Sometimes culture is used to explain failures in communication or adherence to treatment, with the failure attributed to the client. Culture is seen as a barrier between health service providers and their efforts or ability to provide effective care to clients. When considered in this way, the client's culture can be devalued and seen as an obstacle, which can then result in a failure to provide necessary services to vulnerable populations (Kirmayer et al., 2014; Fernando & Keating, 2009).
When clients receive services, misunderstandings or differences in understanding between them and service providers based on lack of cultural understanding and competence, this can negatively affect client outcomes in terms of incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment and failed treatment alliances (Al Masri, 2018). Cultural differences can even occur when clients and service providers are from similar backgrounds, as there is wide variability within cultural groups (McGill University, n.d.).
Incorporating an immigrant or refugee culture in our work is essential. I do not think we can do work without incorporating the culture. How we do that is by listening, directing questions around immigrant and refugee persons, understanding of their life situations, what has happened to them, how do they frame it, what are the explanatory models, how do they express their distress. We can do it simply by asking questions like: "Why do you think this has happened? How did it happen? What does it mean to you? What are the solutions?" We can also refer to the culture of origin saying: "In your country of origin, in your culture of origin, or even in your family, how would you have addressed those issues? How would you have resolved those issues?" We can also address the culture by asking questions around what we may call acculturation or how they are experiencing life in their host society. So in Canada, what is different? What strikes them? How do they feel they are being treated? So going and looking into all those experiences in their daily lives and how they view them and how these experiences make or don't make sense to them and contradict their own values can really help us dig deeper into their cultural modes of being, their cultural modes of expressing their distress and then it can help us in a proactive and a non-oppressive way to construct intervention with them that makes sense culturally but that is also empowering. The utmost and most important recommendation is really to be client-centred and really not to make assumptions, to have an open, respectful attitude. Our role is not to, in a dominant way, make things happen in a client's life. Our role is to support and enrich their toolbox so they can themselves make those changes happen.
Staying attuned to potential impacts of culture, however, and using services such as cultural brokers, can help prevent cultural misunderstandings. Cultural brokers are trained intermediaries who can interpret cultural concepts or frameworks to either clients or service providers and can help advocate for clients when cultural differences are a barrier to mutual understanding (Kirmayer et al., 2011). They can simplify medical terminology, support discussion of next steps and negotiate or follow up on the implementation of therapeutic plans. Cultural brokers serve as guides to bridge cultural gaps in health care setting processes by communicating cultural similarities and differences (Rotich & Kaya, 2014).
Culture can affect people's familiarity with medications and their interpretation of possible side effects. When medications are prescribed, it may be helpful for health care providers to enquire about whether a home remedy or any alternative medicine is being used.