As the complexion of the U.S. population changes, audiolgists must become 'culturally competent' in order to serve their patients.

By Jess Dancer

Before you read any further, note your reactions to this old joke:

Heaven is a place with British humor, French cooks, German mechanics, Italian lovers, and Swiss organizers. Hell is a place with German humor, French mechanics, Swiss lovers, British cooks, and Italian organizers.

See Similarities

Like snowflakes, but staggeringly more complex, humans are unique in terms of both their genetic endowment and their life histories. Genetically, we are the outcome of an estimated 20,000-25,000 genes in the human genome. Our 23 paired chromosomes contain three billion "letters" of the A-C-G-T alphabet of life, enough to fill 200 telephone books of 500 pages each. Each individual's life experience is like no other, so we are truly the product of both our genes and our environment.

Our diversity as humans is apparent to even the most casual observer in how we look, think and act. We differ in our hair, eye, and skin color, our height and weight, our racial and ethnic backgrounds, our languages and cultures, our personalities, our values and customs, our ages, and our attitudes toward life. It can truly be said that when you have met one human being, you have only met one human being, like no other, of the more than six billion individuals currently living on earth.

Despite our many apparent differences, we are more alike than we might think. In fact, 99.8 percent of the DNA in our genes is identical, and our basic hierarchy of needs for food, clothing, shelter, safety, love, esteem and self-fulfillment are remarkably similar throughout the world. Overlying all these needs, according to Carl Rogers, is the actualizing tendency to grow, develop, and realize our full potentials.1 Regardless of our outward differences, these underlying similarities serve to unite us as humans in the ongoing cycle of life.

Recognize Changes

Statistics reveal that the U.S. society is becoming more and more culturally diverse, and somewhere in the middle of this century, the majority non-Hispanic white population of today will make up fewer than 50 percent of its citizens. At that point, America will become a nation of minorities, truly a mosaic nation. Some parts of our country, especially Hawaii and California, already reflect this demographic trend. In most-diverse Hawaii, for example, you are 10 times more likely to meet a person from another race than in least-diverse Maine.2 Even in my home state of Arkansas, deemed "average" on maps of diversity, a stroll down the aisle of a Wal-Mart store in Little Rock reveals a sizeable number of Asians, Latinos, and African-Americans, among other racial and ethnic groups, joining Caucasian shoppers in looking for those alleged lower prices.

Dispel Stereotypes

As diversity increases, so does our need as audiologists to understand and be sensitive to those groups whose customs and values differ from our own. Hearing loss respects no cultural and linguistic boundaries, and the auditory-learning component in communication is predominant in the thousands of cultures and languages spoken worldwide. As communication specialists, audiologists are trained to diagnose and rehabilitate persons with hearing loss through the provision of hearing aids and other restorative services. Part of our training should include cultural competence, an increasingly important topic in today's business of healthcare.

The need for cultural competence is heightened by our natural tendency to stereotype, both positively and negatively, those individuals who belong to groups we perceive as different from ourselves. The word "stereotype" was originally applied to printing, in which a metal place served as a matrix from which unvarying copies could be made. In like manner, groups or individuals who are viewed much the same are "stereotyped" or stamped with the same characteristics. The statement, "All older adults are senile and live in nursing homes," is an example of an ageist stereotype. Perhaps you can come up with a sexist or racist stereotype as well.

Although stereotyping makes it easier to deal with "those people" who are different from us by placing them in invariant categories, such stereotypes have four fatal flaws: They are simple, acquired second-hand, erroneous, and resistant to change. As professionals, how do we deal with stereotypes that may hinder our provision of quality audiology services to all persons who need our help?

The first step is to assess our own stereotypes toward others. Think back to the joke that began this article. Did you smile knowingly or frown uncomfortably at the national stereotypes presented? Either way, you were aware of those behavioral categories more likely attributed to the various nationalities. Like it or not, we all harbor stereotypes which we need to uncover and consciously disavow if they interfere with our relationships, both personal and professional.

As an introvert who is quiet in meetings, I admit that I tend to categorize talkative extroverts as know-it-all windbags and blowhards, at least until I get to know them better. In reality, an extrovert can be kind, considerate, thoughtful, and compassionate, qualities which I admire. Once I know the real person masked by my stereotype, I can react and interact appropriately.

Our tendency to stereotype others is reflected even in our everyday humor, where jokes about blondes or men draw chuckles from even the most enlightened of us. Does it offend you to hear that a blonde couldn't dial 911 because she couldn't find the 11 button on the phone, or that blonde jokes are short so men can remember them?

Here's a quick exercise: Take a piece of paper and write down all the stereotypes you have toward other groups that might interfere with your provision of audiology services to individuals within that group. Read the list aloud, then crumble up the paper and throw it into the nearest wastebasket. Symbolically, you are throwing out these hurtful generalizations. Throw them away in reality, too.

Improve Communications

The second step is to assess your communication skills in dealing with the diversity of patients with hearing loss who seek your help. As audiologists, we are specialists in restoring communication through audiologic rehabilitation. For many of our patients, we spend considerable time in this process, and establishing an interpersonal relationship that transcends cultural boundaries is critical to our ultimate success.

An interpersonal relationship allows you and your patient to establish an interactive, personal knowledge of each other that is unique and ongoing. This shared personal knowledge helps to build the patient's trust and confidence in you and your audiology skills. It helps you to better understand the differing needs of each patient and to tailor rehabilitation to the individual. Your ability to be open and to show empathy and unconditional positive regard further motivates the patient to reach toward actualizing the shared goal of communication improvement.

Respect Differences

The third step is to celebrate diversity in your workplace by using the seven letters in the word TRIBUTE:³

T reat each patient as having unique personal and hearing needs.

R espect cultural differences through both your verbal and non-verbal behaviors.

I dentify the personality and learning preferences of each patient.

B egin by learning some basic information on cultural differences through formal learning in courses and workshops. Supplement this information with your own informal learning experiences in the workplace and in the community.

U se language and cultural translators to keep intended messages clear between you and the patient.

T ell your patients about their hearing loss and hearing needs in plain language, avoiding audiologic jargon.

E xplain that adjusting to hearing loss is a family event, and include family members whenever possible in the rehab process.

By dispelling the stereotypes that separate you from others, you can appreciate the diversity of each new person who enters your audiology practice and enriches your life in novel and interesting ways.

References

1. Boeree, CG. (2006). Carl Rogers biography, accessed online at www.ship.edu/~cgboeree/rogers.html

2. U.S. Diversity Map, accessed online at www.majornewswire.com/dmaps.pdf

3. Dancer, JE and Ward, AL. (2006). A TRIBUTE to diversity in your audiology patients. Audiology Online, accessed online at www.audiologyonline.com/ceus/preview_text_course.asp?class_id=5283

Jess Dancer is professor emeritus in audiology at the University of Arkansas at Little Rock. He can be reached via email at jedancer@ualr.edu

WATCH YOUR LANGUAGE

English is the first language of only 8 percent of the world's people, and that percentage is declining. Mandarin Chinese is currently the most common language in the world, followed by English, but by 2050 there will be a four-way tie for second place between English, Spanish, Arabic and Hindi/Urdu. By 2020, it is estimated that 20 percent of the U.S. population will speak Spanish as a first language.

These statistics point to an increasing need for communication to be conducted with a multi-lingual audience in mind.

Alexander, L. (2006, February-March). An International Audience. Copy Editor, p. 1.

Staff Stuff

If the area surrounding your practice contains a large foreign-born population, consider hiring a staff member from that group. This individual can:

Translate to promote better communication;

Put patients and family members at ease;

Offer a cultural bridge to your practice;

Educate you and other staff members on traditions and customs.