounds result in miscommunication that negatively limits effective encrypting, transmission, reception, and information decoding. It also hinders effective feedback.

With the rapid spread of communication technologies, no community is completely isolated from the rest of the world. Present-day realities, such as new job opportunities and globalization, compel some people to move far away from their local communities and even their countries of origin to other places where the cultures are different. Globalization minimizes the importance of national borders. The world is no longer seen as a globe of many countries but as a borderless entity (Ohmae, 1999 ) and many markets (Levitt, 1983 ) in different countries with different cultures. As a matter of necessity, people from other countries must communicate.

The United Nations ( 2015 ) recognizes culture’s contribution to sustainable development and promotes local cultures in development programmes to increase local population involvement. Despite the United Nations’ lofty ideals of integrating culture into development, culture has hindered development at different levels. Interventions meant to enhance development are sometimes met with opposition from some people who feel that such programmes are against their own culture.

Gumperz ( 2001 , p. 216) argues that “all communication is intentional and grounded in inferences that depend upon the assumption of mutual good faith. Culturally specific presuppositions play a key role in inferring what is intended.” Cross-border communications reflect the kaleidoscope of the diverse colours of many cultures, meeting, clashing, and fusing. Like Adler ( 1991 , p. 64) observes, “foreigners see, interpret, and evaluate things differently, and consequently act upon them differently.” Diversities in culture shape interpersonal communication. Yet the basic communication process is the same everywhere. It is in these processes that challenges arise. Therefore, this study seeks to examine how each of these steps can be adapted to enhance cross-cultural communication, especially in today’s digitized era of collapsing cultural boundaries. Barriers to cross-cultural communication can be significantly reduced if the actors in the communication processes become culture literates and competent communicators.

Study objectives

The objectives of this study are

To examine United Nations efforts to integrate culture into sustainable development.

To suggest modifications to each communication process step to improve effective cross-cultural communication.

Literature review

Some authors have tried to link culture, communication, and sustainable goals.

The need to know about people’s culture

There are compelling reasons to learn about other people’s cultures.

Cultural literacies: Difficulties in cross-cultural communication can be reduced when senders of messages understand that the world is broader than their ethnocentric circles. It demands that senders of messages know that what they believe may not always be correct when communicating with receivers of these messages who are from different cultures. Logical reasoning will expect increased exposure to different cultures to increase understanding. When people of different groups communicate frequently, it is anticipated that they should understand each other better. This is what Hirsch ( 1987 ) labels as cultural literacy . In the ordinary course of things, common knowledge destroys mutual suspicion and misinterpretation that often generate conflicts.

To protect the earth: It is essential to point out that at “the most global level, the fate of all people, indeed the fate of the earth, depends upon negotiations among representatives of governments with different cultural assumptions and ways of communicating” (Tannen, 1985 , p. 203). If the world is to be protected, it is necessary to understand other peoples’ cultures who live and interact with us at different fronts and in this same world. The world is still our haven. Nevertheless, Vassiliou et al. ( 1972 ) find that increased exposure can increase people’s mutual negative stereotyping. Tannen ( 1985 , p. 211) remarks that stereotypes of ethnic groups partly develop from the poor impressions that people from other cultures have about the natives because they hold different meanings for both parties. Stereotyping is detrimental to cross-cultural communication, and its dismissal is necessary for any successful cross-cultural exchange.

Spin-offs from globalization: Bokova ( 2013 ) observes that globalization transforms all societies and brings culture to the front. She remarks that communities are increasingly growing diverse and yet interconnected. The spin-offs from globalization open great doors for exchanges, mutual enrichment of persons from different cultures, and pictures of new worlds.

The dynamics of cross-cultural communication

Different cultures emphasize different values. The emphasis on one value by one culture may lead to difficulties in cross-cultural communication with another person who does not see that particular value in the same light, for example, timeliness. It is crucial to note Sapir’s ( 1956 , p. 104) insistence that “every cultural pattern and every single act of social behaviour involves communication in either an explicit or implicit sense.” Even though Hofstede ( 2005 , p. 1) comments that “cultural differences are nuisance at best and often a disaster,” UNESCO ( 1998 , 1999 ) recognizes cultural diversity as an “essential factor of development” and an issue that matters. This makes cultural diversity a blessing rather than a disaster. The various shades of cultural values influence how we behave and communicate with others outside our cultural environment. Our ideals and biases also influence communication.

Trompenaars and Hampden-Turner ( 1997 ) developed a culture model with seven dimensions. They are universalism versus particularism (rules versus relationships); individualism versus communitarianism (the individual versus the group); specific versus diffuse (how far people get involved); neutral versus emotional (how people express emotions) ; achievement versus ascription (how people view status); sequential time versus synchronous time (how people manage time); and internal direction versus outer direction (how people relate to their environment). These cultural models signify how people from these areas communicate. People from different backgrounds may have difficulties communicating as their values may be significantly different. A good communicator must take note of this distinctiveness in values because they impact the communication processes. For example, a person who is particular about upholding written rules may not be interested in knowing who the culprit is before administering sanctions. But the other person interested in maintaining a good relationship with others may re-consider this approach.

Hofstede ( 1980 ) identifies five significant values that may influence cross-cultural communication:

Power distance: This is the gap between the most and the least influential members of society. People from different cultures perceive equality in various ways. The social hierarchy or status determines where individuals are placed. Status is conferred by inheritance or by personal achievement. Some cling to societal classification and its hierarchy of power. Others value and cherish the equality of all people. Yet, other cultures see other people as dependents and somehow inferior beings. A king in an African community is seen as far more powerful and important than his servants, who are expected to pay obeisance to him. Most countries in Europe are egalitarian. Arabic and Asian countries are high on the power index.

Individualism versus collectivism: This explains the extent to which members of a particular culture value being seen first, as individuals or as members of a community. As individuals, they are entirely held accountable for their errors. They are also rewarded as individuals for their exploits. However, in some cultures, the wider community is involved. Suppose a person makes an inglorious error. The whole community where that individual comes from shares in it. The same goes if he wins laurels and awards. The individual does not exist primarily for himself. African, Japanese, Indian, and most Asiatic nations follow the collective approach. A Chinese man has his Guanxi or Guanshi. This is his network of influential and significant contacts that smoothen his business and other activities (Yeung and Tung, 1996 ). He succeeds or fails based on his personal relationships. In other words, the basis of business is friendship. This is clear evidence of collectivism. Most people from America and Europe are individualistic. It must be pointed out that personal values mediate both community and individualistic spirit. Trompenaars and Hampden-Turner’s communitarianism vs. individualism appears very similar to this Hofstede’s individualism/collectivism orientation. The information receiver who values his individuality will be offended if he is seen as just a group member or if his negative performance on the job is discussed openly. The message sender who appreciates his subordinates would send personalized messages and expect their feedback.

Uncertainty avoidance: This shows the degree to which a particular culture is uncomfortable with uncertainties and ambiguities. Some cultures avoid or create worries about how much they disclose to other people. A culture with high uncertainty avoidance scores wants to avoid doubts by telling and knowing the absolute truth in everything. For them, everything should be plainly stated. When situations are not like this, they are offended, worried, and intolerant of other people or groups they feel are hiding facts by not being plain enough. Hofstede and Bond ( 1988 ) write that this trait is very peculiar to western Europeans. This means that people from countries like Greece, Turkey, and Spain are very high on uncertainty avoidance. Communication between people with high or low uncertainties may be hindered. Some people may appear rude and uncouth because of their straightforward ways of talking. Some Africans may see some Americans and people from Europe as too wide-mouthed because they feel they do not use discretion in talking. They say things they may prefer to keep silent about and hide from the public’s ears. On the other hand, some Americans may see some Africans as unnecessarily secretive. Trompenaars and Hampden-Turner’s ( 1997 ) universalism/particularism explains why some cultures insist on applying the rule of law no matter who the offender is.

Masculinity/feminity roles : Hofstede ( 2001 ) defines masculinity as society’s preference for success, heroism, assertiveness, and material rewards for success. Conversely, femininity is seen as the preference for co-operation, diffidence, caring for the weak and quality of life. The male-female contradiction affects communication. Females are expected to be meek homemakers that tend and nurture their family members. Like Sweden and Norway, cultures that favour females do not discriminate between the sexes. Japan and Nigeria have cultures that are predominantly masculine in orientation. Competitive and aggressive females are frowned at and seen as social deviants. In the other cultures where females are more favoured, a man may land in court and face public condemnation for domestic violence. Hofstede ( 1998 ) believes that how different cultures see the male/female roles influence how they treat gender, sexuality, and religion.

Long-time orientations: A particular society accepts some degree of long or short associations. Japanese culture scores high in long-term orientation values, commitments, and loyalty. They respect tradition, and therefore, changes in their society take a longer time to happen. Cultures with low long-term orientation do not value tradition much, nor do they go out of their way to nurture long-standing relationships. Literally, changes occur in rapid succession. There appears to be more attachment to the pursuit of immediate self-satisfaction and simple-minded well-being. Baumeister and Wilson ( 1996 , pp. 322–325) say that meaning comes from a sense of purpose, efficacy, value, and a sense of positive self-worth. Thus, if you communicate with somebody with a short-term orientation, you may think that he is too hasty and intemperate, while he may feel that you are too sluggish and not ready to take immediate action.

Hall ( 1983 ) introduces two other factors:

Time usage: Some cultures are monochronic, while others are polychronic. Monochronic cultures are known for doing one thing at a time. Western Europe is monochronic in time orientation, as illustrated by the familiar adage that says, “There is a time and place for everything!” Persons from this cultural background are very punctual and strictly adhere to plans. They are task-oriented. Polychronic cultures schedule multiple tasks simultaneously, even though there may be distractions and interruptions while completing them. Plans may often change at short notice. Such different time management and usage may constrict effective communication. A London business entrepreneur will find it difficult to understand why his business partner from Nigeria may be thirty minutes late for a scheduled meeting. The answer is in their perception of time. Some Nigerians observe what is referred to as African time , where punctuality is tacitly ignored.

Low and high context: This refers to how much a culture depends on direct or indirect verbal communication. According to Hall ( 1976 ), low context cultures explicitly refer to the topic of discussion. The speaker and his audience know that the words mean exactly what they say. In high context cultures, the meanings of words are drawn from the context of the communication process. The words may never mean what they say. For example, the sentence: I have heard . In the low context culture, it merely means that the listener has used his ears to listen to what the speaker is saying. In the high context culture, the listener knows more than what the speaker is saying and may be planning something unpleasant. Europeans and North Americans have low contexts. African and Asian nations have high contexts.

Vaknin ( 2005 ) brings in another value:

Exogenic and endogenic: This shows how people relate to their environment. Deeply exogenic cultures look outside themselves to make sense of life. Hence, they believe in God and His power to intervene in the affairs of men. Endogenic cultures draw on themselves when searching for the meaning of life. They think they can generate solutions to tackle the problems facing them. While the endogenic person may exert himself to find a solution to a challenge, his exogenic partner may believe that supernatural help will come from somewhere and refuses to do what is needed. Of course, this provides a problematic platform for effective communication.

The United Nations’ sustainable development goals and culture

The United Nations recognizes that culture is implicitly crucial to the achievement of the SDGs. No meaningful development can occur outside any cultural context because every person is born into a culture. To a large extent, our cultural foundations determine what we do and how we see things. Therefore, culture must be integrated into sustainable development strategies. Some specific goals’ targets acknowledge that culture drives development. Sustainable development revolves around economic, social, and environmental objectives for people. These goals are implicitly or explicitly dependent on culture because culture impacts people.

There are 17 Sustainable Development Goals. However, there are four specific ones that refer to culture are:

SDG 4 focuses on quality education

By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development

In other words, quality education is most effective if it responds to a place and the community’s cultural context and exactitudes. This target hinges on education promoting peace, non-violence, and cultural diversity as precursors to sustainable development. Encouraging respect for cultural diversity within acceptable standards facilitates cultural understanding and peace.

SDG 8 focuses on decent work and economic growth

By 2030, devise and implement policies to promote sustainable tourism that creates jobs and promotes local culture and products

Strengthening trade in cultural goods and services will provide growth impetus for local, national, and international markets. These will create employment opportunities for people whose work revolves around cultural goods. Cultural tourism generates revenues that improve the economy. In this sense, culture facilitates the community’s well-being and sustainability.

SDG 11 focuses on sustainable cities and communities

Target 11.4

Strengthen efforts to protect and safeguard the world’s cultural and natural heritage

When our cultural heritage is carefully managed, it attracts sustainable investments in tourism. The local people living where this heritage is domiciled ensure that it is not destroyed and that they themselves will not damage the heritage areas.

SDG 12 focuses on responsible consumption and production

Develop and implement tools to monitor sustainable development impacts for sustainable tourism that creates jobs and promotes local culture and products

Several indigenous livelihoods and crafts are built on local knowledge and management of the ecosystem, natural resources, and local materials. If natural resources are depleted, production will be endangered. Local livelihoods that utilize low technology and energy generate less waste and keep their environment free from pollution. In other words, proper management of the ecosystem prevents biodiversity loss, reduces land degradation, and moderates adverse climate change effects. Where there are natural disasters, traditional knowledge already embedded in the people’s culture helps them become resilient.

Theoretical framework

The social construction of reality is hinged on the belief that people make sense of their social world by assembling their knowledge. Scheler ( 1960 ) labels this assemblage the Sociology of Knowledge . Berger and Luckmann ( 1966 , p.15) contend that this “knowledge is concerned with the analysis of the social construction of reality.” Social construction theory builds on peoples’ comprehension of their own life experiences. From there, people make assumptions about what they think life is or should be. Young and Collin ( 2004 ) present that social constructionism pays more attention to society than individuals. Communities determine what they feel is acceptable. What is widely accepted by a particular community may be unacceptable to other people who are not members of this group. Therefore, people see an issue as good or bad based on their group’s description. Thus, what is a reality in Society A may be seen as illegal in Society B . Berger and Luckmann ( 1966 ) claim that people create their own social and cultural worlds and vice versa. According to them, common sense or basic knowledge is sustained through social interactions. These, in turn, reinforce already existing perceptions of reality, leading to routinization and habitualization. Berger and Luckmann ( 1991 ) say that dialogue is the most important means of maintaining, modifying, and reconstructing subjective reality.

Burr ( 2006 ) writes that the four fundamental tenets of social constructionism are: a critical instance towards taken-for-granted knowledge, historical and cultural specificity; knowledge sustained by social processes; and that knowledge and social action go together. This taken-for-granted knowledge is a basic common-sense approach to daily interactions. Historical and cultural specificities look at the peculiar but past monuments that have shaped the particular society. Knowledge is created and sustained by socialization. Good knowledge improves the common good. However, whoever applies the knowledge he has acquired wrongly incurs sanctions. This is why convicted criminals are placed behind bars.

Social constructions exist because people tacitly agree to act as if they do (Pinker, 2002 ). Whatever people see as realities are actually what they have learnt, over long periods, through their interactions with their society’s socialization agents such as the family, schools and churches. Cultural realities are conveyed through a language: the vehicle for communication. Language communicates culture by telling about what is seen, spoken of, or written about. However, groups construct realities based on their cultures. The media construct realities through the production, reproduction, and distribution of messages from which their consumers give meaning to their worlds and model their behaviours.

The method of study

The discourse analysis method of study is adopted for this work. Foucault ( 1971 ) developed the ‘discursive field’ to understand the relationships between language, social institutions, subjectivity, and power. Foucault writes that discourses relate to verbalization at the most basic level. The discursive method explores the construction of meanings in human communication by offering a meaningful interpretation of messages to enhance purposeful communication. Discourse analysis examines how written, or spoken language is used in real-life situations or in the society. Language use affects the creation of meaning; and, therefore, defines the context of communication. Kamalu and Isisanwo ( 2015 ) posit that discourse analysis considers how language is used in social and cultural contexts by examining the relationship between written and spoken words. Discourse analysis aims to understand how and why people use language to achieve the desired effect. The discursive method explores the construction of meanings in human communication by offering a meaningful interpretation of messages to enhance purposeful communication. Gale ( 2010 ) says that meaning is constructed moment by moment. Garfinkel ( 1967 ) explains this construction as the common-sense actions of ordinary people based on their practical considerations and judgments of what they feel are intelligible and accountable to others. According to Keller ( 2011 ), a peoples’ sense of reality combines their routinized interactions and the meanings they attach to objects, actions, and events. It is in this understanding of the natural use of language that some barriers to effective cross-cultural communication can be reduced.

Messages may assume different meanings in different situations for other people. These meanings affect social interactions. They either encourage or discourage further human communication. As Katz ( 1959 ) has written, interpersonal relationships influence communication. To make meaning out of messages and improve human relationships, it is necessary to understand that content and context may not represent the same thing to people in different situations. Waever ( 2004 , p. 198) states that “things do not have meaning in and of themselves, they only become meaningful in discourse.” Since people’s perspectives are different, it becomes extremely difficult to form a rigid basis on specific ideas. Ideas are discussed on their merits. Discursive analysis inspects the ways individuals construct events by evaluating language usage in writing, speech, conversation, or symbolic communication (Edwards, 1997 ; Harre and Gillet, 1994 ). Language is the carrier of culture. According to Van Dijk ( 1995 , p. 12), this approach is used to study descriptive, explanatory, and practical issues in “the attempt to uncover, reveal or disclose what is implicit, hidden or otherwise not immediately obvious in relations of discursively enacted dominance or their underlying ideologies.” The media play fundamental roles in the processes of constructing or reconstructing reality. They can do these because of Aririguzoh’s ( 2004 ) observation that the press impacts the political and socio-cultural sub-systems.

Culture at the international galleries

The affairs of culture came into international prominence at the UNESCO’s World Conference on Cultural Policies held in Mexico in 1982. This conference gave a broad definition of culture to include “the whole complex of distinctive spiritual, material, intellectual and emotional features that characterize a society or social group. It includes not only the arts and letters but also modes of life, the fundamental rights of the human being, value systems, traditions and beliefs” (UNESCO, 1982 , p. 1).

The United Nations World Commission on Culture and Development, led by J. Perez de Cuellar, published our Creative Diversity’s Landmark Report (UNESCO, 1995 ). This report points out the great importance of incorporating culture into development. Although the Commission recognizes cultural diversities, it sees them as the actual vehicles driving creativity and innovation. During the World Decade on Culture and Development (1988–1998), UNESCO stepped up again to campaign for greater recognition of culture’s contribution to national and international development policies. In 1998, Stockholm hosted an Inter-governmental Conference on Cultural Policies for Development. Its Action Plan on Cultural Policies for Development reaffirmed the correlation between culture and development (UNESCO, 1998 ). In 1999, UNESCO and the World Bank held the Inter-governmental Conference, Culture Counts , in Florence. Here, ‘cultural capital’ was emphasized as the tool for sustainable development and economic growth (UNESCO, 1999 ).

The United Nations General Assembly adopted the 2005 World Summit Outcome Document . Here, cultural diversity was explicitly admitted as a contributor to the enrichment of humankind. The United Nations General Assembly Resolutions on Culture and Development adopted in 2010 and 2011 (65/166 and 66/208) recognize culture as an “essential component of human development” and “an important factor in the fight against poverty, providing for economic growth and ownership of the development processes.” These resolutions called for the mainstreaming of culture into development policies at all levels. The UN System Task Team on the Post 2015 Development Agenda issued a report, Realizing the Future We Want for All ( 2012 , p. ii), with a direct charge that culture has a clear role to play in the “transformative change needed for a rights-based, equitable and sustainable process of global development.” Paragraph 71 of the report declares:

It is critical to promote equitable change that ensures people’s ability to choose their value systems in peace, thereby allowing for full participation and empowerment. Communities and individuals must be able to create and practice their own culture and enjoy that of others free from fear. This will require, inter alia, respect for cultural diversity, safeguarding cultural and natural heritage, fostering cultural institutions, strengthening cultural and creative industries, and promoting cultural tourism (p. 33).

In 2005, the Convention on the Protection and Promotion of the Diversity of Cultural Expressions member states agreed that cultural diversity “increases the range of choices and nurtures human capacities and values. Therefore, it is a mainspring for sustainable development for communities, peoples and nations” (UNESCO, 2005 , p. 1). The Convention reiterated the importance of the link between culture and development. UNESCO also steers an International Fund for Cultural Diversity to promote sustainable development and poverty reduction among the developing and least developed countries that are parties to the Convention.

UN Resolution 2347 of 2017 focuses exclusively on protecting cultural heritage and its necessity for peace and security. This Resolution brings a thorough awareness of culture’s role as a source of stability, inclusion, driver of reconciliation, and resilience. This Resolution reinforces Resolution 2199, adopted in February 2015, partly to fight against international terrorism financing and prohibit the illicit trafficking of cultural goods from Iraq and Syria.

Communication processes for overcoming difficulties in cross-cultural communication

The primary risk in cross-cultural communication is distortion, which creates misunderstanding or even misrepresentation of the conveyed information. Baumgratz ( 1990 , pp. 161–168) shares the opinion that relevant cultural dimensions of what he calls a social communication situation should be mapped out for individuals or groups who are from different nations or cultural origins but who have realized the need to contribute to the achievement of social, institutional, organizational, group, and personal aims. The tactics to overcome difficulties in cross-cultural communication lie in the communication processes. Any of the steps can become a barrier since culture influences the behaviour of both senders and receivers of messages. Barriers impede communication by distorting, blocking, or creating misunderstandings. Hence, it is necessary to create an enabling environment that will make communicating easier. Each of the communication steps can be strategized to enhance communication.

He is the source or initiator of the message. He can be a person or an organization. If the sender is a person, Malec ( 2018 ) refers to him as the carrier of intangible culture and the creator of the tangible ones. Messages are conveyed through spoken or written words. Nevertheless, messages can also be non-verbal. The encoding includes selecting words, symbols, or gestures in composing a message. The sender should encrypt, transfer meaning, or package his messages in ways that the receivers can access them. He should use symbols that the receiver would comprehend. The first thing he should do is use a language that his receiver understands. For example, it is useless to send a message written in English to another person who only understands French. Not only is the effort wasted, but it might also generate hostility. In Nigeria, Mexican soaps are freely watched. However, their producers avoided the obvious language challenge by dubbing in English voice-overs.

Words mean different things in different languages. For example, a British boss would answer yes to a question. However, his American subordinate would answer, yeah . The boss would think that he is disrespectful and impolite. Meanwhile, the American employee would be bewildered by the boss’s apparent coldness. British people use words that have different meanings from their American counterparts. For example, the word, pant , means underwear to a Briton but a pair of trousers to an American. The Englishman may still run into trouble with other nationals because his words have different meanings to these listeners. For example, the English phrase fart means a different thing among the Danish. For them, the word means speed ! The English word gift means poison in German. If an Englishman calls somebody a brat , his Russian friend will conclude that he is calling him his brother , which is what the word means in his language. Igbo children of south-eastern Nigeria call the hawk leke . But for the Yorubas in the southwest, this is the name given to a male child.

The sender, too, must know that even body language may mean different things. He should not assume that non-verbal messages mean the same in every part of the world. In Japan, nodding the head up and down means disagreement. In Nigeria, it means the opposite. Even though his own culture invariably influences the message’s sender, he should understand that his message is intended for a cross-cultural audience. He must also realize that the contents are no longer meant for ethnic communities defined by geographical locations but for an audience connected by frequent interactions that are not necessarily in the same physical place. A message sender that values esprit de corps will incorporate this into his messages by telling them that the laurel does not go to any person in particular but to the winning team. He thus encourages everybody to join in to win, not as individuals but as members of a group. If he is high on doubt avoidance, he makes his messages very direct and unambiguous and leaves no room for misinterpretation. However, a male sender who wants to assert his masculinity may wish to sound harsh. The sender who regularly attends church services may unconsciously put some words of Scripture in his messages because of his exogenic roots. The sender with monochronic orientation will send one message and expect the task to be completed as scheduled. His linear cultural background will be offended if the result is the contrary. Similarly, the sender who places a high value on rules and regulations would send messages of punishment to those who break them but reward those who keep them without minding his relationships with them. An effective sender of messages to a cross-cultural society should state his ideas clearly, offer explanations when needed, or even repeat the whole communication process if he does not get the appropriate feedback.

This is the information content the sender wants to share with his receivers. These include stories, pictures, or advertisements. He should carefully avoid lurid and offensive content. A French man may see nothing wrong in his wife wearing a very skimpy bikini and other men ogling at her at a public beach. His counterpart from Saudi Arabia will be upset if other men leer at his wife. In addition, the wife would be sanctioned for dressing improperly and appearing in public. If a person has a message to share with others from a different cultural background, he should be careful. His listeners may not isolate his statement as being distinct from his personality.

Societies with high context culture usually consider the messages they send or receive before interpreting them. Messages are hardly delivered straightforwardly. The message is in the associated meanings attached to the pictures and symbols. Thus, those outside that community find it very difficult to understand the meaning of the messages. In low-context communication, the message is the information in words. The words mean what they say. However, a corporate sender of messages, for example, the head of the Human Resources Department of a multi-cultural company interested in building team spirit, may organize informal chit-chats and get-togethers to break the proverbial ice as well as create a convivial atmosphere where people can relate. The message he is passing across is simple: let colleagues relax, relate, and work together as team members irrespective of where they come from. All of these are communicative actions.

The channel’s work is to provide a passage for the sender to guide his message to the receiver. While face-to-face communication is ideal for intimate and close group conversations, it is impossible to talk to everybody simultaneously. Different channels of passing across the same message may be used. For example, the same message may be passed through radio, adapted for television, put online, or printed in newsletters, newspapers, and magazines. The hope is that people who missed the message on one channel may see it on another somewhere else. A pronounced media culture will hasten cross-cultural communication. Many people consume media content. However, these consumers are expected to be media literates. Aririguzoh ( 2007 , p. 144) writes that:

media literacy is the systematic study of the media and their operations in our socio-political systems as well as their contributions to the development and maintenance of culture. It is the information and communication skill that is needed to make citizens more competent. It is the ability to read what the print media offer, see what the visual media present, and hear what the aural media announce. It is a response to the changing nature of information in our modern society.

Official messages should be passed through defined routes and are best written. This would close avenues of possible denials by others if the same message were passed across verbally. It could be difficult to misinterpret the contents of a written document. Written documents have archival values. As much as possible, rumours should be stamped out. A good manager should single out regular gossips in a multi-cultural organization for special attention. Equally, an effective manager heading widely dispersed employees can co-ordinate their activities using communication technologies with teleconferencing features. Aririguzoh ( 2007 , p. 45) notes, “information and communication technologies have transformed the range and speed of dispersing information and of communicating. Today, the whole world lies a click away!”

The media of communication are shaped by the culture of the people who produce them. What they carry as contents and the form they assume are defined by the culture of the sender. In low-context societies, it is common for messages to be written. In high context societies, it is common for statements to be verbal. Importantly, Aririguzoh ( 2013 , pp. 119–120) points out that “… the mass media can effectively be deployed to provide pieces of information that enhance communication, build understanding and strengthen relationships in our rapidly changing environment dictated by the current pace of globalization. The mass media assiduously homogenize tastes, styles, and points of view among many consumers of its products across the globe. They have effectively helped in fading away national distinctions and growing mass uniformity as they create, distribute and transmit the same entertainment, news, and information to millions of people in different nations.”

The receiver is the person the sender directs his message to. In a workplace, the receiver needs the message or information to do his job. The receiver decodes or tries to understand the meaning of the sender’s message by breaking it down into symbols to give the proper feedback. If the message is verbal, the receiver has to listen actively. The message receiver must understand a message based on his existing orientations shaped by his own culture. Even the messages that he picks are selected to conform to his existing preconceptions.

Oyserman et al. ( 2002 ) make an interesting discovery: that receivers from different cultures interpret the message senders’ mannerisms. For an American, a speaker talking very quickly is seen as telling the uncensored truth. In other words, the speaker who talks too slowly implicates himself as a liar! However, for the Koreans, slow speech denotes careful consideration of others. In some cultures, particularly in Asia, the receiver is responsible for effective communication. Kobayashi and Noguchi ( 2001 ) claim that he must become an expert at “understanding without words.” Miyahara ( 2004 , p. 286) emphasizes that even children literarily learn to read other people’s minds by evaluating the subtle cues in their messages and then improvising to display the expected and appropriate social behaviour and communication. Gestures involve the movements of the hands and head of the sender. The receiver clearly understands these body movements. As painted by Sapir ( 1927 , p. 556), “we respond to gestures with an extreme alertness and, one might almost say, in accordance with an elaborate and secret code that is written nowhere, known by none, and understood by all.”

Receivers who value individualism appreciate personal freedom, believe that they can make their own decisions, and respect their performance. Those who prefer communitarianism would prefer group applause and loyalty. A monochromatic receiver would start and finish a task before starting another one. He would be offended when colleagues do not meet deadlines, are late to appointments, and do not keep rigid schedules. His co-worker, who synchronizes his time, develops a flexible working schedule to work at two or more tasks.

This is the final process. Ordinarily, the sender wants a response to determine if the message he sent out has been received and understood. Acknowledging a message does not indicate a clear understanding of its contents. Feedback can be positive or negative. Positive feedback arises when the receiver interprets the message correctly and does what the sender wants. Negative feedback comes when messages are incorrectly interpreted, and the receiver does not do what the sender of the information has intended him to do. Cross-cultural communication recognizes that people come from different backgrounds. Therefore, feedback on diverse messages would be different. A sensitive communicator would be careful how he designs his messages for a heterogeneous audience so that he can elicit the desired feedback.

It must be emphasized that no culture is superior to another as each culture meets the needs of those who subscribe to it. To a large extent, our culture influences our behaviours and expectations from other people. Although there are noticeable similarities and differences, what separates one culture from another is its emphasis on specific values. As the United Nations has affirmed, there is diversity in cultures. These diversities add colour and meaning to human existence. This suggests that particular policies should be carved out to attend to specific locations and supports Satterthwaite’s ( 2014 ) proposition that local actors should be empowered to help achieve the SDGs. What the local populace in one community may appreciate may be frowned upon and even be fought against by residents in another place. As Hossain and Ali ( 2014 ) point out, individuals constitute the societies where they live and work. While Bevir ( 1996 ) describes this relationship as that of mutual dependence, he recognizes that people are influenced by their particular social structures and therefore do not go against them. Bevir believes that social systems exist for individuals.

Societies are built on shared values, norms and beliefs. These, in turn, have profound effects on individuals. Society’s culture affects individuals while the individuals create and shape the society, including initiating sustainable development. Development rests on the shoulders of men. Thus, culture influences the ways individuals behave and communicate. The effective communicator must actively recognize these elements and work them into communication practices. As Renn et al. ( 1997 , p. 218) point out, “sustainable practices can be initiated or encouraged by governmental regulation and economic incentives. A major element to promote sustainability will be, however, the exploration and organization of discursive processes between and among different actors.”

To achieve the United Nations sustainable goals, the competent communicator has to recognize that the culture of the actors in a communication process is the basic foundation for effective communication. For example, while one individual may discuss issues face-to-face and is not afraid to express his feelings candidly, another person may not be so direct. He may even involve third parties to mediate in solving a problem. Either way, their approaches are defined by their cultural backgrounds. It may be counterproductive to assume that either of these approaches is the best. This assertion is supported by the study of Stanton ( 2020 ), who explored intercultural communication between African American managers and Hispanic workers who speak English as a second language. He finds managers that follow culturally sensitive communication strategies getting more work done. Cartwright ( 2020 ) also observes that intercultural competence and recognition of cultural differences in East and Central Europe are foundation pillars for business success. This lends credence to Ruben and Gigliotti ( 2016 ) observation that communication with people from different cultures reduces the barriers associated with intercultural communication and enhances the communication process.

Irrespective of our ethnicities, people want to communicate, understand, appreciate, and be respected by others. Effective communication is the foundation of good human relationships among team members, whether their cultural backgrounds differ or not. Good feedback is achieved when both the sender and receiver of messages create common meanings. This is what discourse is all about. Messages must be meaningful, meaningfully constructed and meaningfully interpreted. Georgiou ( 2011 ) labels this the communicative competence : acknowledgement of the intercultural dimension of foreign language education and successful intercultural interactions that assume non-prejudiced attitudes, tolerance and understanding of other cultures, and cultural self-awareness of the person communicating. An efficient communicator must understand that culture shapes people, and the people then shape society. In other words, communication shapes the world. Therefore, appropriately chosen communication strategies help blend the different cultures.

According to Bokova ( 2013 ), there is “renewed aspirations for equality and respect, for tolerance and mutual understanding, especially between peoples of different cultures.” This means that if all parties respect other team members’ cultures, a clement work environment is inevitable. Cultural literacy creates more tolerant and peaceful work environments. Achieving this starts with a re-examination of the whole communication process. The crux of cross-cultural communication is developing effective ways to appreciate the culture of others involved in the acts of communication. Understanding these differences provides the context for an enhanced understanding of the values and behaviours of others. Reconciling these differences confers competitive advantages to those who communicate effectively. The media must provide the links between senders and receivers of messages in the context of their socio-cultural environments.

The United Nations appreciates the distinctiveness in cultures and has incorporated it as a significant factor in achieving sustainable development goals. This global body has produced different documents championing this. Every development takes place in an environment of culture. The heart of sustainable development is the man. The SDGs will be more meaningful and easily achievable by recognizing that actions should be both locally and culturally relevant. Cultural differences can be effectively managed if senders and receivers of messages understand that culture shapes how people communicate and, by extension, the relationship with other people who may not necessarily be from their tribal communities. Breaking down the barriers to cross-cultural communication lies in understanding these distinct differences and consciously incorporating them into the communication processes to enhance communication competencies.

Data availability

All data analysed are contained in the paper.

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I acknowledge: Dr. Emmanuel Mogaji of Greenwich University for reading and pointing out helpful corrections; Professors Innocent Chiluwa, Abiodun Gesinde, David Imhonopi and Dr Evaristus Adesina of Covenant University, who went through the manuscript, suggested corrections and encouraged me not to give upe and my daughter, Victoria-Grace Onyekachi Miracle Aririguzoh, who proofread this manuscript and brought in sunshine when the clouds were grey.

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5.8: Case Study

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Page ID 144532

Cultural Appropriation: High School Celebrates Graduating Seniors with “Senores/Senoritas” Dress-Up Day

In the United States, we have a cultural tradition of dressing up for Halloween. This tradition dates back to ancient Celtic beliefs. Basically, in order to protect themselves from evil spirits on New Year’s Even when the boundary between the living and the dead was most accessible, people hid behind animal skin costumes. Over the many hundreds of years, dressing up in costume has become less about hiding from spirits and more about the nonverbal expression of individuality. This case study looks at an extreme case of dress-up that went horribly wrong and showed cultural appropriation at its worst and most offensive. The importance of this case study shows that cultivating and improving cultural intelligence is a necessary communication skill in today’s global environment.

Back in 2012, an Orange County high school made headlines with a dress-up day titled “Senores and Senoritas Day,” which was supposed to be a play on the word seniors . Canyon High School is located in Anaheim, California, and this event was intended to be a spirit day celebrating graduating seniors and California’s Mexican heritage. This event dates to at least 2009. According to the US Census Bureau American Community Survey, Hispanics/Latinos made up 52.8% of this city’s population between 2008 and 2012. It made sense to celebrate Hispanic heritage by highlighting some of the nonverbal elements of culture such as clothing, food, communication, and body language. However, the school’s administration did not properly specify guidelines for this event and broadly announced for students to wear Hispanic-themed attire.

As a result, students showed up to school dressed as US Border Patrol agents, immigration agents, gardeners, a pregnant woman pushing a baby stroller, and gang members with bandanas and teardrop tattoos. While these may seem like extreme examples, could students have dressed up in anything that did not perpetuate stereotypes? Even with clear guidelines, how does one avoid reducing the Hispanic culture to stereotypes and caricatures? How did the administration not see that this event was the epitome of cultural appropriation?

Students wearing Border Patrol T-shirts and stereotypical gang-member costumes

A former student raised concerns during his senior year but was told by an unidentified administrator to “get a sense of humor” (Do & Rojas, 2012). Upon taking a Chicano Studies class in college, he was motivated to take his concerns to the district level and insist they investigate. After an internal investigation, which included interviews with students and staff, a review of emails, and social media postings, it was found that, “There was a lack of oversight/supervision and that the school administration should not have allowed this activity.” The report also stated: “Even if strict guidelines were provided the result would still lead to hurtful and demeaning messages about Mexican culture and to the students of Mexican, Hispanic, and Latino descent” (Orange Communication System, 2012a).

Arya (2021) points out that recognizing that there “is an asymmetry of power between two cultures that involves the majority/dominant culture taking from the marginalized culture” vital to understanding cultural appropriation. She notes, “Cultural appropriation is important because it concerns the phenomenon of exploitation that has existed historically and continues to do so between cultures of unequal power” (Ayra, 2021). While Anaheim’s Hispanic population was near 53%, Canyon High School was in the more affluent area of Anaheim Hills. At that time, the Los Angeles Times California Schools Guide reported about 55% of the students at Canyon HS were White compared to 16% Latino. Additionally, only 8% of the faculty was Latino, while white faculty dominated at 87% (“Enough Is Enough, Student Said of Seniores, Senoritas Day,” 2012).

At the conclusion of the district’s investigative report, Leal and Langhorne (2012) reported in the Orange County Register that the district required:

The high school’s administrators to complete sensitivity training
The principal to address the inappropriateness of the dress up event in parent communication
The school to sponsor an “International Week” to acknowledge and appreciate cultural diversity
The school to enact a thorough review process for all proposed activities to consider what might go wrong and who it may offend

You may watch a YouTube video on the event here: High School Cancels Demeaning Costume Event .

While this problem may seem to have been resolved, upon further digging, it was discovered that Greg Bowden, the principal of this high school, had been involved in previous district controversies. Back in 1988, Bowden was the band director at another high school in the district when the Associated Student Body and members of the pep squad donned afros and blackface to perform as the Jackson Five (San Roman, 2012). In 2008, Bowden and Canyon High School were at the center of a shocking physical and verbal bullying incident where a student was being called “faggot” and received no support from the administration. The real question is, “How did this individual continue to move up in the district without any repercussions and continue to overlook blatant cultural insensitivities?” (Orange Communication System, 2012a)

Reflection Questions

Define cultural appropriation . How does this case exemplify cultural appropriation?
What role does nonverbal communication play in cultural appropriation?
Cultural appreciation and celebrations are common on school campuses. What can be learned from this case to set “appropriate” tones for future celebrations?
Examine the consequences levied upon the school as a result of the investigation. Are these meaningful consequences from which the school and community can learn?
What other examples of cultural appropriation can you think of that we, as a society, need to rectify?

MINI REVIEW article

Cross-cultural communication on social media: review from the perspective of cultural psychology and neuroscience.

1 School of International Economics and Management, Beijing Technology and Business University, Beijing, China
2 School of Economics, Beijing Technology and Business University, Beijing, China
3 Institute of the Americas, University College London, London, United Kingdom

Introduction: In recent years, with the popularity of many social media platforms worldwide, the role of “virtual social network platforms” in the field of cross-cultural communication has become increasingly important. Scholars in psychology and neuroscience, and cross-disciplines, are attracted to research on the motivation, mechanisms, and effects of communication on social media across cultures.

Methods and Analysis: This paper collects the co-citation of keywords in “cultural psychology,” “cross-culture communication,” “neuroscience,” and “social media” from the database of web of science and analyzes the hotspots of the literature in word cloud.

Results: Based on our inclusion criteria, 85 relevant studies were extracted from a database of 842 papers. There were 44 articles on cultural communication on social media, of which 26 were from the perspective of psychology and five from the perspective of neuroscience. There are 27 articles that focus on the integration of psychology and neuroscience, but only a few are related to cross-cultural communication on social media.

Conclusion: Scholars have mainly studied the reasons and implications of cultural communication on social media from the perspectives of cultural psychology and neuroscience separately. Keywords “culture” and “social media” generate more links in the hot map, and a large number of keywords of cultural psychology and neuroscience also gather in the hot map, which reflects the trend of integration in academic research. While cultural characteristics have changed with the development of new media and virtual communities, more research is needed to integrate the disciplines of culture, psychology, and neuroscience.

Introduction

Cross-cultural communication refers to communication and interaction among different cultures, involving information dissemination and interpersonal communication as well as the flow, sharing, infiltration, and transfer of various cultural elements in the world ( Carey, 2009 ; Del Giudice et al., 2016 ). With more than half of the world’s population using social media, such as Facebook, Twitter, and WeChat, communication across culture has become smoother and more frequently ( Boamah, 2018 ; Chin et al., 2021 ). Subsequently, cultural exchanges, collisions, conflicts, and integration among various nationalities, races, and countries on these platforms have become obvious, and related research articles by scholars in different disciplines have increased ( Papa et al., 2020 ). In traditional cross-cultural research, experts often divide different cultures based on their boundaries, such as countries, races, languages, and so on. However, with the development of digitalization, new cultural relationships have been formed both within and outside geopolitical boundaries, and new understanding and theories are needed to explain the motivation, process, and implications of cross-cultural communications in the digital era ( Chin et al., 2020 ). Research in this field is an emerging area, and scholars are studying from different perspectives ( Xu et al., 2016 ; Santoro et al., 2021 ). Cultural psychology and neuroscience are two main base theories, and they show a trend of integration, such as cultural neuroscience and cultural neuropsychology. In this case, it is important to highlight the important achievements of this field and identify potential research gaps to provide potential directions for further research. This review aims to provide an overview of cross-cultural communication research from the perspective of cultural psychology and neuroscience and identify the integrating trend and potential directions.

Method and Source

We used the Web of Science (WoS) database to select relevant articles published between January 2010 and December 2021. The following inclusion criteria were used:

1. The document types should be articles rather than proceedings papers or book reviews. And the articles should be included in the Web of Science Core Collection.

2. When searching for articles, the topic should include at least two keywords: “cultural psychology,” “neuroscience,” “social media.”

3. Articles must be published after 2010 to ensure the content of the literature is forward.

4. This study should investigate the integration of cultural psychology and neuroscience or explore cultural issues in social media from the perspective of cultural psychology or neuroscience. The content could be cultural conflict and integration on social platforms, explanations of cultural conflict and integration on social platforms, or integration of neuroscience and cultural psychology.

Based on the above inclusion criteria, 85 relevant studies were searched, analyzed, and evaluated. These documents were identified according to the procedure illustrated in Figure 1 . The following combinations of keywords were used: (cultural psychology AND social media), (neuroscience AND social media), (cultural psychology AND neuroscience), [social media AND (cross-cultural communication OR cultural conflict OR cultural integration)], and (neuroscience, cultural psychology, and cross-cultural). The number of studies was further reduced by limiting the document type and time range. Consequently, we obtained an initial pool of 544 articles. To ensure the relevance of the literature in the initial pool, we reviewed the titles and abstracts of these articles. Articles targeting pure neuroscience and information technology were excluded and 72 articles were retained. We selected 65 articles after reviewing the full text. For most papers excluded from the initial pool, cultural issues on social media were not the main topic but digital media or culture itself. The most typical example of irrelevant articles was that culture or cultural psychology was only briefly mentioned in the abstracts. Moreover, 20 additional relevant articles were identified via full-text review of citations and first author searches. Using the above steps, 85 articles were selected for the literature review.

Figure 1 . Schematic representation of literature search and selection procedure.

Overview of Selected Articles

Here, frequency refers to the percentage of occurrences of an item in the total number of studies. The keywords “acculturation,” “cultural evolution” occurred frequently together with “social media,” “culture,” and “neuroscience.” This is as expected because psychologists and economists have long known that human decision-making is influenced by the behavior of others and that public information could improve acculturation and lead to cultural evolution. The popularity of social media clearly gives public information an opportunity to spread widely, which has caused an increase in research on the cross-cultural communication of social media. In the last decade, the link between cultural issues and social media research has grown. This is reflected in the knowledge graph ( Figure 2 ). Keywords “culture” and “social media” generate lots of links with “social media” and “mass media,” which is shown in blue node groups and white node groups. “Social media” and “cultural globalization,” “biculturalism,” “acculturation” also form node convergences. The integration of neuroscience and cultural psychology is also represented in Figure 2 as an orange node group. These integration trends can also be verified in the time dimension. As time passes, keyword frequencies have changed from a single component of “social media” or “culture” to a multi-component of “social media,” “culture,” “acculturation,” “neuroscience,” “cultural evolution.” The frequency of all keywords is presented through the overall word cloud.

Figure 2 . Keywords knowledge graph.

We identified three different research topics from the 85 selected articles: cross-cultural communication on social platforms, explanation of cultural conflict and integration on social platforms, and the integration of neuroscience and cultural psychology. Existing literature has analyzed and studied the interaction between cross-cultural users, enterprises, and countries on social media. For instance, some scholars have found that social media play a significant role in negotiating and managing the identity of transient migrants relating to the home and host culture during the acculturation process ( Cleveland, 2016 ; Yau et al., 2019 ). Social media usage by expatriates also promotes cultural identity and creativity ( Hu et al., 2020 ). In addition to the discussion of existing phenomena, many articles have discussed the causes of social media cultural transmission. A new research field, cultural neuroscience, indicates the integration of neuroscience and cultural psychology. These issues are reviewed in the following sections.

There were 44 articles on cultural communication on social media, which accounted for 51.76% of the 85 selected papers. Among these, there were 26 studies on cultural communication on social media from the perspective of psychology, five articles from the perspective of neurology, four articles about enterprises using social media for cross-cultural operations, and nine articles about how governments use social media for cross-cultural communication. Although there are 27 articles that discuss the trend of integration of psychology and neuroscience, few use integrated methods to analyze the behavior of cross-cultural communication.

From Perspective of Cultural Psychology

Cultural psychology researchers have focused on why information is shared. Some scholars have divided the reasons into individual and network levels ( Wang et al., 2021 ). Studies have explored information sharing within a specific domain, such as health information and news dissemination ( Hodgson, 2018 ; Li et al., 2018 ; Wang and Chin, 2020 ). Cultural psychology provides a rich explanation for the factors that influence cultural communication. Cultural background affects the process of cultural communication, such as self-construal, which the host country may alter it ( Huang and Park, 2013 ; Thomas et al., 2019 ). This may influence communication behaviors, such as people’s intention to use social media applications, attitudes toward social capital, social media commerce, and sharing behavior itself ( Chu and Choi, 2010 ; Han and Kim, 2018 ; Li et al., 2018 ).

Factors other than culture cannot be ignored: public broadcast firms and fans promote communication, controversial comments may draw more attention, the sociality of the social media capsule expands the scope of information communication, and how news is portrayed has changed ( Meza and Park, 2014 ; Jin and Yoon, 2016 ; Hodgson, 2018 ). Demographic factors, such as sex and age, are not ineffective ( Xu et al., 2015 ). The experiential aspects have also been noted ( Wang et al., 2021 ). Scholars have also noted the importance of cultural intelligence ( Hu et al., 2017 ).

The topic that researchers are most interested in is the relationship between society and individuals. Many studies have focused on the influence of collectivist and individualist cultures, such as social media users’ activity differences, attentional tendencies, and self-concept ( Chu and Choi, 2010 ; Thomas et al., 2019 ). There are some other interesting topics, such as the relationship among multicultural experiences, cultural intelligence, and creativity, the evaluation of the validity of the two measures, the changing status of crucial elements in the social system, and the government effect in risk communication ( Hu et al., 2017 ; Ji and Bates, 2020 ). Extending to the practical level, mobile device application usability and social media commerce were evaluated ( Hoehle et al., 2015 ; Han and Kim, 2018 ).

At the methodological level, researchers have bridged the gap between reality and online behaviors, and the feasibility of social media dataset analysis has been proven ( Huang and Park, 2013 ; Thomas et al., 2019 ). Some new concepts have been examined and some models have been developed ( Hoehle et al., 2015 ; Li et al., 2018 ). The most common method is to quantify questionnaire information ( Chu and Choi, 2010 ; Hu et al., 2017 ; Han and Kim, 2018 ; Li et al., 2018 ; Wang et al., 2021 ). The online survey accounted for a large proportion of respondents. Exploratory factor analysis (EFA) is used to evaluate other measures ( Ji and Bates, 2020 ). Researchers are particularly interested in the metric approach ( Meza and Park, 2014 ). Some combine other methods, such as profile and social network analyses ( Xu et al., 2015 ). Scholars have used qualitative research to obtain detailed feedback from respondents ( Jin and Yoon, 2016 ; Hodgson, 2018 ). Content analysis was also used ( Yang and Xu, 2018 ).

From Perspective of Neuroscience

Neuroscientific explanations focus on understanding the mechanisms of cultural conflict and integration. Neuroscience researchers are concerned about the effects of the brain on cultural communication and the possible consequences of cultural communication on human behavior and rely on the study of the brain as a tool. Neuroscience can be used to study how people behave in reality. Given the similarity between offline and online behaviors, neuroscience can study online behaviors and link them to cultural communication ( Meshi et al., 2015 ). Cross-sectional and longitudinal studies, both inside and outside the laboratory, have become the subject of neuroscience studies. One example of long-term studies outside the laboratory is the study of natural Facebook behavior that was recorded for weeks ( Montag et al., 2017 ).

Motivation research is a well-documented topic. The reason for using social media, motivation to share information, and neural factors related to sharing behavior have been discussed ( Fischer et al., 2018 ). Many scholars have connected motivation with social life based on the inseparable relationship between online behaviors and social life. Some academics hope to provide predictions of real life, such as forecasting marketing results, while some warned of the risks, in which tremendous attention has been paid to the situation of adolescents ( Motoki et al., 2020 ). They are susceptible to acceptance and rejection ( Crone and Konijn, 2018 ). Behavioral addiction and peer influence in the context of risky behaviors also lead to public concern ( Meshi et al., 2015 ; Sherman et al., 2018 ).

On a practical level, neuroscience studies have made predictions possible through the findings of activity in brain regions linked to mentalizing ( Motoki et al., 2020 ). Judgments of social behavior are also warranted, and peer endorsement is a consideration ( Sherman et al., 2018 ). Thus, the dangers of cultural communication can be alleviated.

At the methodological level, the feasibility of linking directly recorded variables to neuroscientific data has been proven, which provides a methodological basis for further studies linking neuroscience and cultural communication ( Montag et al., 2017 ). Neuroscience researchers have shown a preference for magnetic resonance imaging (MRI) methods, which include functional and structural MRI scans ( Montag et al., 2017 ; Sherman et al., 2018 ). Although some scholars have pointed out the shortcomings of MRI research and attempted to use the electroencephalographic (EEG) method, most scholars still use MRI and combine it with other methods, such as neuroimaging ( Motoki et al., 2020 ). Despite the similarities in the methods used, there were differences in the scanned areas. Some researchers scan multiple regions, such as the ventral striatum ( VS ) and ventromedial prefrontal cortex (VMPFC), while others focus on analyzing the content of a single region, such as the nucleus accumbens (NAcc; Baek et al., 2017 ). Related characteristics have been discussed, such as theta amplitudes that affect information sharing ( Fischer et al., 2018 ). Some inquire whether the different properties of brain regions can lead to different results ( Montag et al., 2017 ).

Integration of Neuroscience and Cultural Psychology

Of the 85 papers we selected, 27 discussed the integrated development of psychology and neuroscience, and the number of articles in this discipline increased. Cultural psychology has made remarkable progress in identifying various cultural traits that can influence human psychology and behavior on social media. Cultural neuroscience as a cross-subject of the rise in recent years, through the integration of psychology, anthropology, genetics, neuroscience, and other disciplines, explains the interaction of culture and the human brain, and how they jointly affect the neural mechanism of cognitive function. At an early stage, scholars presented the interactive dynamic evolutionary relationship between the brain and culture from multiple perspectives ( Moffittet et al., 2006 ). However, with technological improvements in brain imaging, it is possible to solve and explore interactions between the human brain, psychology, and cultural networks using an empirical approach.

Cultural characteristics have dramatically changed during the last half-century with the development of new media and new virtual ways of communication ( Kotik-Friedgut and Ardila, 2019 ). Existing research has shown that the neural resources of the brain are always adapted to the ever-increasing complexity and scale of social interaction to ensure that individuals are not marginalized by society ( Dunbar and Shultz, 2007 ). The interaction between biological evolution and cultural inheritance is a process full of unknowns and variables. Therefore, research on the relationships between culture, psychology, and neuroscience will progress together.

At the methodological level, communication on social media by users from different backgrounds provides a new research environment and massive data for cross-disciplinary research. Big data on social media and AI technology can analyze not only the reactions, emotions, and expressions of an individual but also the relevant information of an ethnic group or a cultural group. A number of neurological and psychological studies are beginning to leverage AI and social media data, and the two disciplines are intertwined with each other ( Pang, 2020 ; Wang et al., 2021 ). This quantitative analysis also helps enterprises and government departments to understand and affect cultural conflicts and integration ( Bond and Goldstein, 2015 ).

Different Schools of Thoughts

Social media provides platforms for communication and facilitates communication across cultures; however, the specific content exchanged is considered from the perspective of cultural proximity. Although some scholars think that social media can significantly promote mutual acceptance and understanding across cultures, others have realized that digital platforms actually strengthen the recognition and identity of their respective cultures ( Hopkins, 2009 ). To study the motivations, results, and implications of cross-cultural communication in virtual communities and conduct an empirical analysis, psychologists and neuroscientists provide their grounds and explanations.

Current Research Gaps

Although there are many articles discussing the trend of integration of psychology and neuroscience, few of them use integrated methods to analyze the behavior and implications of cross-cultural communication, mainly on cultural evolution and social effects. There are both practical and theoretical needs to be addressed to promote deep integration. For example, both private and public departments urgently need to learn scientific strategies to avoid cultural conflicts and promote integration. Further, a systematic and legal theory is also needed for scholars to conduct research in the sensitive field, which may be related to privacy protection and related issues.

Potential Future Development

For the research object, the classification of culture in emerging research is general, while with the development of big data methods on social media, cross-cultural communication among more detailed groups will be a potential direction. For the research framework, although cultural neuroscience is already a multidisciplinary topic, the ternary interaction among the brain, psychology, and culture in a virtual community will be very important. For the research method, brain imaging technology-related data and social media data may cause issues, such as privacy protection, personal security, informed consent, and individual autonomy. These legal and ethical issues require special attention in the development process of future research.

Cross-cultural communication research in the digital era not only needs to respond to urgent practical needs to provide scientific strategies to solve cultural differences and cultural conflicts, but also to promote the emergence of more vigorous theoretical frameworks and methods. Existing articles have mainly studied the reasons and implications of cultural communication on social media from the perspectives of cultural psychology and neuroscience separately. The CiteSpace-based hot topic map also shows the clustering trend of keywords related to cultural psychology and neuroscience, reflecting the intersection of the two fields. At the same time, there are many links between the two keyword nodes of “culture” and “social media,” which indicates that there is no lack of studies on cultural communication on social media from the perspective of cultural psychology. While cultural characteristics have changed with the development of new media and big data and related technologies have improved significantly, more research is needed to integrate the disciplines of culture, psychology, and neuroscience both in theory and methods.

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

This paper was funded by the Beijing Social Science Fund, China (Project No. 21JCC060).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: cross-culture communication, social media, cultural psychology, neuroscience, cultural neuropsychology, social neuroscience

Citation: Yuna D, Xiaokun L, Jianing L and Lu H (2022) Cross-Cultural Communication on Social Media: Review From the Perspective of Cultural Psychology and Neuroscience. Front. Psychol . 13:858900. doi: 10.3389/fpsyg.2022.858900

Received: 20 January 2022; Accepted: 14 February 2022; Published: 08 March 2022.

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Copyright © 2022 Yuna, Xiaokun, Jianing and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Han Lu, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Cultural studies and communication.

Toby Miller Toby Miller School of Journalism, Media, and Cultural Studies, University of Cardiff
https://doi.org/10.1093/acrefore/9780190228613.013.93
Published online: 24 October 2018

Communication and cultural studies share turbulent and contradictory histories, epistemologies, methods, and geographies, both on their own and as partners and rivals. This is in keeping with their status as interdisciplinary areas that emerged in the early to mid-20th century and crossed the humanities and the social sciences. Communication and cultural studies are linked and distinguished both by the topics they analyze and by their politics, countries, disciplines, theories, languages, and methods. Whereas the dominant forms of communication studies are dedicated to scholarly objectivity and disciplinary coherence, cultural studies is more akin to a tendency connected to concerns and identities on the margins of academia, and committed to methodological diversity. And whereas the critical strand of communication studies, notably political economy, examines such social forces of domination as the state and capital, cultural studies investigates the struggles undertaken by ordinary people to interpret dominant cultural forms in terms of their conditions of existence. The supposedly pessimistic orientation of political economy is frequently eschewed in favor of a faith in the resistive qualities of the oppressed and silenced. A similar perspective characterizes cultural studies’ rejection of effects studies for neglecting the politicized way that active audiences interpret media texts. In place of such concerns, the dominant strands of cultural studies tend to favor aesthetic and anthropological ways of analyzing societies to examine subjectivity and power and work with the understanding that popular culture represents and creates rituals and vice versa, through institutions and discourses that construct identities, which in turn form them.

popular culture
communication
communication and critical studies

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Understanding Cultural Diversity in Healthcare

Case Studies

See culture in action. Case studies bring you up close and personal accounts from the front lines of American hospitals and other countries on the issues of cultural diversity in healthcare.

The following case studies are presented by topic and contain quick recaps of some common cultural misunderstandings. More detailed information can be found in Caring for Patients from Different Cultures.

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Do you have a case study or field report about cultural diversity in healthcare that you would like to share? We want to hear about it!

Stereotyping
Communication
Time Orientation
Religious Beliefs and Customs
End of Life
Mental Health
Traditional Medicine
Additional Case Studies

Lamar Johnson, a thirty-three-year-old African American patient had been deemed a “frequent flyer” (a term used to describe those who keep coming to the hospital for the same reason, often assumed to be drug seekers) by the nurses and doctors in the emergency department. Each time he came in complaining of extreme headaches he was given pain medication and sent home. On this last admission, he was admitted to the ICU, where Courtney, a nurse, had just begun working. When she heard him described as a frequent flyer, she asked another nurse why he was thought to be a drug seeker. She was told, “He has nothing else better to do; I’m not sure why he thinks we can supply his drug habits.” Although Courtney says her instincts told her that something else was going on, she saw his tattoos, observed his rough demeanor, and went along with what everyone else was saying. While she was wheeling him to get a CT scan, Mr. Johnson herniated and died. It turned out that he had a rare form of meningitis and truly was suffering from severe headaches. If some of the staff had not stereotyped him as a drug seeker on one of his earlier visits, perhaps his life could have been saved. This incident left a lasting impression on Courtney, who vowed not ever to judge a patient on his looks, and to trust her instincts, rather than let others influence her nursing care.

While taking a course on cultural diversity, Anike Oghogho, a nurse from Nigeria, recognized his tendency to stereotype. He related an example of an African American male patient who presented with a swollen left foot. The patient, Jefferson Bell, kept ringing the call light and asking for more pain medication. Anike said that in the past, he would have assumed Mr. Bell was merely seeking pain meds. This time, however, he reassessed the patient. He discovered that Mr. Bell’s fourth and fifth toes were more red and swollen and had pus. Anike summoned the physician and Mr. Bell was eventually taken to the operating room for incision and drainage of his left foot. Stereotyping could have severely harmed the patient; fortunately, Anike had learned the lesson of not stereotyping in his class.

Hilda Gomez, a monolingual Spanish-speaking patient, came in to the clinic three days in a row to complain of abdominal pain. The first two times, the staff used her young, bilingual daughter to translate. They then treated Mrs. Gomez for the “stomach ache” she described. The staff didn’t understand why she kept returning with the same problem. Finally, on her third visit, the nurse located a Spanish-speaking interpreter. It turned out that Mrs. Gomez needed treatment for a sexually transmitted disease, but was too embarrassed to talk about her sexual activity with her daughter as interpreter. It taught the staff an important lesson.

Helena became very frustrated while caring for Gwon Chin, a seventy-nine-year-old Korean man who had recently suffered a stroke. Her frustration and impatience were aimed at Mr. Gwon’s wife and daughter. Since Mr. Gwon spoke only Korean, she had asked his bilingual daughter to tell her father not to get out of bed because his gait was unsteady. Helena was afraid he would fall and hurt himself. Throughout the day, however, Mr. Gwon continued to attempt to get out of bed. He became very agitated and his wife and daughter seemed almost afraid of him. When Helena questioned the daughter about it, she would only say that her father was “confused.” Eventually Helena called on a Korean nurse to help her. When the nurse told Mr. Gwon not to get out of bed because he might fall, he asked in a surprised tone, “Why would I fall?” When the nurse explained that he was unsteady from the stroke, the patient was shocked. “I had a stroke?!” Helena was in disbelief. He had been on the unit for two days; how could he not know he had had a stroke? When she questioned Mr. Gwon’s daughter about this, she explained that her brother has been out of town. He would be back today and tell him. When Helena, stunned by this, asked the daughter why she didn’t tell her father, she replied, “I could never tell my father what is wrong with him and what he can or can’t do. It would be disrespectful for me to do that when he has always told me what to do and what was wrong.”

Although Helena was angry that Mr. Gwon’s daughter preferred having her father possibly fall and hurt himself than tell him why he was in the hospital and that he must stay in bed, Helena remained silent. She asked the Korean nurse to explain to the patient how the numbness on his left side would make walking difficult so he should remain in bed. She also added that his son would be in later that day and would explain everything to him. After that, the patient remained calm and stayed in bed. [For more discussion, see Chapter 2 of Caring for Patients From Different Cultures .]

Juanita Avelar was a forty-nine-year-old Mexican woman with kidney failure and diabetes. She relied on her niece and nephew to drive her to the clinic and was often late. In Mexican culture, the needs of the family typically take precedence over those of an individual. The nurses learned to take this into account when scheduling her appointments, and they allowed plenty of time for the family to discuss Mrs. Avelar’s condition as a family. When certain tests and medications required specific timing for accuracy and effectiveness, they stressed the importance of clock time.

Mrs. Mendez, a sixty-two-year-old Mexican patient, had just had a femoral-popliteal bypass graft on her right leg. She was still under sedation when she entered the recovery room, but an hour later she awoke and began screaming, “ Aye! Aye! Aye ! Mucho dolor ! [Much pain].” Robert, her nurse, immediately administered the dosage of morphine the doctor had prescribed. This did nothing to diminish Mrs. Mendez’s cries of pain. He then checked her vital signs and pulse; all were stable. Her dressing had minimal bloody drainage. To all appearances, Mrs. Mendez was in good condition. Robert soon became angry over her outbursts and stereotyped her as a “whining Mexican female who, as usual, was exaggerating her pain.”

After another hour, Robert called the physician. The surgical team came on rounds and opened Mrs. Mendez’s dressing. Despite a slight swelling in her leg, there was minimal bleeding. However, when the physician inserted a large needle into the incision site, he removed a large amount of blood. The blood had put pressure on the nerves and tissues in the area and caused her excruciating pain.

She was taken back to the operating room. This time, when she returned and awoke in recovery, she was calm and cooperative. She complained only of minimal pain. Had the physician not examined her again and discovered the blood in the incision site, Mrs. Mendez would have probably suffered severe complications.

Bobbie, a nurse, had two patients who had both had coronary artery bypass grafts. Mr. Valdez, a middle-aged Nicaraguan man, was the first to come up from the recovery room. He was already hooked up to a morphine PCA (patient-controlled analgesia) machine, which allowed him to administer pain medication as needed in controlled doses and at controlled intervals. For the next two hours, he summoned Bobbie every ten minutes to request more pain medication. Bobbie finally called the physician to have his dosage increased and to request additional pain injections every three hours as needed. Every three hours he requested an injection. He continually whimpered in painful agony.

Mr. Wu, a Chinese patient, was transferred from the recovery room an hour later. In contrast to Mr. Valdez, he was quiet and passive. He, too, was in pain, because he used his PCA machine frequently, but he did not show it. When Bobbie offered supplemental pain pills, he refused them. Not once did he use the call light to summon her. [For more discussion, see Chapter 5 of Caring for Patients From Different Cultures .]

Pepe Acab, a Filipino patient, was being discharged on Coumadin, a blood thinner, to prevent clotting. Vitamin K reverses the effect of the drug and must be avoided. Normally, Libby, his nurse, would tell such patients to avoid foods like liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and any green, leafy vegetables. She suddenly realized, however, that there might be other foods he should avoid. She spoke with Mr. Acab and his wife, and got a list of foods he commonly ate. She then did some research and discovered that two foods on the list—soybeans and fish liver oils—are very high in Vitamin K. She was then able to educate him properly on what to avoid.

Susi Givens, a thirty-seven-year-old woman with two children, was horseback riding one day when a snake startled her horse. She was thrown off and landed on a stump, resulting in massive internal injuries. She was rushed to the hospital, where the surgical team discovered that there was a large amount of blood in her abdomen and that she needed to have a kidney removed.

Mrs. Givens had a medical alert card identifying her as a Jehovah’s Witness and stating that under no circumstances was she to receive blood. Her physician knew this but felt impelled by his oath to save lives to give her a blood transfusion. The hospital was unable to locate her husband, so the physician decided to transfuse her.

His actions saved her life; however, she was not grateful. She sued her doctor for assault and battery and won a $20,000 settlement. [For more discussion, see Chapter 4 of Caring for Patients From Different Cultures .]

Sol and Deborah Meyers, an Orthodox Jewish couple, came to the hospital late Friday night when Deborah was in active labor. When she gave birth at midnight, the nurses suggested that Sol accompany her to the postpartum unit and then return home to rest. He thanked them, then explained that he could not drive home because it was the Sabbath. The nurses suggested that he call a friend or relative to pick him up. Sol replied that he could not use the phone on the Sabbath, and even if he made a call, no one would answer because all his friends and relatives were also Sabbath-observant. The nurses understood and arranged for him to stay in his wife’s room, but were left wondering why Sol could drive to the hospital but not drive back home.

In the morning, a nurse noticed that Deborah had not received breakfast and was instead eating snacks from the bag she had brought from home. The nurse asked if she needed help ordering food, and Deborah explained that the hospital-provided meals did not adhere to kosher dietary laws. The nurse, trying to be helpful, suggested that Sol purchase kosher food from the gift shop on the first floor, but was told that due to the laws of the Sabbath, Sol was forbidden to ride in an elevator or handle money. The nurse left the room, confused but glad the couple had brought some food of their own.

Later that afternoon, the nurse returned to check on Deborah, and made friendly conversation by asking how the baby’s nursery was decorated at home. She was surprised to learn that in Orthodox tradition, minimal preparations are made before a baby’s birth, and the baby’s room was not set up at all. Intrigued, she asked Sol to explain some of the laws of Sabbath observance. She learned that the couple had been able to drive to the hospital because, according to halacha (Jewish law), childbirth is considered an emergency requiring the breaking of the Sabbath, but that once the birth was over, they were not allowed to drive home due to the absence of an emergency.

Raj Singh, a seventy-two-year-old Sikh from India, had been admitted to the hospital after a heart attack. He was scheduled for a heart catheterization to determine the extent of the blockage in his coronary arteries. The procedure involved running a catheter up the femoral artery, located in the groin, and then passing it into his heart, where special x-rays could be taken. His son was a cardiologist on staff and had explained the procedure to him in detail.

Susan, his nurse, entered Mr. Singh’s room and explained that she had to shave his groin to prevent infection from the catheterization. As she pulled the razor from her pocket, she was suddenly confronted with the sight of shining metal flashing in front of her. Mr. Singh had a short sword in his hand and was waving it at her as he spoke excitedly in his native tongue. Susan got the message. She would not shave his groin.

She put away her “weapon,” and he did the same. Susan, thinking the problem was that she was a woman, said she would get a male orderly to shave him. Mr. Singh’s eyes lit up again as he angrily yelled, “No shaving of hair by anyone!”

Susan managed to calm him down by agreeing. She then called her supervisor and the attending physician to report the incident. The physician said he would do the procedure on an unshaved groin. At that moment, Mr. Singh’s son stopped by. When he heard what had happened, he apologized profusely for not explaining his father’s Orthodox Sikh customs. [For more discussion, see Chapter 4 of Caring for Patients From Different Cultures .]

Ricky, a five-year-old African American male with asthma, was supposed to take a controller medication (asthma inhaler #1, Steroid) twice a day as a preventative measure. When he was wheezing and/or having breathing problems, he was supposed to take asthma inhaler #2 (Albuterol) as an emergency medication. Dr. Arabel felt that she had given very clear instructions on how to use the two inhalers, but Ricky’s mother kept bring him back to the clinic with a lot of wheezing; his asthma was obviously not being well controlled. As it turned out, Ricky had not been using the inhalers as directed. His mother, who was enrolled in school, was overwhelmed and did not understand the significance of his asthma and the need to use the two inhalers properly. On one of the visits, Dr. Arabel learned that Ricky’s grandmother had accompanied them to the clinic. She brought the grandmother into the exam room, and explained everything to her. Once the grandmother became involved, everything changed. There were no more emergency room/urgent clinic visits and Ricky’s asthma was much better controlled. He only rarely needed the “emergency” Albuterol compared to earlier. Involving the grandmother had made a tremendous difference. [For more discussion, see Chapter 6 of Caring for Patients From Different Cultures .]

Julia was treating Mrs. Torres, an elderly Hispanic patient who was intubated. When she needed information, she would direct her questions to the eldest son. She assumed he would be the family spokesperson. However, he rarely had an answer for her. While in many cases the eldest son would be the decision-maker, in this case he was not. The youngest daughter held the durable power of attorney for medical decisions. It was several days before anyone even thought to ask the family who held power of attorney. The staff had made the mistake of stereotyping. Once Julia learned that the youngest daughter was responsible for making medical decisions for her mother, such decisions were reached more quickly and without unnecessary strain on the rest of the family. [For more discussion, see Chapter 6 of Caring for Patients From Different Cultures .]

Juan Martinez, a thirty-six-year-old Mexican man with second-degree burns on his hands and arms, posed a problem. The skin grafts had healed, and there was now danger that the area would stiffen and the tissue shorten. The only way to maintain maximum mobility was through regular stretching and exercise. The nurses explained to Mr. Martinez’s wife that feeding himself was an essential therapeutic exercise. The act of grasping the utensils and lifting the food to the mouth stretches the necessary areas. Mrs. Martinez seemed to understand the nurses’ explanation, yet she continued to cut her husband’s food and put it in his mouth.

When Linda, one of his nurses, observed this, she took the fork out of Mrs. Martinez’s hand and told Mr. Martinez to feed himself because he needed to exercise his arms and hands. Linda again explained to Mr. Martinez’s wife how important it was for him to do it himself. Mrs. Martinez appeared skeptical but did not argue. Mr. Martinez looked at Linda peevishly and made a feeble attempt at eating. His wife watched with pity. Linda knew from seeing Mr. Martinez when his wife was not around that he was perfectly capable of feeding himself. Linda left the room. When she looked in five minutes later, she saw Mrs. Martinez once again cutting her husband’s food and putting it in his mouth. [For more discussion, see Chapter 6 of Caring for Patients From Different Cultures .]

Before taking my course in cultural diversity, Jennifer, like all the nurses on her unit, tried to avoid taking care of Naser Assharj, a middle-aged Iranian Muslim patient, because the entire staff found his family to be very “uptight and demanding.” The nurses rotated care for this patient, because no one was willing to care for him more than one day at a time. When Jennifer learned a bit about Muslim culture, however, she understood why his family kept demanding a private room and made such a fuss over his meals. It was their way of showing love and care for their family member. He needed a private room so that, as devout Muslims, the family could pray together five times a day as commanded by Allah. It was also important that his food be halal , or follow the Muslim laws of what is permissible (see Chapter 5). Once Jennifer realized this, she contacted her supervisor and arranged to have the patient moved to a private room and spoke to the dietician regarding his food. The family members were very grateful for her efforts, and became much easier to deal with.

Amira Faroud was a three-year-old Middle Eastern patient, newly diagnosed with type 1 diabetes. Understanding the importance of involving the entire family in the patient’s care, Lisa tried to get the patient’s father, Mr. Faroud, to participate. She had seen other fathers reluctant to learn in the past, but eventually, they all were persuaded. But not Mr. Faroud. He would not even consider it. Eventually, Lisa changed the teaching plan to include Amira’s grandmother rather than her father, and all went well. [For more discussion, see Chapter 7 of Caring for Patients From Different Cultures .]

A female resident could not get a Hispanic mother to sign consent for a procedure for her child; she, too, insisted on waiting for her husband. In this case, however, it was urgent that the procedure be done as soon as possible. The resident asked an older male physician to speak to the mother. Apparently, the combination of his age and gender were enough to convince her to sign consent without speaking first to her husband.

Amiya Nidhi was a young woman in her twenties who had recently immigrated to the United States from India. She was in the hospital to give birth. Her support person was her sister, Marala. Marala kept telling her to get an epidural, but Amiya said that even though she would like one, she could not get one; her husband would not allow it. Cindy, her nurse, overheard the conversation. Having learned that husbands are the authority figure in the traditional Indian household, she went to speak with Mr. Nidhi. She explained why an epidural would be advisable. She said that he seemed pleased that she came to him about it. He said he would think about it, and let her know. About thirty minutes later, he came to Cindy and told her that he would like his wife to have an epidural. Everyone was pleased. By using cultural competence, Cindy helped her patient get the care she wanted, while still respecting the authority structure within the family. [For more discussion, see Chapter 7 of Caring for Patients From Different Cultures .]

An Iranian mother and father admitted their thirteen-month-old child, Ali, to the pediatrics unit. After three days of rigorous testing and examination, it was discovered that Ali had Wilms’ tumor, a type of childhood cancer. Fortunately, the survival rate is 70 to 80 percent with proper treatment.

Before meeting with the pediatric oncologist to discuss Ali’s treatment, Mr. and Mrs. Mohar were concerned and frightened, yet cooperative. Afterward, however, they became completely uncooperative. They refused permission for even the most routine procedures. Mr. Mohar would not even talk with the physician or the nurses. Instead, he called other specialists to discuss Ali’s case.

After several frustrating days, the oncologist decided to turn the case over to a colleague. He met with the Mohars and found them extremely cooperative. What caused their sudden reversal in behavior? The fact that the original oncologist was a woman.

Several weeks later, it became necessary to insert a permanent line into Ali to administer his medication. The nurse attempted to show Mrs. Mohar how to care for the intravenous line, but Mr. Mohar stopped her. “It is my responsibility only. You should never expect my wife to care for it.” Throughout each encounter with the hospital staff, Mrs. Mohar remained silent and deferred to her husband. [For more discussion & explanation, see Chapter 7 of Caring for Patients From Different Cultures .]

A twenty-eight-year-old Arab man named Abdul Nazih refused to let a male lab technician enter his wife’s room to draw blood. She had just given birth. When the nurse finally convinced Abdul of the need, he reluctantly allowed the technician in the room. He took the precaution, however, of making sure Sheida was completely covered. Only her arm stuck out from beneath the blankets. Abdul watched the technician intently throughout the procedure. [For more discussion & explanation, see Chapter 7 of Caring for Patients From Different Cultures .]

Fatima, an eighteen-year-old Bedouin girl from a remote, conservative village, was brought into an American air force hospital in Saudi Arabia after she received a gunshot wound to her pelvis. Her cousin Hamid had shot her. Her family had arranged for her to marry him, as was local custom, but she wanted nothing to do with him. She was in love with someone else. An argument ensued, and Hamid left. He returned several hours later, drunk, and shot Fatima, leaving her paralyzed from the waist down.

Fatima’s parents cared for her for several weeks after the incident but finally brought her to the hospital, looking for a “magic” cure. The physician took a series of x-rays to determine the extent of Fatima’s injuries. To his surprise, they revealed that she was pregnant. Sarah, the American nurse on duty, was asked to give her a pelvic exam. She confirmed the report on the x-rays. Fatima, however, had no idea that she was carrying a child. Bedouin girls are not given any sex education.

Three physicians were involved in the case: an American neurosurgeon who had worked in the region for two years; a European obstetrics and gynecology specialist who had lived in the Middle East for ten years; and a young American internist who had recently arrived. No Muslims were involved. The x-ray technician was sworn to secrecy. They all realized they had a potentially explosive situation on their hands. Tribal law punished out-of-wedlock pregnancies with death.

The obstetrician arranged to have Fatima flown to London for a secret abortion. He told the family that the bullet wound was complicated and required the technical skill available in a British hospital.

The only opposition came from the American internist. He felt the family should be told about the girl’s condition. The other two physicians explained the seriousness of the situation to him. Girls in Fatima’s condition were commonly stoned to death. An out-of-wedlock pregnancy is seen as a direct slur upon the males of the family, particularly the father and brothers, who are charged with protecting her honor. Her misconduct implies that the males did not do their duty. The only way for the family to regain honor was to punish the girl by death.

Finally, the internist acquiesced and agreed to say nothing. At the last minute, however, he decided he could not live with his conscience. As Fatima was being wheeled to the waiting airplane, he told her father about her pregnancy.

The father did not say a word. He simply grabbed his daughter off the gurney, threw her into the car, and drove away. Two weeks later, the obstetrician saw one of Fatima’s brothers. He asked him how Fatima was. The boy looked down at the ground and mumbled, “She died.” Family honor had been restored. The ethnocentric internist had a nervous breakdown and had to be sent back to the United States.

Sofia Toledo, a sixty-five-year-old upper-class Mexican woman, refused to be dialyzed when she learned that her usual dialysis station was unavailable. She said she would wait until her next treatment, when she could have her customary place. Unfortunately, this was not a viable alternative. Missing a treatment could result in serious complications or even death. When Julia, the nurse, asked her why the new station was unacceptable, Mrs. Toledo was very vague.

Julia finally called Mrs. Toledo’s daughter, and together they solved the problem. Mrs. Toledo’s usual station was unusual in that neither the nurses nor the patients at the other dialysis stations could see it very well. The rest of the stations were very open, designed for high visibility by the nurses. To be dialyzed, the patient had to remove her pants and don a patient gown. Her underwear was exposed during the process. Mrs. Toledo’s sense of modesty, a quality very strong in Hispanic women, made the more open station intolerable.

Julia said that at the time she found Mrs. Toledo’s behavior annoying. She and the other nurses saw it as a delay that would prevent them from leaving on time. They did not want to have the extra work of moving machinery or remixing the dialysate. She did not understand the importance of modesty in Hispanic culture, but she did realize that it was important to Mrs. Toledo, a normally “compliant” patient. In this case, a screen or curtain might have alleviated the problem.

Kayla was a staff nurse on a medical-surgical floor when she first met Dr. Ling, an Asian physician. They got along well until Kayla transferred to the diabetes clinic. Clinic protocols allow nurses to order new medications, adjust medications, and order lab work as needed, as long as they get a physician to sign the order. When Kayla asked Dr. Ling for his signature, he would rudely question why she felt the medication was necessary, and on a few occasions refused to sign, stating that he disagreed with the medication she had ordered. After learning more about Asian culture in a cultural competence course, she realized he probably perceived her approach as showing a lack of respect, despite the fact that she was following clinic protocols. She then changed her approach. Rather than just asking him to sign the medication order, she would go to him, explain the situation with the patient, tell him what she was considering, and ask him what he would like done. Kayla reported that Dr. Ling was much more receptive to this approach, probably because it allowed him to feel respected and in control. Taking the extra time to do this repaired the lines of communication between them. Although it could be argued that Dr. Ling is the one who should have changed his behavior, that is probably less realistic than having Kayla apply her cultural knowledge to achieve the results that she wanted.

Josepha, a Filipina nurse, did not get along well with her coworkers. The nursing staff on her unit was composed of two Anglo Americans, two Nigerians, and Josepha. She felt her coworkers were taking advantage of her, because they would ask for assistance whenever they saw her. Josepha was angry over what she perceived as obvious discrimination. She cheered herself by reminding herself that she was a better nurse than the others; she could do her work without their help. In addition, she was not lazy like they were. She took care of her patients; the other nurses insisted that their patients take care of themselves.

One day, Rena, one of the Anglo nurses, was unusually friendly, so Josepha opened up to her. As they got to know each other better, Josepha shared her feelings of being taken advantage of. Rena explained that it was common procedure for the nurses to help each other with their work. Rena confided that the others thought Josepha was being snobbish and proud because she never asked for help. They saw what Josepha had interpreted as laziness on the part of the others as being team players. Rena also explained that American health care providers believe that independence is important and encourage self-care among their patients.

Josepha was stunned by Rena’s revelations. Rena offered to help bridge the communication gap between Josepha and her coworkers. She explained to the others that Josepha was trying to save face by never asking for help; she didn’t want them to think she couldn’t do her job. Josepha began to teach her patients self-care and to ask her coworkers for assistance. Over time, the cross-cultural misunderstandings were resolved, and Josepha’s coworkers became her best friends.

Leslie reported that her hospital had recently hired five new Korean nurses. Unfortunately, they did not get along well with the rest of the nursing staff. They rarely said “please” or “thank you” and were generally perceived as rude. Leslie was reading an earlier edition of this book and suddenly realized that the Korean nurses were older than the other nurses on the unit and probably felt that “please” and “thank you” were implicit. Leslie then showed the other staff nurses the section on “Please” and “Thank You.” She reported that morale on the unit is much improved. Sometimes, all it takes is a little understanding.

An American physician and professor, consulting in Japan, was about to address a group of university physicians; it was fully understood by all that he would give his talk in English. He nevertheless prepared a brief introduction in Japanese, concluding with the statement, “My Japanese is limited, so with your permission, I will continue in English.” When he asked his Japanese secretary if his statement was grammatically correct, she seemed uncomfortable. On further questioning she reluctantly admitted that, grammar aside, it was not appropriate for someone of his stature to ask the audience for permission, and that this would diminish the audience’s ability to respect anything else he said. Instead, she suggested, he should merely announce that he would continue in English. In this context “asking permission” was entirely pro forma in American culture; it would be seen as a polite gesture. In Japan, however, it was considered inappropriate from someone in a position of authority, and would likely result in a loss of respect for the person doing the asking. [For further discussion, see Chapter 8 of Caring for Patients From Different Cultures .]

A labor and delivery nurse reported that the most difficult patient she ever attended was Robabeh Farag, an Iranian woman, who yelled and screamed for the entire duration of her labor. After she delivered their child, her husband presented her with a three-karat diamond ring. When her nurse commented on the expensive gift, she responded dramatically, “Of course. He made me suffer so much!” Iranian custom is to compensate a woman for her suffering during childbirth by giving her gifts. The greater the suffering, the more expensive the gifts she will receive, especially if she delivers a boy. Her cries indicate how much she is suffering. A young Iranian doctor recently told me that when his wife has a baby, he will present her with a diamond ring or a watch. [For further discussion, see Chapter 9 of Caring for Patients From Different Cultures .]

Naomi Freedman, an Orthodox Jewish woman, was in labor with her third child. She had severe pains, which were alleviated only by back rubs between contractions. Her husband asked Marge, a nurse, to remain in the room to rub his wife’s back. Because she had two other patients to care for, Marge began to instruct him on how to massage his wife. To Marge’s surprise, he interrupted her, explaining that he could not touch his wife because she was unclean. Marge, assuming he meant she was sweaty from labor, suggested that he massage her through the sheets. In an annoyed tone, he explained that he could not touch his wife because she was bleeding. Marge was further surprised when, while Naomi began pushing, her husband left the room and did not return until after their baby was born.

Marge later learned from Mrs. Freedman that in halacha (Jewish law), the blood of both menstruation and birth render a woman spiritually unclean and therefore physical contact between husband and wife was prohibited. Mrs. Freedman also explained that in some Orthodox communities, husbands are prohibited from being present at birth in non-emergency situations.

[For further discussion, see Chapter 9 of Caring for Patients From Different Cultures .]

Maria Salazar was a thirty-two-year-old recent immigrant from Mexico with an infected incision from a caesarean section. She asked Tonya, her nurse, for some water. When Tonya grabbed the bedside pitcher to refill it, she discovered it was full. When Tonya pointed this out to her, she answered in Spanish, “Yes, but I have a fever and a cough. If I drink that cold water I will get even more sick.” Tonya, who spoke some Spanish, was taking a course in cultural diversity at the time and was elated to see hot/cold beliefs in action. She then emptied the ice water and refilled it with warm water. Curious, Tonya asked her if there were any changes she would like to see in her treatment. Mrs. Salazar nodded her head. She said she didn’t understand why the nurses kept insisting she do things that would make her ill—things like taking a shower. Didn’t they understand she had a fever and had just delivered a baby? And why did they want her to spend so much time walking, when she knew she should stay in bed and rest as much as possible? [For further discussion, see Chapter 9 of Caring for Patients From Different Cultures .]

Raul Santiago was a Hispanic male in his seventies who had been in the hospital for seven months. He had been admitted for abdominal pain, but it soon became apparent that he had advanced stage pancreatic cancer. Mr. Santiago had 12 children, who all conspired to avoid using the word “cancer” in front of their father or to even acknowledge his fatal prognosis. Instead, they referred to his condition as “abdominal pain.” During the time he was in the hospital, Mr. Santiago became close to the nursing staff. One day while Tiffany was administering his pain medication, he looked directly at her and said with resignation, “I’m going to die, aren’t I?” Without waiting for her to respond, he continued. He explained to Tiffany that he didn’t want his children to suffer because of his illness, and he knew that if they knew that he knew he had cancer, it would cause them great distress. He told her that he was ready to be with his wife who had died two years earlier. He was content to pretend to be ignorant of his disease if it eased his family’s suffering. Whether or not it would have caused his children to suffer if they knew he knew, or if it would have been a relief is unknown. But the nurses honored his decision.

A fifty-two-year-old African American man named William Jefferson was admitted to the critical care unit with a diagnosis of pneumonia. On admission, he was offered an Advance Directive, which he refused, saying that God would help him with his illness. His lung cancer had gone into remission after radiation treatment; he believed that God had helped him through that illness, and would help him through the current one. He thought that signing a Do Not Resuscitate form or Advance Directive would be a sign of giving up or losing faith in God. Unfortunately, he died ten days later, after enduring a great deal of suffering. [For further discussion, see Chapter 10 of Caring for Patients From Different Cultures .]

Ngoc Ly, a twenty-five-year-old Vietnamese man, was hit by a car while riding his bicycle to work. Paramedics were able to resuscitate him, but the physician at the local trauma center determined that Mr. Ly was clinically brain dead. He placed him on life support until the family could be notified.

An interpreter explained Mr. Ly’s condition to his wife and parents. They nodded in understanding and quietly left the hospital. Normally, the staff neurosurgeon would then have pronounced Mr. Ly dead and removed him from the ventilator, but he was suddenly called to surgery.

Later that afternoon, Mr. Ly’s family met with Dr. Isaacs, the physician they had spoken to earlier. Dr. Isaacs intended to tell them of the plan to pronounce Mr. Ly dead and discontinue the ventilator, but the Lys had other plans. They informed him that they had consulted a specialist who said this was not the right time for him to die. Dr. Isaacs was confused. What kind of specialist would make such a recommendation? An astrologer who had read Ngoc Ly’s lunar chart advised that his death be postponed until a more auspicious date.

The physician had never encountered a situation like the one now facing him. Fearing legal repercussions if he did not abide by the family’s request, he agreed to keep Mr. Ly on life support until further notice. A little less than a week later, the Lys called to tell him that Ngoc could now die. [For further discussion, see Chapter 10 of Caring for Patients From Different Cultures .]

Canh Cao was a thirty-four-year-old Vietnamese woman who was treated by a medical student at a public health clinic. She had made several visits for various physical complaints—abdominal pain, backache, headaches. She was diagnosed with somatoform pain disorder—preoccupation with pain in absence of physical findings.

Several months later, Cao attempted suicide. She was sent for evaluation to a psychiatrist, who at that point diagnosed her with depression. She had been depressed all along, but the medical student was both inexperienced and unaware of cultural issues, so he missed it. [For further discussion, see Chapter 11 of Caring for Patients From Different Cultures .]

Amelia avoided a potential child abuse report with a Cambodian family, the Chhets. The child had suspicious burn marks on her body. Instead of assuming child abuse, she first interviewed both parents separately. Both explained that they had treated their child using cupping and coining to make her feel better and help her recover more quickly. Amelia then explained to her supervisor what she had learned from the parents, and they decided it was not a child abuse situation. The Chhets practiced the traditional form of cupping. [For further discussion, see Chapter 12 of Caring for Patients From Different Cultures .]

Mexican American mother refused to use cooling measures in caring for her febrile infant, despite medical instructions to do so. Mrs. Lopez had called the hospital because her infant’s temperature was very high. She was told to give the baby a mild analgesic and a cool bath and then to bring her in. Mrs. Lopez ignored both cooling instructions and, to the consternation of the medical staff, brought the child wrapped in several layers of blankets, outer garments, undershirt, and several pairs of socks. When asked why she did not follow the instructions given her, she replied, “He must sweat the fever out. Besides, he could get pneumonia from the night air and die.” [For further discussion, see Chapter 12 of Caring for Patients From Different Cultures .]

Fariba was asked to interpret for Fereydoon Jalili, an Iranian man who had come to the hospital with gastrointestinal bleeding. Mr. Jalili spoke some English, and when the physician had asked him what medications he was taking, he told him he didn’t take any. When Fariba was brought in to interpret, she began talking to him about his health. During their conversation, he admitted that he took vitamins to stay healthy and he was very proud of the fact that he had never been sick. He also mentioned that he took two aspirins a day for his heart after seeing a commercial on television which said it prevented heart attacks. When Fariba asked him why he didn’t tell the doctor about the vitamins and aspirin, he said that he didn’t consider anything he bought over-the-counter to be a “real” medication. Once the physician learned what he had been taking, he educated Mr. Jalili on appropriate aspirin consumption, since that was the likely cause of his GI bleed. [For further discussion, see Chapter 12 of Caring for Patients From Different Cultures .]

Jen, a second-year medical student, was on a pediatrics visit learning how to perform a newborn exam. As she followed the attending into the patient’s room, she noticed that the baby’s mother was sitting on the side of the crib talking in Spanish to her husband. The attending started to explain to Jen what is important to notice about a baby and what to look for on the physical exam, and proceeded to ask her questions about the causes of pneumonia and meningitis in the newborn period. As they were talking, the infant’s mother came over to the crib. In an attempt to welcome her into their conversation, Jen said “hello,” and proceeded to compliment her on her beautiful child. As soon as she finished the sentence, the mother said “thank you,” but frowned, and her demeanor changed slightly—she stopped smiling, and looked nervous.

Jen wondered what she had done wrong, and suddenly realized that the family was Mexican, and her complimentary words, intended as a tool to gain the mother’s trust, resulted in causing her distress. Remembering what she had learned about Mexican culture and mal de ojo (evil eye), she touched the baby’s hand, and looked back at the mother. The change was remarkable—the mother smiled back at her, and nodded her head. She did not say anything, but her smile and nod tacitly communicated her gratitude for preventing mal de ojo. [For further discussion, see Chapter 12 of Caring for Patients From Different Cultures .]

An eighty-three-year-old Cherokee woman named Mary Cloud was brought into the hospital emergency room by her grandson, Joe, after she had passed out at home. Lab tests and x-rays indicated that she had a bowel obstruction. After consulting with Joe, the attending physician called in a surgeon to remove it. Joe was willing to sign consent for the surgery, but it would not be legal; the patient had to sign for herself. Mrs. Cloud, however, refused; she wanted to see the medicine man on the reservation. Unfortunately, the drive took an hour and a half each way, and she was too ill to be moved. Finally, the social worker suggested that the medicine man be brought to the hospital.

Joe left and drove to the reservation. He returned three hours later, accompanied by a man in full traditional dress complete with feather headdress, rattles, and bells. The medicine man entered Mrs. Cloud’s room and for forty-five minutes conducted a healing ceremony. Outside the closed door, the stunned and amused staff could hear bells, rattles, chanting, and singing. At the conclusion of the ceremony, the medicine man informed the doctor that Mrs. Cloud would now sign the consent form. She did so and was immediately taken to surgery. Her recovery was uneventful and without complications. . [For further discussion, see Chapter 12 of Caring for Patients From Different Cultures .]

Emma Chapman was a sixty-two-year-old African American woman admitted to the coronary care unit because she had continued episodes of acute chest pain after two heart attacks. Her physician recommended an angiogram with a possible cardiac bypass or angioplasty to follow. Mrs. Chapman refused, saying, “If my faith is strong enough and if it is meant to be, God will cure me.”

When Judy, her nurse, asked her what she thought had caused the problem, she said she had sinned and her illness was a punishment. According to her beliefs, illnesses from “natural causes” can be treated through nature (e.g., herbal remedies), but diseases caused by “sin” can be cured only through God’s intervention. Remember, treatment must be appropriate to the cause. In addition, Mrs. Chapman may have felt that to accept medical treatment would be perceived by God as a lack of faith.

Mrs. Chapman finally agreed to the surgery after speaking with her minister, whom Judy called to the hospital. [For further discussion, see Chapter 12 of Caring for Patients From Different Cultures .]

A fifty-year-old Mexican woman named Sandra Ramirez came to the ER with epigastric pain. She told the nurse that she had been experiencing the pain constantly for the past week, but denied any nausea, vomiting, diarrhea, or constipation. There had been no changes in her diet or bladder or bowel function. She revealed that when she had experienced similar pain in the past, she was treated with an unknown medication that helped her greatly. The nurse who was interviewing her had just been introduced in class to the concept of the 4 C’s, so she also asked the patient what she thought the problem was. The patient called her condition “stressful pain,” and elaborated that it wasn’t the pain that caused stress, but that stress caused the pain. It turned out that the medication that had helped her in the past was Xanax. She had stopped taking it eight days earlier; the pain began seven days ago. Had the nurse not gotten the patient’s perspective on her condition—that it was related to stress—they would have done just a standard abdominal workup and perhaps not discovered that it was due to anxiety.

Emma Chapman, a sixty-two-year-old African American woman, was admitted to the coronary care unit because she had continued episodes of acute chest pain after two heart attacks. Her physician recommended an angiogram with a possible cardiac bypass or angioplasty to follow. Mrs. Chapman refused, saying, “If my faith is strong enough and if it is meant to be, God will cure me.” When her nurse asked what she thought caused her heart problems, Mrs. Chapman said she had sinned and her illness was a punishment. Her nurse finally got her to agree to the surgery by suggesting she speak with her minister. If she hadn’t learned about Mrs. Chapman’s religious beliefs while asking what she that was the cause of her heart problems, she might not have thought to contact her clergyman.

Olga Salcedo was a seventy-three-year-old Mexican woman who had just had a femoral-popliteal bypass. Anabel, her nurse, observed that Mrs. Salcedo’s leg was extremely red and swollen. She often moaned in pain and was too uncomfortable to begin physical therapy. Yet during her shift report, her previous nurse told Anabel that Mrs. Salcedo denied needing pain medication. Later that day, Anabel spoke with the patient through an interpreter and asked what she had done for the pain in her leg prior to surgery. Mrs. Salcedo said that she had sipped herbal teas given to her by a curandero (a traditional healer; see Chapter 12); she didn’t want to take the medications prescribed by her physician. Anabel, using cultural competence, asked Mrs. Salcedo’s daughter to bring in the tea. Anabel paged the physician about the remedy and brought it to the pharmacist, who researched the ingredients. Because there was nothing contraindicated, the pharmacist contacted Mrs. Salcedo’s physician, who told her she could take the tea for her pain. The next day, Mrs. Salcedo was able to go to physical therapy and was much more motivated and positive in demeanor. Although it took some time to coordinate the effort, in the end, it resulted in a better patient outcome. Had Anabel not asked what she had been using to cope with her pain, it is likely Mrs. Salcedo would have delayed physical therapy and thus her recovery.

Jorge Valdez, a middle-aged Latino patient, presented with poorly managed diabetes. When Dr. Alegra, his physician, told him that he might have to start taking insulin, he became upset and kept repeating, “No insulin, no insulin.” Not until Dr. Alegra asked Mr. Valdez what concerns he had about insulin did he tell her that both his mother and uncle had gone blind after they started taking insulin. He made the logical—though incorrect—assumption that insulin caused blindness. In this case, the patient expressed his fears, and because the physician was competent enough to pick up on them and explore them, she was able to allay them. In many cases, however, unless the physician specifically asks about concerns, patients will say nothing and simply not adhere to treatment. By asking, the health care provider can correct any misconceptions that can interfere with treatment.

A 35-year-old Jewish woman went in for a baseline mammogram. A lump was discovered. When discussing it with the radiologist, the woman questioned him about all the possible treatments if it turned out to be cancerous, as well as all the side effects of the treatment. The radiologist had little patience for her questions; he repeatedly told her they should wait until after they get the results of the biopsy before they start discussing the side effects of chemotherapy and radiation. The woman, however, felt that she had to know everything possible about the potential negative outcome; only through knowledge could she feel a degree of control. The lump turned out to be benign, but she went into the biopsy procedure much more relaxed than she would have had she not known every possible eventuality.

A 27-year-old pregnant Mexican woman who had been living in the US for two years went to see a genetic counselor at the urging of a friend. XFAP tests indicated the possibility of Down syndrome in her unborn child. She declined the offer of amniocentisis, however, based upon the manner of the genetic counselor, who told her not to be afraid and to do whatever she wanted. The patient later said she interpreted the lack of directiveness as an indication that the positive screening was “no big deal” and that if there were any real danger, the counselor would have insisted on the test.

A middle-aged Mexican female patient suffering from acute liver cirrhosis with abdominal ascites, began to experience extreme shortness of breath. The physician, a liver specialist, asked her to sign consent for an abdominal tap. The patient refused, saying, “I am going to wait until my husband arrives.” The physician was not happy with her response as he felt it was necessary to do the procedure as soon as possible. Fortunately, the patient’s husband arrived within an hour, the paracentesis was done, and her shortness of breath was minimized.

An African American man in his 40s, suffering from diabetes and hypertension presented to his physician, complaining of “feeling poorly”. When questioned, he admitted that he was not taking his insulin regularly; only when he felt that his sugar was high.

A Chinese woman in her 60s was diagnosed with cancer and scheduled to receive chemotherapy. She was unaware of her diagnosis, due to her son’s insistence. The staff was uncomfortable with having to withhold this information from her, so they asked her whether she wanted to know her diagnosis and why she was receiving chemotherapy medication. Her answer was no. She said, “Tell my son; he will make all of the decisions.” They resolved the matter by having hersign a Durable Power of Attorney, appointing her son as legal decision-maker. They were thus able to remove the legal and ethical obstacles to her care.

Bobbie, the nurse, had two patients who had both had coronary artery bypass grafts. Mr. Valdez, a middle-aged Nicaraguan man, was the first to come up from the recovery room. He was already hooked up to a morphine PCA (patient-controlled analgesia) machine, which allowed him to administer pain medication as needed in controlled doses and at controlled intervals. For the next two hours, he summoned Bobbie every ten minutes to request more pain medication. Bobbie finally called the physician to have his dosage increased and to request additional pain injections every three hours as needed. Every three hours he requested an injection. He continually whimpered in painful agony. Mr. Wu, a Chinese patient, was transferred from the recovery room an hour later. In contrast to Mr. Valdez, he was quiet and passive. He, too, was in pain, because he used his PCA machine frequently, but he did not show it. When Bobbie offered supplemental pain pills, he refused them. Not once did he use the call light to summon her.

Nurses usually report that “expressive” patients often come from Hispanic, Middle Eastern, and Mediterranean backgrounds, while “stoic” patients often come from Northern European and Asian backgrounds. As a young Chinese man told me, “Even since I was little boy, my family watched dubbed Chinese movies, and by watching many of the male protagonists state ‘I’d rather shed blood than my tears,’ it is imbedded in my mind that crying or showing pain shows my weakness.” However, simply knowing a person’s ethnicity will not allow you to predict accurately how a patient will respond to pain; in fact, there are great dangers in stereotyping, as the next case demonstrates.

Mrs. Mendez, a sixty-two-year-old Mexican patient, had just had a femoral-popliteal bypass graft on her right leg. She was still under sedation when she entered the recovery room, but an hour later she awoke and began screaming, “Aye! Aye! Aye! Mucho dolor! [Much pain].” Robert, her nurse, immediately administered the dosage of morphine the doctor had prescribed. This did nothing to diminish Mrs. Mendez’s cries of pain. He then checked her vital signs and pulse; all were stable. Her dressing had minimal bloody drainage. To all appearances, Mrs. Mendez was in good condition. Robert soon became angry over her outbursts and stereotyped her as a “whining Mexican female who, as usual, was exaggerating her pain.”

Reports from the Field

Field reports are submitted by students, peers and colleagues in the healthcare profession. Do you have field report to share? Submit it here. Thank you!

A Filipino Case Study

Patient safety and satisfaction have always been a priority in nursing, but they can be compromised by nursing priority and time constraint. With higher patient to nurse ratios, increase patient acuity, managed health care system, and higher demands for quality patient care, nurses today are working harder. Read More

Conditions in Kenya, Africa

HE DIDN’T ANSWER

Rounds have started. I move from bed to bed with the doctors, three patients at a time. Bed 3 contains Matu, Mugambi and Karanja. Matu’s spine is beginning to curve from six weeks of clutching his knees so he doesn’t touch the cold, contaminated floor. His spot at the foot of the bed is tinged yellow. He’s 4. He was treated for malaria and discharged two weeks ago, but with no family to claim him he’s still hereŠand getting sick again. Read More

A Case of Polygamy

This is a case of a 49-year-old Hispanic male who was involved in a motor vehicular accident while not wearing a seat belt. He suffered multiple chest injuries, fractured ribs and humerus and sustained severe subdural bleeding. He was unconscious when brought to the Emergency Department, where a trauma work-up was done. His CT scan of the head revealed severe bleeding and was inoperable. His pupils were fixed and dilated. Read More

I was on a pediatrics visit at Harbor-UCLA hospital learning how to perform a newborn exam. As I followed the Peds attending into the patient’s room, I noticed that the baby’s mom was sitting on the side of the crib talking in Spanish to her husband. The attending, I’ll call her Dr. Gabe, started to explain what is important to notice about a baby, what to look for on the physical exam, and proceeded to ask Read More

Homelessness in our Hometown: The Hidden Community

In today’s society a person’s worth is determined by their material possessions, the size of their home, what kind of car they drive and how well they dress. How are you viewed by society if you have nothing and live on the streets? What kind of treatment do you receive if you chose to live this way? Read More

Cultural Incompetence

Maria was a 4-month-old Hispanic infant with a history of Down’s syndrome and an ASD/VSD congenital anomaly. After her cardiac surgery, she had several complications that resulted in a lengthy ICU stay. During that time she had two cardio-pulmonary arrests, which resulted in the need to try to contact her parents. Her parents visited infrequently due to work obligations and the need to care for their other children. Read More

A Vietnamese Death

I was invited to do a presentation on cultural competence to the hospice staff and a large, successful, and very white hospital. As part of my preparation, I visited the in patient hospice one afternoon. At the end of my visit I sat with the nurses as they debriefed the shift. One, a leader of some sort, said that she was pleased I would talk to them since she felt that she needed to know more. Read More

Dangerous Dominican Powder

An article in the Nov. 6, 2003 issue of the New York Times, written by Richard Pérez-Peña, reported on a highly poisonous powder sold. Read More

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Communication →

16 Feb 2024
Research & Ideas

Is Your Workplace Biased Against Introverts?

Extroverts are more likely to express their passion outwardly, giving them a leg up when it comes to raises and promotions, according to research by Jon Jachimowicz. Introverts are just as motivated and excited about their work, but show it differently. How can managers challenge their assumptions?

06 Nov 2023

Did You Hear What I Said? How to Listen Better

People who seem like they're paying attention often aren't—even when they're smiling and nodding toward the speaker. Research by Alison Wood Brooks, Hanne Collins, and colleagues reveals just how prone the mind is to wandering, and sheds light on ways to stay tuned in to the conversation.

31 Oct 2023

Checking Your Ethics: Would You Speak Up in These 3 Sticky Situations?

Would you complain about a client who verbally abuses their staff? Would you admit to cutting corners on your work? The answers aren't always clear, says David Fubini, who tackles tricky scenarios in a series of case studies and offers his advice from the field.

24 Jul 2023

Part-Time Employees Want More Hours. Can Companies Tap This ‘Hidden’ Talent Pool?

Businesses need more staff and employees need more work, so what's standing in the way? A report by Joseph Fuller and colleagues shows how algorithms and inflexibility prevent companies from accessing valuable talent in a long-term shortage.

23 Jun 2023

This Company Lets Employees Take Charge—Even with Life and Death Decisions

Dutch home health care organization Buurtzorg avoids middle management positions and instead empowers its nurses to care for patients as they see fit. Tatiana Sandino and Ethan Bernstein explore how removing organizational layers and allowing employees to make decisions can boost performance.

24 Jan 2023

Passion at Work Is a Good Thing—But Only If Bosses Know How to Manage It

Does showing passion mean doing whatever it takes to get the job done? Employees and managers often disagree, says research by Jon Jachimowicz. He offers four pieces of advice for leaders who yearn for more spirit and intensity at their companies.

10 Jan 2023

How to Live Happier in 2023: Diversify Your Social Circle

People need all kinds of relationships to thrive: partners, acquaintances, colleagues, and family. Research by Michael Norton and Alison Wood Brooks offers new reasons to pick up the phone and reconnect with that old friend from home.

15 Nov 2022

Why TikTok Is Beating YouTube for Eyeball Time (It’s Not Just the Dance Videos)

Quirky amateur video clips might draw people to TikTok, but its algorithm keeps them watching. John Deighton and Leora Kornfeld explore the factors that helped propel TikTok ahead of established social platforms, and where it might go next.

03 Nov 2022

Feeling Separation Anxiety at Your Startup? 5 Tips to Soothe These Growing Pains

As startups mature and introduce more managers, early employees may lose the easy closeness they once had with founders. However, with transparency and healthy boundaries, entrepreneurs can help employees weather this transition and build trust, says Julia Austin.

15 Sep 2022

Looking For a Job? Some LinkedIn Connections Matter More Than Others

Debating whether to connect on LinkedIn with that more senior executive you met at that conference? You should, says new research about professional networks by Iavor Bojinov and colleagues. That person just might help you land your next job.

08 Sep 2022

Gen Xers and Millennials, It’s Time To Lead. Are You Ready?

Generation X and Millennials—eagerly waiting to succeed Baby Boom leaders—have the opportunity to bring more collaboration and purpose to business. In the book True North: Emerging Leader Edition, Bill George offers advice for the next wave of CEOs.

05 Aug 2022

Why People Crave Feedback—and Why We’re Afraid to Give It

How am I doing? Research by Francesca Gino and colleagues shows just how badly employees want to know. Is it time for managers to get over their discomfort and get the conversation going at work?

23 Jun 2022

All Those Zoom Meetings May Boost Connection and Curb Loneliness

Zoom fatigue became a thing during the height of the pandemic, but research by Amit Goldenberg shows how virtual interactions can provide a salve for isolation. What does this mean for remote and hybrid workplaces?

13 Jun 2022

Extroverts, Your Colleagues Wish You Would Just Shut Up and Listen

Extroverts may be the life of the party, but at work, they're often viewed as phony and self-centered, says research by Julian Zlatev and colleagues. Here's how extroverts can show others that they're listening, without muting themselves.

24 May 2022

Career Advice for Minorities and Women: Sharing Your Identity Can Open Doors

Women and people of color tend to minimize their identities in professional situations, but highlighting who they are often forces others to check their own biases. Research by Edward Chang and colleagues.

12 May 2022

Why Digital Is a State of Mind, Not Just a Skill Set

You don't have to be a machine learning expert to manage a successful digital transformation. In fact, you only need 30 percent fluency in a handful of technical topics, say Tsedal Neeley and Paul Leonardi in their book, The Digital Mindset.

08 Feb 2022

Silos That Work: How the Pandemic Changed the Way We Collaborate

A study of 360 billion emails shows how remote work isolated teams, but also led to more intense communication within siloed groups. Will these shifts outlast the pandemic? Research by Tiona Zuzul and colleagues. Open for comment; 0 Comments.

Cold Call Podcast

What’s Next for Nigerian Production Studio EbonyLife Media?

After more than 20 years in the media industry in the UK and Nigeria, EbonyLife Media CEO Mo Abudu is considering several strategic changes for her media company’s future. Will her mission to tell authentic African stories to the world be advanced by distributing films and TV shows direct to customers? Or should EbonyLife instead distribute its content through third-party streaming services, like Netflix? Assistant Professor Andy Wu discusses Abudu’s plans for her company in his case, EbonyLife Media. Open for comment; 0 Comments.

11 Jan 2022

Feeling Seen: What to Say When Your Employees Are Not OK

Pandemic life continues to take its toll. Managers who let down their guard and acknowledge their employees' emotions can ease distress and build trust, says research by Julian Zlatev and colleagues. Open for comment; 0 Comments.

04 Jan 2022

Scrap the Big New Year's Resolutions. Make 6 Simple Changes Instead.

Self-improvement doesn't need to be painful, especially during a pandemic. Rather than set yet another gym goal, look inward, retrain your brain, and get outside, says Hirotaka Takeuchi. Open for comment; 0 Comments.

Institute of Advanced Studies (IAS)

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CfP: ‘Traversing beyond Borders: Intermediality and Cross-Cultural Communication’

15 April 2024

A postgraduate conference to be held on 31 May 2024 in the IAS Common Ground, UCL. Deadline for submissions: Monday 22 April, 2024

painting sev kardesim love sister and brother by merve iseri

Our one-day PGR Conference (funded by IAS Critical Area Studies small grant) aims to showcase the research of PGR students from various fields whose work is relevant to the discourse of either ‘intermediality’ or ‘cross-cultural communication’. We will not only explore the interaction between different cultures and languages in world literature, but also discuss the intersection between different forms of media, such as poetry and visual arts, music and literature, especially the artist creations whose inspiration is connected to literary works. The conference also plans to invite artists to participate as panellists and workshop leaders in the spirit of encouraging the collaboration between academia and creative industries.

We are enormously delighted to announce that we have invited London-based Turkish artist Merve İşeri to be our keynote speaker, whose creation is based on the unique understanding of immigration, displacement of identity, cross-cultural experience, and memory. For more information about İşeri’s works, please see her website: https://www.merveiseri.com/

We invite abstracts on the following themes, but are not limited to:

Intermediality between visual art, literature, music, film, and beyond.
Dialogues between different languages, cultures, and religions.
Marginalised narratives in histories and memories.
Representation of travel, exile and homecoming.
Literature and science.
Migration and diaspora studies.
The afterlife of literature. Adaptation, translation and publication studies.

Abstracts should be 250-300 words. Please send abstracts, along with a short bio (around 100 words, including name, email address, academic affiliation, research background) to [email protected] by 5pm Monday 22 April, 2024 . Notification of acceptance will be sent by 3rd May, 2024.

Possible formats may include:

15-20 minutes paper presentations.
5 minutes lightning talks.
Proposals of a full panel session (the bio must include the details of all panellists)
Theatrical and musical performances.
Poetry reading and spoken word performances.
Collaborate workshops.

Our event will be supplied by full-day catering and a wine reception in the end. If you have any questions, please contact Serena Qihui Pei (UCL) and Gefan Wang (KCL) at [email protected]

Image credit: ‘Sev Kardesim’* (love, sister and brother) by Merve İşeri (2021). Oil, pastel, acrylic, and pigment spray paint on canvas. * The painting’s title alludes to the song of the same name by Turkish singer Şenay.

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Aldi’s Culture, Cultural Traits & Core Values

Aldi company culture, organizational culture and cultural traits, corporate grocery store business work analysis case study

Aldi’s organizational culture promotes workplace behaviors and human resource capabilities that maximize strategic success. The discount supermarket chain employs its business culture to support human resource potential for a productive workforce. This company culture provides social support for workplace effectiveness, which addresses competition and the related factors outlined in the Five Forces analysis of Aldi . This cultural support ensures business strength against competitors, like Walmart , Costco , Whole Foods , and Amazon ’s e-commerce and brick-and-mortar stores. These competitors and even Home Depot , which is not a direct competitor, influence workplace culture standards for the retail industry and affect Aldi’s work culture strategy.

Aldi’s Core Values . Consistency, simplicity, and responsibility are the core values that determine Aldi’s culture. These core values establish the fundamental principles and philosophy that guide employee behaviors and decisions impacting the retail business organization. With these core values, the company culture shapes human resources in support of business goals derived from Aldi’s mission statement and vision statement . For example, the core value of consistency and the cultural traits of gratitude and kindness create a satisfactory workplace and a great shopping experience that retains customers.

Aldi’s Cultural Traits & Focus Areas

Aldi’s organizational culture involves business goals for human resource development and quality service. The company’s strategic management and human resource management focus on the following areas for employees. These factors become cultural traits embedded into the workplace, promoting job satisfaction and motivating workers to achieve customer satisfaction objectives for retail business growth. The following are the traits that define Aldi’s culture:

Gratitude and kindness
Work-life balance
Emphasis on development
Cooperation for a great work environment

Gratitude and kindness . Aldi’s management approach involves kindness and gratitude toward employees. Consequently, employees are motivated to adopt kindness and gratitude as traits of their work culture. This cultural trait helps create a positive shopping experience and contributes to the success of Aldi’s marketing mix (4Ps) . For example, this company culture supports satisfactory retail service and complements promotional tactics by motivating workers to engage customers in a positive way. Kindness and gratitude in this organizational culture contribute to a positive customer experience at Aldi grocery stores.

Work-life balance . Aldi’s company culture puts value on work-life balance, which is supported through human resource management and other aspects of the business. As a result, employees value and expect work-life balance, integrating it into their mindset about the retail business and its workplaces. Through this cultural trait, the discount supermarket chain achieves job satisfaction while facilitating Aldi’s stakeholder management and CSR and ESG strategy. For example, with this organizational culture, the company’s CSR/ESG approach aims to satisfy workers’ interests regarding compensation, career development, and work-life balance in the retail business. This means that Aldi’s strategies for various aspects of its business create a multi-pronged solution that supports human resource development and the corporate culture.

Emphasis on development . Career development is a major objective in Aldi’s human resource management. This objective is also built into the company culture. For example, employees value career development and align their behaviors and aspirations accordingly. Workers’ expectations and goals for career development influence their decisions and Aldi’s organizational culture. The company reinforces this trait to encourage a career-focused workforce that benefits the retail business. The implementation of cultural support for career development depends on the divisions, groups, and teams in Aldi’s company structure (organizational structure). This retail business culture develops with some constraints or limitations based on the company’s structural characteristics. Also, the area of job design and human resources in Aldi’s operations management coordinates with this organizational culture to promote career development and motivate workers at the company’s offices and stores.

Cooperation for a great work environment . Aldi’s culture encourages social connections among employees for a great work environment, based on the company’s efforts to provide meaningful and rewarding work experiences. This cultural trait helps workers maintain a positive perspective in the workplace. This perspective motivates Aldi’s employees to exhibit behaviors that positively influence customer perception about the retail business organization. Arguably, market trends, as well as the social and technological factors enumerated in the PESTLE/PESTEL analysis of Aldi , influence the design of the work environment and affect the development of this organizational culture. For example, social trends determine employees’ preferences in the company and human resource management priorities for the design of offices and grocery stores.

Strategic Implications of Aldi’s Company Culture

Aldi’s organizational culture motivates employee behaviors for retail business effectiveness. For example, the company’s gratitude and kindness toward its workers translate to cultural traits of gratitude and kindness that are exhibited in the workplace, including Aldi grocery stores. This condition shows that the company culture contributes to a positive shopping experience that can attract and retain customers.

The emphasis on career development in Aldi’s culture motivates employees to strive for excellence, such as in providing efficient service at the stores. Consequently, this company culture enhances employee productivity and job performance, which are factors that enhance retail business growth and strategic effectiveness. Thus, Aldi’s business culture motivates high productivity and effectiveness among workers while satisfying their personal goals regarding career development.

Considering Aldi’s core values, the traits of the company’s organizational culture reflect a business model that focuses on effective and efficient human resources supporting core retail operations. These cultural traits shape human resource development and the business capabilities for implementing Aldi’s generic strategy for competitive advantage and strategies for intensive growth . For example, this company culture affects workers’ knowledge, skills, and abilities that determine strategy development and implementation in retail operations. Also, this work culture enhances competitive advantages, like the business strengths outlined in the SWOT analysis of Aldi . For instance, the career development aspect of this corporate culture improves employee performance and, consequently, the capabilities of the retail business organization.

About Aldi .
Aldi – Explore Our Work Culture and Jobs and Careers .
Aldi Careers and Jobs .
Dyer, C. (2023). The Power of Company Culture: How any business can build a culture that improves productivity, performance and profits . Kogan Page Publishers.
Reis, A. D., & Veríssimo, J. M. C. (2023). The journey of culture and social responsibility and its relationship with organizational performance: Pathway and perspectives. Journal of Organizational Effectiveness: People and Performance, 10 (1), 22-42.
Riani, A., Asya, V. R., & Yuwono, F. S. P. (2023). Literature study of the effect of corporate culture on work motivation and employee performance. American Journal of Economic and Management Business (AJEMB), 2 (3), 89-93.
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Please note you do not have access to teaching notes, tackling the social marketing formative research bottleneck: comparative analysis of the complementary nature of community-generated personas and focus groups.

Journal of Social Marketing

ISSN : 2042-6763

Article publication date: 16 April 2024

This study aims to understand the utility of personas and illustrate, through a case study, how a persona-building exercise in a Community Based Prevention Marketing (CBPM) training of community leaders elicited important insights that complemented findings from ongoing formative research on vaccine hesitancy in the Hispanic/Latino population in the USA during COVID-19 pandemic.

Design/methodology/approach

An exploratory concurrent parallel qualitative study design compared three personas created by community-based organization members ( n = 37) to transcripts from five formative research focus groups ( n = 30) from the same project. All participants in this study were recruited by the National COVID-19 Resiliency Network as part of their capacity-building and formative research activities. Grounded theory guided the content analysis.

This study found personas and focus groups to be complementary. A high degree of co-occurrence was observed when investigating the uptake of the COVID-19 vaccine under the categories of barriers, culture and communication. Between the two methods, the authors found strong associations between fear, disruption to the value system, work-related barriers, inaccessibility to health care and information sources and misinformation. Areas of divergence were negligible.

Research limitations/implications

While personas provided background information about the population and sharing “how” to reach the priority population, focus groups provided the “why” behind the behavior, followed by “how”.

Practical implications

A community-driven persona-building process built on cultural community knowledge and existing data can build community capacity, provide rich information to assist in the creation of tailored messages, strategies and overall interventions during a public health crisis and provide user-centered, evidence-based information about a priority population while researchers and practitioners wait on the results from formative research.

Originality/value

This case study provided a unique opportunity to analyze the complementary effectiveness of two methods acting in tandem to understand the priority population: stakeholder-informed persona-building and participant-informed focus group interviews. Understanding their complementary nature addresses a time gap that often exists between researchers and practitioners during times of crises and builds on recommendations associated with bringing rigor into practice, promoting academic contribution to real-world issues and building collaborative partnerships. Finally, it supports the utility of a nimble tool that improves social marketers’ ability to know more about their audience for intervention design when time is of the essence and formative research is ongoing.

Vaccine-hesitancy
Social marketing
Participatory design

Acknowledgements

Funding: This work was supported by the U.S. Department of Human and Health Services Office of Minority Health as part of the National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic Minority Communities (NIMIC) designed to work with community-based organizations across the nation to deliver education and information on resources to help fight the pandemic [Grant # 1 CPIMP201187-01–00].

Khaliq, M. , Wimbish, D. and Makris, A. (2024), "Tackling the social marketing formative research bottleneck: comparative analysis of the complementary nature of community-generated personas and focus groups", Journal of Social Marketing , Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/JSOCM-06-2023-0141

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EMT en Español Para Autismo : A Collaborative Communication Intervention Approach and Single Case Design Pilot Study

Original Article
Open access
Published: 13 April 2024

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Natalie S. Pak ORCID: orcid.org/0000-0003-1032-5813 1 nAff2 ,
Tatiana Nogueira Peredo ORCID: orcid.org/0000-0002-2558-6736 1 ,
Ana Paula Madero Ucero 1 &
Ann P. Kaiser ORCID: orcid.org/0000-0001-9406-685X 1

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The primary purpose of the current pilot study was to test the effects of an adapted and collaborative intervention model with a systematic teaching approach on Latina Spanish-speaking caregivers’ use of EMT en Español Para Autismo strategies with their young children on the autism spectrum. A multiple baseline across behaviors single case design was replicated across two dyads. A series of family interviews and a direct therapist-child intervention phase supported individualization of the intervention. Families were provided speech generating devices as part of their children’s intervention protocol. Caregivers were taught to use EMT en Español Para Autismo strategies with aided language input. Strategies included contingent target-level and proximal target-level language modeling, linguistic expansions, and communication elicitations. Secondary variables measured included generalization of strategy use to unsupported interactions and at a 2-month follow-up, child communication outcomes, and social validity. There was a strong functional relation for one dyad between the adapted and collaborative intervention and caregiver use of EMT strategies. The functional relation was weakened by behavioral covariation for the other dyad. Children increased the quantity and diversity of their communication during the study. Caregivers generalized their use of most EMT strategies and reported most aspects of the approach to be socially valid. The current study provides an initial demonstration of an effective model for adaptation and individualization of naturalistic developmental behavioral interventions for Latino Spanish-speaking families with children on the autism spectrum.

Avoid common mistakes on your manuscript.

Early diagnoses of autism are increasingly prevalent in the United States, affecting an estimated 1 in 46 preschool-aged children across all races and ethnicities and 1 in 34 Hispanic children (Shaw et al., 2023 ). Latino Spanish-speaking (LSS) families face multiple systemic barriers to accessing early intervention for their young children on the autism spectrum and are more likely than non-Latino White children to receive no or inadequate services (Stahmer et al., 2019 ; Zuckerman et al., 2017 ). Caregiver-mediated (or implemented) interventions have been shown to positively influence children’s language outcomes for monolingual English-speaking children (Heidlage et al., 2020 ; Roberts et al., 2019 ). In this article, caregiver refers to children’s primary caregivers in the home (e.g., parent, other family member). Importantly, LSS caregivers report a desire to be partners in the delivery of intervention for their children on the autism spectrum, and they report children’s communication skills to be a high priority for intervention (DuBay et al., 2018 ). In a scoping review of the literature, DuBay ( 2022 ) identified 19 studies investigating culturally adapted caregiver-mediated interventions for Latino families and children on the autism spectrum. Only two involved interventions specifically targeting children’s early communication skills (Gevarter et al., 2022 ; Meadan et al., 2020 ). To reduce the disparities in early intervention services, more culturally and linguistically adapted caregiver-implemented language interventions for children on the autism spectrum are necessary (Martinez-Torres et al., 2021 ).

EMT en Español

EMT en Español is a Spanish language, caregiver-mediated adaptation of Enhanced Milieu Teaching (EMT) that has been tested with LSS families and their preschool children with language delays (Peredo et al., 2018 , 2022 ). EMT en Español and EMT are naturalistic developmental behavioral interventions (NDBIs) which involve use of behavioral principles to teach developmentally appropriate communication skills in naturalistic settings (Schreibman et al., 2015 ). Among NDBIs, EMT is uniquely focused on improving child language and communication development and has been demonstrated to be effective for children with a variety of etiologies of language impairments (Kaiser & Hampton, 2017 ; Kaiser et al., 2021 ; Roberts & Kaiser, 2015 ; Wright et al., 2013 ).

Cultural and linguistic adaptations to interventions such as EMT may be linked to dimensions of the ecological validity model (EVM), a framework designed specifically for adapting interventions to be more culturally sensitive for Spanish-speaking families (Bernal et al., 1995 ). According to this model, there are eight dimensions that can influence the cultural consistency of an intervention for a given client or community. These dimensions are language, persons, metaphors, content, concepts, goals, methods, and context. Adaptations to EMT en Español have addressed several dimensions of the EVM (see Peredo et al., 2018 , and Peredo et al., 2022 , for more details). For example, rather than simply following the child’s lead, caregivers are coached to first comment on the child’s focus of interest within adult-directed activities. This addresses the dimensions of content and concepts. Additional adaptations have been implemented in the procedures and delivery of intervention (method). For example, interventionists speak Spanish with families (language, persons) and deliver intervention in homes during familiar and/or valued routines (context, goals) (Peredo et al., 2018 , 2022 ).

These adaptations have been tested in two studies. Using a single-case experimental design, Peredo et al. ( 2018 ) demonstrated that three Spanish-speaking mothers from Mexico applied EMT en Español strategies with their preschool children with developmental language disorders when the mothers were taught using a systematic training approach (Teach-Model-Coach-Review or TMCR; Roberts & Kaiser, 2015 ). The mothers generalized use of most EMT en Español strategies to a novel context at home and reported using the strategies additional times throughout the week. Results for LSS caregivers receiving systematic instruction to use EMT en Español were also positive in a small randomized trial (Peredo et al., 2022 ). Twenty LSS caregivers and their children with language delays (age range 29–43 months) were randomized to a 24-session intervention at home ( n = 10) or waitlist control group ( n = 10). There were statistically significant intervention effects for caregivers’ use of matched turns, expansions, and linguistic targets ( d = 1.24–1.90).

EMT en Español Para Autismo

The current study was a pilot investigation of EMT en Español Para Autismo , an adaptation of EMT en Español aiming to address the specific needs of LSS families of children on the autism spectrum. Prior to the study, four LSS primary caregivers of children on the autism spectrum provided feedback on EMT en Español materials in a focus group format. The focus group caregivers were positive about the materials, reported the materials were relevant to them, and noted areas in which they would benefit from more information. This feedback was combined with clinical expertise and experience from previous EMT studies with children on the autism spectrum (e.g., Hampton et al., 2021 ) to make adaptations for the current study.

The first adaptation was to include information to expand caregivers’ knowledge about autism. Focus group findings were consistent with reports that LSS parents of children on the autism spectrum often begin evaluation and treatment services with limited knowledge about autism, which can lead to self-blame for their children’s challenges (Chlebowski et al., 2018 ; Zuckerman et al., 2017 ). The second adaptation was to teach caregivers individualized strategies for promoting child engagement in interactions and activities, which was a need reported by focus group caregivers. Strategies to support children’s engagement have been reported in previous EMT and EMT en Español studies. These include: (a) arranging the setting to support children’s contact with activities and to minimize distractions, (b) choosing high interest toys, (c) sitting at the child’s level, (d) scaffolding play and engagement, (e) shifting activities when children lose interest, and (f) specific behavior supports such as use of timers and first-then charts (Hampton et al., 2019 , 2021 ; Peredo et al., 2018 , 2022 ). In the current pilot study, many of the same strategies were employed; however, the selected strategies were individualized based on family concerns and preferences expressed throughout the study and based on an initial phase of therapist-delivered child intervention. The third adaptation was to provide access to high-tech augmentative and alternative communication (AAC) for children who began the study with little to no expressive spoken language. AAC, which includes various modes of communication used instead of or in addition to speech, may be important for young children at high risk of delayed development of spoken language (Beukelman & Light, 2020 ). Specifically, children received speech-generating devices (SGDs) in the form of iPad minis with the Proloquo2Go communication app (AssistiveWare, 2023 ). Spanish and English were both available on the Proloquo2Go app; Spanish vocabulary was primarily used during the study for language modeling, with vocabulary selections made collaboratively with each family. Families were coached to model language with both the SGD and speech while delivering EMT en Español Para Autismo with their children (i.e., aided AAC modeling; Beukelman & Light, 2020 ).

The primary purpose of this pilot study was to assess the effects using a systematic teaching approach to teach LSS caregivers of children on the autism spectrum to implement EMT en Español Para Autismo . We posed the following research questions: (a) Do LSS caregivers of children on the autism spectrum use EMT en Español Para Autismo strategies during coached caregiver-child interactions when taught using the TMCR approach? (b) Do LSS caregivers use EMT en Español Para Autismo strategies during caregiver-child interactions without coaching during and after the intervention period when taught using the TMCR approach? (c) Do LSS children on the autism spectrum increase the frequency and diversity of their communication when their caregivers are taught EMT en Español Para Autismo strategies? (d) How do caregivers perceive the intervention approach?

Experimental Design

The experimental design was a single-case multiple baseline design across behaviors replicated across caregiver-child dyads (Baer et al., 1968 ). In multiple baseline designs across behaviors, participants are taught functionally similar but independent behavior sets with a time-lagged introduction of intervention for each behavior set (Gast et al., 2018 ). In the current study, the behavior sets (i.e., tiers of the intervention) were sets of EMT en Español Para Autismo strategies: (a) contingent target-level language modeling, (b) contingent higher-level language modeling including proximal targets and expansions, and (c) communication elicitation strategies (see Table 1 for definitions). Environmental arrangement strategies to support child engagement and communication (e.g., eliminating distractions, using timers if needed to increase duration of child play, reducing questions and instructions) were taught in Tier 1 along with target level language models. The sequence of study phases and activities is shown in Fig. 1 .

Flowchart of study activities. The order of phases is pre-intervention, Tier 1 intervention, Tier 2 intervention, Tier 3 intervention, and post-intervention. Within each intervention tier, there is an interview activity, workshop, TMCR intervention, and a generalization session. Boxes with square corners indicate activities that were part of the experimental design

The study phases were (a) pre-intervention, (b) teaching caregivers three sets of EMT strategies using the TMCR approach across tiers of the intervention design, and (c) post-intervention assessment. The pre-intervention phase included three initial baseline sessions with the caregiver, eight sessions of direct therapist delivery of the intervention to the child, and a second set of three baseline sessions. Measuring caregiver baseline performance prior to and after therapist-child intervention was included to detect any change in caregiver use of strategies from watching the therapist use the strategies before the TMCR intervention. The experimental design was implemented in the second set of baseline sessions and the planning, teaching, and coaching components of the intervention during the TMCR phase (boxes with square corners in Fig. 1 ). The post-intervention phase included a caregiver exit interview immediately after intervention and a follow-up observation 2 months later.

Recruitment

Caregiver-child dyads who met the following criteria and wished to participate in the study were recruited: (a) Spanish was the primary language spoken in the home; (b) the child had an autism diagnosis or flagged on an autism screening measure; (c) the child was 30–42 months old at the beginning of intervention; (d) the child had a Total Language Score at least 1.5 SD below the mean standardized score on the Preschool Language Scales, 5th edition Spanish (PLS-5 Spanish; Zimmerman et al., 2012 ); and (e) at least one primary caregiver was willing and able to participate in the intensive intervention for several months. Participants were recruited from a list of children who were assessed for eligibility for an ongoing randomized controlled trial (Kaiser & Peredo, 2019 –2024) but were excluded because the children already had an autism diagnosis or exhibited characteristics of autism based on the Screening Tool for Autism in Toddlers and Young Children (STAT; Stone & Ousley, 2008 ). A bilingual member of the research team called participants who had consented to being contacted for future studies for a phone screening. Subsequent in-person eligibility assessments were conducted in families’ homes. Interested families whose children demonstrated characteristics of autism based on the STAT but did not yet have a diagnosis were provided with a full evaluation including administration of the TELE-ASD-PEDS (Corona et al., 2020 ) and a diagnostic interview by qualified providers. Prior to any study activities, consent was obtained from caregivers indicating that they wished to participate and that they gave consent for their children to participate. Written consent forms and verbal explanations of the consent forms were in Spanish. All study procedures and materials were approved by a university Institutional Review Board (IRB). Participating families received toys and books (shape sorter, blocks, bubbles, and two bilingual picture books) at the beginning of the study valued at approximately $50. Additional incentives included intervention materials that were collaboratively selected with the family during the individualization process described in the following section.

Intervention Planning and Individualization

Individualizing the intervention at the beginning of the study occurred during the therapist-child intervention phase and the series of interviews (see Fig. 1 ). The primary purposes of the therapist-child intervention phase were to (a) give the child experience in the intervention context as a foundation for the caregiver-implemented intervention and (b) provide the research team with specific information about how to best individualize intervention based on their interactions with the child. Family members in addition to the participating caregiver were invited to the initial interview and planning session, which occurred after all baseline sessions were completed and prior to any caregiver instruction (see Fig. 1 ). The Family Values and Activities Interview (FVAI) was administered in Spanish by the interventionist using the FVAI protocol (Peredo, 2016 ). The first part of this semi-structured protocol was a series of open-ended questions about the family values, goals, and beliefs about communication. The second part included questions about the activities that occurred frequently, were important to the family, or both.

During the planning portion of the session, the family and interventionist first selected specific routines or activities that were typical for each family and could be used in the intervention sessions to practice the EMT en Español Para Autismo intervention strategies with coaching. Second, the interviewer, interventionist, and family collaborated to select additional play materials (within a $50 budget per family) that would be engaging for the child and facilitate communicative interactions. Third, families and therapists determined whether to introduce the SGD if the child used fewer than five spoken words at the beginning of intervention and during therapist-child intervention sessions. When applicable, families were provided iPad minis loaded with Proloquo2Go. Activity grid displays with Spanish vocabulary were primarily used for this pilot study. The families kept the SGDs between sessions during the study and after the study ended. Prior to beginning the caregiver-implemented intervention phase, children’s abilities to visually scan symbols on the iPad were tested using a “chase the ball” task to determine the grid size (see Hampton et al., 2020 , for a description). Core vocabulary words (e.g., sí/yes, no, poner/to put) were added to each page, and activity pages were individualized to the participant. Symbols were added on an ongoing basis based on caregiver preferences and therapist suggestions, ensuring that an adequate number of verbs, nouns, and adjectives were available, and that vocabulary matched the family’s dialect and vocabulary preferences (Bernal et al., 1995 ; Binger et al., 2023 ).

Each family also participated in two shorter mid-intervention interviews (“mini-interviews”; see Fig. 1 and Online Resource) with the interventionist. The mini-interviews occurred immediately before the introduction of Tier 2 and Tier 3 strategies. During mini-interviews, the interventionist asked the families how they felt about the intervention, their child’s progress, and any changes in family activities relevant to intervention.

Participants

Five dyads completed in-person screening for the study. One dyad did not enroll in the study due to limited ability to participate in study sessions multiple times per week. Two dyads enrolled in the study but dropped out before starting intervention or before completing Tier 1 of intervention. In both cases, the caregivers did not wish to continue with the study sessions because their children became eligible to start receiving services at school or from other providers. Table 2 shows characteristics of the two dyads who enrolled and completed the study.

Dyad 1 included a 33-month-old boy and his maternal grandmother, referred to as Daniel and Dayana. Daniel received an autism diagnosis from an evaluation team in Mexico during the study prior to the FVAI and planning session. Daniel was not receiving any additional services at the beginning of the study, but he began attending full-day monolingual English-speaking preschool during Tier 2 of the study intervention. Dayana and Daniel’s mother participated in the initial FVAI and planning session. Per the family’s report and observation during therapist-child sessions, Daniel enjoyed playing with a variety of toys, movement (e.g., jumping on a trampoline), and looking at books. He communicated primarily by vocalizing, leading others by the hand, and giving objects. The therapist and family decided to introduce the SGD, which was available during all subsequent TMCR and generalization sessions except for one session when the battery had died. Although Daniel preferred reading books independently and would turn away when others joined him, shared book-reading was valued by the family and was incorporated into TMCR sessions. The additional materials collaboratively selected for intervention included toys representing various foods and cooking tools, board books, and a pop-up toy. Snack and mealtime routines were preferred activities for Daniel and were selected as contexts for caregiver practice and coaching. Daniel’s mother, father, and grandmother all participated in the first mini-interview (prior to Tier 2) and the exit interview. Only Dayana participated in the second mini-interview (prior to Tier 3). During mini-interviews, the family discussed child progress that they noticed, such as that he was making eye contact more often and sleeping better. After the first mini-interview, drawing with markers was added as an intervention session activity and handouts were provided to help with ongoing potty training outside of sessions. Although shared book-reading continued to be a struggle, the family continued to state its importance and it remained an intervention session activity.

Dyad 2 included a 31-month-old boy and his mother, referred to as Luis and María. Luis demonstrated signs of autism during screening and was subsequently diagnosed during a professional evaluation arranged by the research team. Luis attended a bilingual English- and Spanish-speaking childcare for approximately 4–7 h each weekday at the beginning of the study, but his enrollment was inconsistent during the study. Each week, he received occupational therapy 30 min and speech-language therapy 60 min in English. His mother had monthly telepractice consultations in Spanish regarding strategies to support Luis at home. María participated in the FVAI and planning session. Per caregiver report and observation during therapist-child sessions, Luis enjoyed taking walks, watching television, shared book reading, blocks, tickles, and sensory play (e.g., Play-Doh). He communicated by vocalizing, using gestures such as reaching and giving, and a few spoken words (e.g., mamá, no). María was hesitant about the SGD, as she wanted to limit her children’s screen time; however, she agreed to try using it for a few sessions before deciding. In the fifth TMCR session with the SGD, María mentioned that she liked that he was trying to use the device more frequently to communicate. The SGD was available in all subsequent TMCR and generalization sessions. The additional materials selected for intervention included puppets, books, and a Play-Doh set. Preparing and eating food, getting dressed, and combing hair were preferred routines for Luis; these were incorporated into TMCR sessions as routines for practice and coaching with EMT en Español Para Autismo strategies. María and Luis’s grandmother participated in mini-interviews. They reported noticing changes in the child’s communication and behavior, including more vocalizations and pointing, more interest in play, and more awareness of his surroundings. They also shared that they still hoped he would talk more. Brushing teeth and washing dishes were routines added to TMCR sessions based on feedback during mini-interviews. Playing with Play-Doh became a favorite activity for Luis.

Sessions occurred up to three times per week (approximately 120–180 min/week) in families’ homes and were video recorded. One interview with Dayana occurred via a Zoom (version 5.13.7) videoconference due to family illness. There were two primary interventionists, one for each of the two participating families. The first interventionist (female, 31 years old, Korean/White) was a doctoral candidate in Special Education and a speech-language pathologist with 4 years of training and experience delivering EMT and EMT en Español to young children with language delays in research settings. She was a proficient Spanish speaker, a native English speaker, and a lifelong resident of the United States. The second interventionist (female, 42 years old, Latina) had over 20 years of clinical experience in language and behavioral interventions with young children. She had a master’s degree in psychology and over 5 years of experience with EMT en Español and TMCR in research settings. She was a native Spanish speaker, a fluent English speaker, and had been a resident of the United States (9 years) and Mexico.

Pre-Intervention Phase

Pre-intervention activities are shown in Fig. 1 . During caregiver baseline sessions (approximately 25 min per visit), the therapist video recorded the caregiver and child interacting in typical play or book-reading contexts for 15 min. Families were provided with the standard toys and books at the first session. During therapist-delivered intervention sessions (approximately 35 min per visit), the intervention lasted 25 min, including 20 min of play with toys and 5 min of book reading. The caregiver was invited but not required to observe the session. No caregiver instruction occurred in this phase.

Teach-Model-Coach-Review Phase

TMCR sessions lasted approximately 1 h and contained four segments corresponding to teach, model, coach, and review. The duration and activities of each are shown in Table 3 .

The Teach portion included a workshop (20–30 min) when a new strategy was introduced (i.e., at the beginning of the phase change for each tier), and the remaining sessions included a shorter review of the target strategies (5–10 min). During the Model portion (10 min), the therapist modeled all EMT en Español Para Autismo strategies with the child, including those that had not yet been taught to the caregiver. To avoid behavioral covariation across tiers (Gast et al., 2018 ), the therapist narrated and discussed her use of only the strategies that had been introduced to the caregiver. In the Coach segment (15 min), the caregiver used strategies during play, book-reading, and routines that had been collaboratively selected during the planning meeting. The interventionist coached the caregiver and provided brief positive feedback to support her use of the targeted strategies. The interventionist modeled and coached the caregiver to model spoken language targets while simultaneously activating corresponding symbols with the SGD (Biggs et al., 2018 ; Sevcik et al., 1995 ). In some cases, 10 min of play was divided into shorter segments with visual timers for the child. Finally, in the Review segment (5–10 min), the caregiver and therapist reviewed and reflected on the session. Overall, the child received intervention from the caregiver for 15 min during the Coach component and from the interventionist for 10 min during the Model component. Only 10 min of caregiver-child interaction were coded, as described below.

Generalization sessions lasted 15 min and occurred four times for each family during the TMCR phase—once before each of the three workshops, and once before the exit interview. Like baseline sessions, the therapist did not provide any coaching or instruction before, during, or after the caregiver-child interaction. Like TMCR sessions, the therapist asked the family to engage in the three activity contexts: play (10 min), book-reading (2–3 min), and routine (2–3 min) (Table 3 ).

Post-Intervention Phase

Daniel’s mother, father, and grandmother participated in the exit interview (English version available in Online Resource). María and Luis’s grandmother participated in the exit interview. The exit interviews were conducted in Spanish by the interventionist who did not coach the family. Questions were related to the utility of EMT en Español Para Autismo strategies, approximately how often the caregivers practiced the strategies each week during different types of activities, and how the intervention could be improved for families who would participate in the future. The interviewer also asked families to rate the effectiveness and appropriateness of each of the EMT en Español Para Autismo strategies on a 5-point Likert-type scale (1 = ineffective or inappropriate, 5 = very effective and appropriate). Follow-up generalization session procedures were identical to TMCR phase generalization session procedures.

Data Collection

Sessions were transcribed and coded from video following each session using Systematic Analysis of Language Transcripts (SALT) software, Version 20 (Miller & Iglesias, 2020 ). Transcription and coding were performed by native Spanish speakers who were unaware of condition changes to mitigate potential bias (Ledford et al., 2018 ). These transcribers and coders were undergraduate students or bachelor’s or master’s level research staff who had been trained to transcribe and code similar interactions using videos from EMT en Español projects. Coded segments were 10 min in length and included 8 min of play, 1 min of routines, and 1 min of book reading from caregiver-child interactions (i.e., in TMCR sessions, the Coach segment).

Dependent variable definitions are in Table 1 . Caregiver variables were the caregivers’ use of EMT en Español Para Autismo strategies. Target level language for the current study was based on a three-level framework for Spanish language targets developed and used in an ongoing study with LSS children with developmental language disorders (Kaiser & Peredo, 2019 –2024). Children in the current study were in the first level; target level and proximal target level language models are described in Table 1 . Child dependent variables were the number of total words (NTW), the number of different words (NDW), and the number of times the child communicated with a vocalization, gesture, or word in any mode. All words used by the children were in Spanish during these sessions; however, any words used in English would also have been counted in NTW and NDW.

Fidelity and Reliability

Procedural fidelity refers to the extent to which each experimental condition was executed as planned (Barton et al., 2018b ). For each type of session (baseline, therapist-child intervention, TMCR, or generalization), 33% of sessions were randomly selected (using the RAND() function in Excel) for procedural fidelity measurement by a trained research team member who did not participate in carrying out sessions. Fidelity checklists specific to each session type were completed from video by a trained observer (other than the interventionist) in a REDCap database (Harris et al., 2009 ). The interventionists were unaware of which sessions were randomly selected for procedural fidelity measurement. Procedural fidelity averaged 90.2% (75.0–100.0%) across 39 sessions.

Point-by-point interobserver reliability was measured for a randomly selected sample of 33% of sessions for caregiver-child interaction data. The first author performed the random selection of sessions using Excel. Coders were unaware of which sessions were randomly selected for interobserver reliability until after primary transcription and coding of the session were complete. Interobserver reliability for 29 caregiver-child interactions averaged 89.1% (77.5–95.5%) for caregiver data and 87.2% (73.1–95.1%) for child data.

There were concerns regarding low interobserver reliability for some sessions, especially at the beginning of the study. Many disagreements were related to determining whether child vocalizations had communicative intent and whether the adult gave the child enough time to respond. Coding error patterns were reviewed, discussed, and consensus coded at weekly meetings throughout the study (Yoder et al., 2018 ). Consensus codes were revised in the primary data. Midway through the study, to ensure consistency of coding over the course of the study, a trained coder reviewed and verified coding of sessions that had been transcribed and coded up to that point. Sixty-four caregiver-child interactions (out of 82 coded sessions, 78%) were verified.

Data Analysis

Caregiver data were graphed and visually analyzed to inform decision-making and to determine the presence or absence of a functional relation for each dyad (Barton et al., 2018a ; Gast et al., 2018 ). Graphs were produced using GraphPad Prism 10 for Windows version 10.1.0 (GraphPad Software, LLC , 2023). The first, second, and fourth authors reviewed primary data weekly throughout the study; decisions were made by consensus. Secondary dependent variables (i.e., generalization and maintenance of caregiver strategy use, child communication) were also graphed and visually analyzed at the end of the study but were not considered in decisions related to phase changes. In addition to visual analysis, we measured the magnitude of change for each demonstration of effect by calculating the log response ratio (LRR) effect sizes. LRRs are advantageous because of the relative insensitivity to procedural variables and the interpretation as percentage of change over baseline (Pustejovsky, 2018 , 2019 ). LRRs were calculated using RStudio version 4.0.2 (R Core Team, 2020 ) and the batch_calc_es() function in the SingleCaseES package (Pustejovsky et al., 2021 ). To analyze the social validity of the intervention, responses and notes relevant to the fourth research question (pertaining to how caregivers perceived the intervention approach) from mini-interviews and exit interviews were synthesized by the first author and reviewed by the second and fourth authors. Responses to Likert-type questions were averaged, and family comments were summarized.

Caregiver Strategy Use

Dayana’s data are in Fig. 2 . Her use of target level language (Tier 1), expansions (a Tier 2 dependent variable), and communication elicitations (Tier 3) were low and stable during baseline. Contingent target language and communication elicitations immediately increased (within 3 sessions) and her expansions began on a clear increasing trend after the strategies were introduced. In baseline, contingent proximal target language (a Tier 2 dependent variable) increased from near zero to approximately 20 ( M = 15.5, range 3–23) when Tier 1 strategies were introduced. Proximal targets increased again slightly and became more variable ( M = 26.0, range 13–41) in Tier 2. Dayana generalized her use of all strategies to sessions without coaching during the study and at follow-up, although communication elicitations decreased at the 2-month follow-up. Overall, Dayana increased use of contingent targets by 883% over baseline ( LRRi = 2.30) and her use of proximal targets by 211% over baseline ( LRRi = 1.13) with the TMCR intervention. Effect sizes for expansions and communication elicitations were not interpretable because caregiver use of these strategies was near 0 in baseline.

Graphs with four tiers depicting Dayana’s use of strategies. Strategy use increased intervention was introduced for target language and communication elicitations. Proximal targets increased when Tier 1 intervention began. Expansions increased gradually when Tier 2 intervention began. The vertical lines indicate when intervention began for each strategy. Gray boxes indicate when therapist-child intervention occurred. Line graphs show the number of times the caregiver used the targets or proximal targets in coached interactions (black circles) and uncoached interactions (white circles). White bars indicate opportunities to expand or communication elicitation attempts. Black bars indicate expansions or high-quality communication elicitations

María’s data are in Fig. 3 . Her use of Tier 2 strategies (proximal target language modeling and expansions) were low and stable during baseline. Contingent target language (Tier 1) and communication elicitations (Tier 3) were somewhat variable during baseline. Data for all strategies demonstrated clear increases in level in the first or second session after the strategies were introduced. There were slight decreasing trends for target language (Tier 1), expansions (a Tier 2 dependent variable), and communication elicitations (Tier 3). Contingent target language remained variable during the intervention phase ( M = 26.3, range 6–46) but was higher than baseline ( M = 7.2, range 2–16), on average. Caregiver 2’s generalization to sessions without coaching was variable across strategies. She used targets and communication elicitations but not proximal targets at the follow-up session (there were no opportunities for expansions). Overall, María increased her use of targets by 250% over baseline ( LRRi = 1.25) and her use of proximal targets by 168% over baseline ( LRRi = 0.99) with the TMCR intervention. The effect sizes for expansions and communication elicitations were not interpretable because caregiver use of these strategies was near 0 in baseline.

Graphs with four tiers depicting María’s use of strategies. Strategy use increased for each set when intervention was introduced, but contingent targets remained variable. The vertical lines indicate when intervention began for each strategy. Gray boxes indicate when therapist-child intervention occurred. Line graphs show the number of times the caregiver used the targets or proximal targets in coached interactions (black circles) and uncoached interactions (white circles). White bars indicate opportunities to expand or communication elicitation attempts. Black bars indicate expansions or high-quality communication elicitations

Child Communication

Child communication outcomes are displayed in Figs. 4 and 5 .

Line graphs showing Daniel’s NTW, NDW, and social communication per caregiver-child interaction in TMCR (black circles) and generalization (white circles) sessions. Vertical lines indicate when new intervention strategies were introduced. NTW and NDW were low in baseline and Tier 1. They increased and became variable in Tiers 2 and 3. Social communication was highly variable and increasing in Tiers 2 and 3. Gray boxes indicate when therapist-child intervention occurred

Line graphs showing Luis’s NTW, NDW, and social communication per caregiver-child interaction in TMCR (black circles) and generalization (white circles) sessions. Vertical lines indicate when new intervention strategies were introduced. NTW and NDW were low in baseline. They increased and were variable in all three tiers of intervention. Social communication was highly variable and had an increasing trend across all phases. Gray boxes indicate when therapist-child intervention occurred

Nearly all words children used were communicated via the SGD. Daniel’s communication with words remained near zero until Tier 2 of intervention, then NTW and NDW increased and became more variable. In Tier 3, Daniel averaged 20.7 total words (range 0–45) and 10.8 different words (range 0–23) per session. For social communication (i.e., utterances with vocalizations, gestures, or words), there was a decreasing trend in baseline ( M = 16.2, range 4–30), and data were variable through the middle of Tier 2. In Tier 3, Daniel was communicating more frequently on average ( M = 34.7, range 15–54) than in baseline with a large amount of overlap. Luis communicated using fewer than five words per session until the end of Tier 1 when he used 14 words in one session. NTW and NDW were variable but higher than baseline throughout Tiers 2 and 3 (NTW, M = 11.3, range 3–25; NDW, M = 8.2, range 3–17). The number of social communication acts was variable throughout the study with an increasing trend. Luis’s social communication in Tier 3 ( M = 32.8, range 19–51) was higher than in baseline ( M = 12.7, range 5–29) with some overlap. Notably, Luis’s NTW and NDW decreased to 0 at the follow-up session. Upon arrival, it was discovered that his SGD had been malfunctioning for some time. It was repaired prior to the follow-up generalization session.

Social Validity

At the exit interview, caregivers reported that the most helpful component of TMCR was watching the interventionist model the intervention with the child (Dayana) or practicing implementing the strategies with coach feedback (María). Both reported using EMT en Español Para Autismo strategies every day, including during play, pre-academic activities (e.g., coloring, book-sharing), and caregiving routines (e.g., bath time, mealtime). They rarely used intervention strategies during housekeeping routines (e.g., laundry, cleaning). Both participating caregivers taught the strategies to other family members. When asked how the intervention could be improved, one family suggested adding music to some of the activities to help the child concentrate. The other family suggested a longer intervention period. Dayana rated all strategies on which she was trained with a 5 (very effective and appropriate). María rated all strategies with a 4 or 5 except for the Tier 1 strategies of reducing instructions and questions, which she rated a 1 (ineffective and inappropriate). Both families reported difficulty with managing the SGD. María did not agree with allowing children to frequently use tablets and phones, but she could see her child was happy when he was understood by others. Daniel’s family became frustrated when he became so focused on his device that he did not participate in the activity at hand (e.g., eating his food at mealtime).

The primary purpose of the current pilot study was to test the effects of the collaborative TMCR approach to teach EMT en Español Para Autismo strategies to two Latina Spanish-speaking caregivers with their toddlers on the autism spectrum. Social validity analyses indicated both families felt the intervention was effective with some concerns related to use of the SGDs. This study extends the small research base on culturally and linguistically adapted early communication interventions for LSS families and their children on the autism spectrum.

The study’s development and design had unique strengths. First, the intervention was initially adapted for LSS families of young children with language delays (Peredo et al., 2018 , 2022 ) and adapted again for children on the autism spectrum. Second, the intervention was individualized for each participating dyad based on repeated family interviews throughout the study and a direct therapist-delivery phase of intervention prior to caregiver coaching. The essential components of EMT that support children’s language development (e.g., environmental arrangement, contingent language modeling) were maintained; however, these components allowed the therapist to build and maintain rapport with the family during baseline and while teaching the intervention strategies. They also supported collaboration and family preference related to intervention materials, activities, engagement supports, and introduction and programming of the SGD.

TMCR and EMT en Español Para Autismo Strategies

There was a clear functional relation between systematic implementation of the TMCR approach and use of EMT en Español Para Autismo strategies for one of the caregivers (María). In other words, she increased her use of specific EMT en Español Para Autismo strategies when and only when she was taught each strategy using the TMCR approach (Gast et al., 2018 ). For Dayana, there were three demonstrations of the effect of TMCR on use of target level language, expansions, and communication elicitations (Gast et al., 2018 ). However, the confidence in the functional relation was weakened by the covariation between contingent target and proximal target level language. The increase in proximal target level language (a Tier 2 strategy) corresponded with the introduction of Tier 1 strategies. This covariation indicates that use of proximal and target level phrases were not fully independent behaviors for Dayana; rather, she began using simpler phrases at a higher rate when target level language was introduced and did not discriminate targets from proximal targets. Although unexpected, this response generalization is not surprising given the precise linguistic distinctions between target-level and proximal target-level language targets as shown in Table 1 . For example, the label for popsicle would be a target if it were in singular form (la paleta) and a proximal target if it were in plural form (las paletas). Many caregivers would likely benefit from being taught target level and proximal target level language simultaneously rather than teaching proximal targets at the same time as expansions.

The caregivers reported the TMCR approach to be effective and helpful for them in learning the strategies. They reported that most of the EMT en Español Para Autismo strategies were effective and appropriate with one exception. María indicated that reducing instructions and questions to balance matched turns was ineffective and inappropriate for her in interactions with her child. This finding is somewhat consistent with other EMT en Español studies in which caregivers reported a cultural tension with reducing questions and directions but found it to be an effective strategy for their child (Peredo et al., 2018 , 2020 ). Further research on the perceived effectiveness of reducing test questions and behavioral directions from LSS caregivers of children on the autism spectrum will help determine if further adaptation of this strategy is needed.

The findings should be interpreted in light of the fact that caregiver opportunities to practice and demonstrate skills such as use of targets and expansions were contingent on the opportunities presented by child communication and engagement. Simply put, for caregivers to immediately increase their behavior, there had to be child-presented opportunities to respond. Measuring contingent behavior in this way closely reflects the posited active ingredient of the intervention (Dillehay, 2023 ), and it may explain differences between results in the current and previous studies. Unlike in the Peredo et al. ( 2018 ) study, in the current pilot study, Dayana’s use of expansions increased gradually. Daniel often activated the same word many times in a row, and it was difficult to determine his communicative intent. This could have influenced Dayana’s ability to respond contingently using expansions and coders’ interobserver agreement.

Independent Use of Strategies

Use of strategies generalized or partially generalized to sessions without coaching support, including at follow-up. The overall number of generalization sessions was small, and the context only differed from the intervention context by one variable (the absence of coaching support); however, the current data are encouraging when interpreted alongside the caregiver reports that they used EMT en Español Para Autismo strategies throughout the week during play, book reading, and routines. The individualization of the intervention (i.e., collaborative selection of toys, interviews) may also have supported generalization by ensuring intervention activities aligned with family activities outside the study and that multiple family members were involved (DuBay et al., 2018 ). María’s use of Tier 2 strategies did not generalize or maintain at the 2-month follow-up. At that session, she did not have opportunities to expand because Luis did not use any verbal utterances. Luis’s decrease in verbal communication may have been related to lack of access to his SGD prior to the follow-up session. Families would likely benefit from booster sessions and check-ins for technical support for long-term generalization and maintenance of strategy use (Kent-Walsh & McNaughton, 2005 ).

Child Outcomes

While the design of this pilot study did not control for possible effects of maturation on child communication, both children in the study demonstrated significant growth during the 6–7 months they were in the study. Neither child was receiving any other targeted language intervention in Spanish at the time that might have accounted for the growth. Both children began using SGDs provided during the study (and were not using them during baseline), which was likely critical for supporting their increased communication, in addition to implementation of the EMT en Español Para Autismo strategies with aided modeling by their caregivers and the therapists. Also important to note regarding child outcome data was that, to increase coding reliability, a decision was made to score child vocalizations or activation of SGD symbols as communicative if the caregiver responded contingently. Therefore, it is possible that a greater proportion of child vocalizations and SGD activations were coded as communicative in later sessions than in earlier sessions, reflecting both increases in caregiver responsiveness and differences in child communication.

Limitations

The first major limitation to this pilot study was the number of participants. Four families enrolled in the study, and only two families completed the intervention. Both families that dropped out indicated that they did not want to tire their child by having them in too many therapies. This speaks to the time and effort that families must contribute to participating in an intensive early childhood intervention and particularly to the research requirements associated with added paperwork and scheduling of sessions. For researchers, it is important to consider shorter baselines, limited paperwork, and designs that require fewer sessions. Solutions in practice may include a greater degree of collaboration between the multiple providers (Part C developmental therapists, speech language pathologists, and others), more efficient use of therapy time, and continuously engaging with families to understand their priorities in choosing services and delivery models.

Another limitation was that introduction of new EMT en Español Para Autismo strategies roughly coincided with minor changes to routine contexts for intervention (described in the Participants section). After mini-interviews, routines began to include coloring for Daniel and brushing teeth and washing dishes for Luis. It is possible that the new contexts influenced the caregivers’ use of strategies at the time they were introduced; however, those changes would likely have affected caregivers’ data in all tiers. Routine contexts also comprised a small proportion of the data collection period in each session (1 min out of 10 min).

Other limitations pertained to interpretation of child outcomes. Given the study design, child communication outcomes could not be attributed specifically to caregiver use of EMT en Español Para Autismo strategies. The children received the full intervention from the therapist during the initial direct intervention phase and during the model portions of the TMCR sessions. The caregivers were not taught the full intervention until Tier 3 near the end of the study. Additionally, the contribution of the children’s access to the SGD could not be separated from the effects of the EMT en Español Para Autismo intervention delivered by the therapist and the caregiver. Future studies should investigate caregiver implementation of EMT en Español Para Autismo with SGDs using a study design that allows for detection of effects of caregiver training alone on child outcomes.

Future Directions for Research

Future research should build on the current findings by systematically replicating the current study with additional LSS families from diverse backgrounds. Children on the autism spectrum are heterogeneous as well, with different interests and abilities including social communication, receptive and expressive language skills, and engagement in play-based activities (McDuffie et al., 2012 ). Systematic assessment, the direct therapist intervention component, as well as the collaborative interview process and strategic individualization in this pilot study present one potential model for future studies to individualize EMT en Español Para Autismo for diverse LSS participants.

Future research should also expand the intervention to address all aspects of using AAC with this population of families. Although both children demonstrated increases in verbal communication using SGDs, one caregiver indicated that she was reluctant to use it at the beginning of the intervention and the other family reported difficulty managing the SGD during everyday routines. Researchers should continue to develop materials and methods for teaching LSS caregivers about AAC (De Leon et al., 2023 ), the evidence to support its use by children on the autism spectrum (e.g., Hampton et al., 2020 ), and instruction in how to model language using SGDs (Biggs et al., 2018 ; Sevcik et al., 1995 ). Low-tech forms of AAC may also be effective and preferred by some families. These materials should be culturally and linguistically adapted with the help of LSS families, as were the workshops for the current study. Future studies should also delineate systematic procedures for selection of Spanish and English vocabulary to include on the devices, incorporating principles of typical bilingual Spanish and English language development and individualized family communication needs (Binger et al., 2023 ; Soto & Cooper, 2021 ).

Implications for Practice

Practitioners could apply the collaborative interview process when working with LSS families and children on the autism spectrum using the protocols in the Online Resource and published by Peredo ( 2016 ). Conversations or interviews prior to implementing family-centered intervention have been recommended when working with culturally and linguistically diverse families (Cycyk & Iglesias, 2015 ; Peredo, 2016 ). In the current study, these interviews systematically occurred at regular intervals throughout intervention. Intervention should ideally be provided by practitioners that speak Spanish when that is the family’s home language. However, practitioners working with interpreters or with limited proficiency in the family’s home language could also use similar interview questions to structure conversations to better understand family values, frequent activities, and preferences.

Bilingual practitioners may also consider a direct intervention component when working with LSS families with toddlers on the autism spectrum. A direct therapist intervention phase prior to caregiver coaching could support planning and collaboration by giving the practitioner a better understanding of potentially needed supports (e.g., AAC, behavior supports). A continued direct intervention throughout the caregiver coaching phase, either via the Model component of TMCR or additional direct intervention sessions, could support overall dosage of intervention received by the child. This dual implementer approach could ease the pressure on caregivers to deliver the entire dosage of intervention necessary to see language skill gains while still engaging and empowering families to support their child’s growth.

Few intervention studies have focused specifically on the experiences, needs, and preferences of LSS families with children on the autism spectrum. This study demonstrated effective application of the TMCR approach to teach caregivers a culturally, linguistically, and individually adapted intervention. The caregivers in the current pilot study implemented EMT en Español Para Autismo strategies with their children on the autism spectrum, generalized use of most of the strategies to unsupported interactions, and gave positive feedback about their experience with the intervention. The children increased the frequency and diversity of communication with their caregivers over time. This study contributes to the literature on family-centered naturalistic developmental behavioral interventions for diverse families and children on the autism spectrum. More systematic inquiry is needed to understand the effects and social validity of the TMCR approach and EMT en Español Para Autismo strategies for diverse families.

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Acknowledgments

This work was funded in part by an internal Scaling Success grant from Vanderbilt University, the United States Office of Special Education Programs Grants (H325D180095, PI: Ann P. Kaiser), and a Semmel Dissertation Enhancement Award from the Department of Special Education, Peabody College, Vanderbilt University. This study was registered on the Open Science Framework ( https://doi.org/10.17605/OSF.IO/HJ9MK ). We sincerely thank our coders Georgina Cisneros, Monica Alonso, Gabriela Conde, Vanessa Schor, and Kelsey Dillehay for their contributions to this project.

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Natalie S. Pak

Present address: Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL, USA

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Department of Special Education, Peabody College, Vanderbilt University, Nashville, TN, USA

Natalie S. Pak, Tatiana Nogueira Peredo, Ana Paula Madero Ucero & Ann P. Kaiser

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NSP contributed to the study conceptualization, methodology, data collection, writing original draft, project administration, analysis. TNP contributed to the study conceptualization, methodology, funding acquisition, writing review & editing, supervision. APMU contributed to the study conceptualization, data collection, writing review & editing. APK contributed to the study conceptualization, methodology, writing review & editing, funding acquisition, supervision.

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Pak, N.S., Peredo, T.N., Madero Ucero, A.P. et al. EMT en Español Para Autismo : A Collaborative Communication Intervention Approach and Single Case Design Pilot Study. J Autism Dev Disord (2024). https://doi.org/10.1007/s10803-024-06322-5

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Communication competencies, culture and SDGs: effective processes to cross-cultural communication

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Introduction

Statement of the problem

Study objectives

Literature review

The need to know about people’s culture

The dynamics of cross-cultural communication

The United Nations’ sustainable development goals and culture

Theoretical framework

The method of study

Culture at the international galleries

Communication processes for overcoming difficulties in cross-cultural communication

Data availability

Acknowledgements

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5.8: Case Study