Intercultural communication in health care: challenges and solutions in work rehabilitation practices and training: a comprehensive review

Abstract

Purpose: The purpose of this comprehensive literature review it to explore cross-cultural issues in occupational rehabilitation and work disability prevention. Method: A literature review on cross-cultural issues was performed in medicine, health sciences, and social sciences databases (PubMed, Ingenta, Canadian Centre for Occupational Health and Safety, Ergonomics Abstract, Google Scholar, OSH Update and the Quebec Workers’ Compensation Board data base). A total of 27 documents published until 2010 in English or French were selected and analyzed. Results: Cross-cultural issues in occupational rehabilitation show that representations of pain, communication and therapist–patient relationship and intercultural competence could be presented as the major topics covered in the selected literature. As for the general topic of immigrant workers and OSH, barriers were identified revealing personal, relational, contextual and structural levels that put immigrant and minority workers in situation of vulnerability (ex. linguistic and cultural barriers, lack of knowledge of the system, precarious work or exposition to higher risk hazards, etc.). Cultural issues in occupational rehabilitation put less attention to work-related contextual factors but emphasized on attitude and pain behaviours, perceptions of illness and appropriate treatment, therapist–patient relationship and cultural competences among OT professionals. Conclusions: The growth of immigration in countries such as Canada poses a real challenge to the delivery of health care and rehabilitation services. Despite growing concerns in providing culturally appropriate heath cares, intervention models, tools and training tools are still lacking in occupational rehabilitation and disability management. Nevertheless, cultural competence seems to be a promising concept to be implemented in work rehabilitation and disability management.

Implications for Rehabilitation

• Cultural differences may result in diverging and conflicting representations of health, illness and therapy, and this may hinder the healing process or even cause its failure.

• Assessing health and illness representations (perception and definition of the problem and its solution) may help clinicians facilitate cross-personal communication and develop therapeutic alliance.

• Cultural competence in health care is multi-faceted (individual, organization, health policies) and is becoming an unavoidable aspect of developing culturally adapted interventions.

Keywords::

• Therapeutic relationship
• intercultural communication
• occupational rehabilitation
• work

Acknowledgements

The author wishes to thank IRSST colleagues for providing fruitful critics and suggestions. Special thanks must also be addressed to Madame Danielle Gratton, psychologist and consultant in intercultural relations at Jewish Rehabilitation Hospital (Laval, Québec) and researcher at Laboratoire de recherche sur les relations interculturelles (LABRRI) for her critical and very insightful comments.

Declaration of Interest: This literature review was supported and funded by the Occupational Health and Safety Research Institute Robert-Sauvé (IRSST).