Providing care for individuals from diverse cultural backgrounds requires a degree of self-reflection.

A key foundation of cultural competence is understanding one’s own values and biases, as well as recognizing both the differences and similarities among individuals within one’s own cultural context. This, in turn, forms the basis for understanding and respecting the cultures of others.

Healthcare professionals who demonstrate awareness of and interest in different cultures and communication styles are more likely to have effective and meaningful interactions with their patients and their families.

One of the most important things we do in healthcare is to build trust with our patients. If we fail to take a patient’s cultural background into account, they may perceive us as rude, uncaring, or not competent in our role.

Factors related to illness—such as fear, anxiety, and how a patient responds to pain or difficult news—are largely shaped by culture. Culture influences a person’s health, attitudes, behaviour, and how they communicate with others.

Illness is, in many ways, a culturally shaped experience. People do not necessarily perceive or experience illness in the same way, or even agree on whether they are ill. Individuals from different cultural backgrounds may express common symptoms in different ways, for example pain or grief.

Cultural and religious influences play an important role in shaping attitudes, particularly during challenging moments such as receiving a diagnosis, undergoing major interventions like surgery or medical treatment, and at the end of life.

Showing genuine interest in a patient’s cultural perspective is key. Asking questions such as “How are you used to doing this?” can be an effective way to open communication. When patients feel that interest, it helps build trust in the relationship between them and the healthcare professional.

Be Aware of Non-Verbal Communication

Choosing the right language for communication is essential, but it is equally important to recognise that communication norms may differ significantly between cultural groups.

Language and the way we express ourselves are strongly influenced by culture. Differences are not only seen in whether people rely more on spoken language or gestures and facial expressions, but also in what specific gestures actually mean.

In some cultures, facial expressions and body language play a major role in communication, while others rely more heavily on spoken language (as is often the case in Iceland).

Non-verbal communication is an important tool. For example, maintaining eye contact is encouraged in Icelandic culture, but in other cultures it may be perceived as aggressive or disrespectful.

It is also important to be aware that some languages may not have direct equivalents for certain medical terms or healthcare roles, such as depression or psychologist. This can make it difficult for patients to express themselves, or for healthcare professionals to explain concepts clearly.

Landspítali has issued a quality guideline on interpretation services, which includes useful information and tools for communicating with patients who do not speak Icelandic.

It is not always possible to access an interpreter for a specific language when needed, particularly in emergency situations. In such cases, telephone interpretation services (e.g. Language Line) can be used.

Not everyone is suitable to act as an interpreter. Trained interpreters are familiar with medical terminology and are bound by confidentiality, which is essential for building trust with patients and their families.

An interpreter should always be offered, even if a relative or companion speaks Icelandic. In some cultures, it may be considered inappropriate for family members to be informed about a patient’s personal matters, particularly if the relative is younger than the patient.

A relative who communicates well in everyday situations may still lack the ability to accurately interpret medical terminology and should therefore not act as an interpreter.

Some immigrant communities in Iceland are very small, and patients may therefore have to rely on interpreters they know personally. When discussing sensitive issues, this can be challenging, as the patient may not feel comfortable or trust the interpreter.

Gender roles vary significantly across cultures, including in healthcare settings.

In some cultures, the head of the family is expected to make decisions and receive information, even in matters related to healthcare and patient education for another family member.

Some patients may feel more comfortable speaking with a healthcare professional of the same gender, when this can be accommodated.

We must ensure that patients understand the information provided in patient education, including the purpose of interventions, so they can make informed decisions about their care.

Preferences for receiving information vary across cultures. Some patients want full information about their condition, while others may prefer that a family member receives information and makes decisions on their behalf.

Others may refuse treatment due to cultural or religious beliefs.

Communication in Iceland is generally informal. It is common to use first names, and formal forms of address are rarely used.

However, this may differ for patients from other cultural backgrounds. Some may prefer more formal address, such as being addressed by their surname, title, or with formal language.

It is important to allow extra time for patient education when working with patients from different linguistic backgrounds, especially when interpretation services are used, as communication through a third party takes longer.

Use short and clear messages. Avoid technical terms and complex phrasing.

These principles apply broadly in patient communication, not only when working with patients from different cultural or linguistic backgrounds.