Communication skills are highlighted as the third vital component of cultural safety. Without knowing the processes of communication according to others, health providers risk misinterpreting or overlooking the person's health related concerns. Inappropriate or ineffective communication can disadvantage minority groups in terms of access to cancer services available to other Australians.
The heterogeneity of Indigenous culture means that communication processes may not be the same for all Indigenous people. However, some key principles to consider in the process are described below.
Video 15: Roslyn (1.20 min)
Ros talks about the need for intuition and sensitivity, and advises getting to know your local Indigenous community.
The use of silence and avoiding eye-engagement are features of communication for some Indigenous people.13, 42 This can be misinterpreted as disinterest or indifference to the situation.13, 28
English is not always the primary language of rural and remote Indigenous people and even if they know a word or term it does not follow that it is understood.13 Trudgen (2000) learnt from his considerable experience working in Arnhem Land that if the Yulngu people didn't understand the context or meaning of what a non-Indigenous person said, rather than ask questions or risk embarrassment, they responded by saying Yo yo (yes yes) to anything.13
Miscommunication is an important factor contributing to health inequities, as poor communication can block access to news and knowledge outside the domains of Indigenous people's culture:
'...what may be life-saving information from health professionals. It [poor communication] stops them [Indigenous people] knowing what they are giving consent for, how to comply with medical instructions and how to intervene in their own health problems'13
Use of silence
Silence and body language are important means of communication for many Indigenous people who regard this mode to be more telling than what is said.13, 42
Indigenous people often use silence when contemplating a question being asked and as a means of communicating with each other. Use active listening when in conversation with Indigenous people, allowing space for silence rather than trying to interject or pre-empt a reply.13, 43
Indigenous people may interpret non-Indigenous peoples' non-verbal communications (e.g. mode of dress, behaviour, body stance and facial expressions).
Indigenous people can feel daunted or intimidated by whiteman's authority as conveyed by persistent questioning, loud voices, being too close, rigid routines, and official uniforms.43, 44 This apprehension toward authority is sometimes another remnant of colonisation, when white health authorities dominated Indigenous health matters and ridiculed traditional practices.13
A quieter tone of voice may be preferred to loudness, which can be considered aggressive and impolite.
Eye-engagement can be inappropriate when in conversation with some people, usually Elders. Speaking to a person indirectly using a quiet tone of voice is considered polite. This may not apply to all Indigenous people, so it's best to observe how people interact with others or ask your local Indigenous health worker or other health care providers.
Different approaches to managing time and space can, if not respected, lead to misunderstanding and miscommunication between cultural groups.
Indigenous peoples' traditional perception of time as a cyclical process of events differs from the western cultural view of time as a linear, one directional segment or measured portion.44, 46
While traditionally-oriented communities may not adhere to western time measures, they still have a daily round of life and history marked by significant events. For example, the daily life in one community may be marked by the start of the school day, opening of the local shop, sunrise and sunset, full moon to new moon and so forth.44
This different perception of time may have implications for conventional routines and order which characterise western health care management and for methods of clinical assessment.
Video 16: Roslyn (1.12 min)
Ros talks about taking the time to build rapport and a relationship, and how you may be viewed as culturally inappropriate if you do not take this time.
A useful strategy for building effective, appropriate relationships with Indigenous people is to first give information about yourself before asking about and taking information from the Indigenous person and their family. Start with a conversation about everyday matters and share a bit of your personal self.
There are a number of resources available which provide information and guidelines for effective communication with Indigenous people. These include:
- Department of Health Reconciliation Action Plan 2013-201753
- Queensland Government, Department of Communities, Aboriginal and Torres Strait Islander Partnership48
- South Australian Government Aboriginal Cultural Respect Framework(PDF, 487KB)49
Discuss what adjustments might be required in your work area to accommodate different perceptions of time if this was an issue for Indigenous people in your service.
Discuss with your local Indigenous health workers or other members of the Indigenous community ways to effectively and appropriately communicate with Indigenous people in your region.