Intercultural Competence and Communication over Language Barriers

  • Pernilla PergertEmail author
  • Elisabet Tiselius


Intercultural healthcare refers to when people of different cultures and languages communicate and interact in the healthcare context. Intercultural competence (also referred to as simply cultural competence) is crucial for providing culturally congruent and meaningful care. Such competence has been described as a process in healthcare interactions and systems that aim to increase equity and reduce disparities in care. Intercultural competence shares core components with patient-centred care, but patient-centred care is difficult when the patients’ values conflict with those of the healthcare professionals and systems. Since cultural diversity can lead to conflicts about fundamental values, intercultural healthcare requires that professionals have opportunities and skills to deal with value conflicts. We present a relational ethics approach for intercultural competence. The basic ideas of both relational ethics and intercultural competence are that they exist in relationships, the context is important, and true dialogue is the core. This chapter explains the components of intercultural competence, including intercultural dialogue, intercultural reflection, and intercultural learning. Furthermore, communication over language barriers is critical to enabling intercultural dialogue and should continuously be developed through intercultural learning in the process of understanding and adapting to the other. We will also discuss professional interpreters’ impact on cultural learning and mutual understanding in the intercultural healthcare context. We argue that healthcare professionals need to learn effective interpreting use as part of intercultural competence.


Cultural competence Language barriers Communication Interpreter Intercultural learning Relational ethics 



The first author would like to acknowledge the Swedish Childhood Cancer Fund for financial support (FoAss13/017).


  1. 1.
    Abbe M, Simon C, Angiolillo A, Ruccione K, Kodish ED. A survey of language barriers from the perspective of pediatric oncologists, interpreters, and parents. Pediatr Blood Cancer. 2006;47(6):819–24. Scholar
  2. 2.
    Angelelli CV. Medical interpreting and cross-cultural communication. Cambridge: Cambridge University Press; 2004.CrossRefGoogle Scholar
  3. 3.
    Austin W. Ethics in a time of contagion: a relational perspective. Can J Nurs Res. 2008;40(4):10–24.PubMedGoogle Scholar
  4. 4.
    Austin W, Bergum V, Dossetor J. Relational ethics. In: Tshudin V, editor. Approaches to ethics. Woburn, MA: Butterworth-Heinemann; 2003. p. 45–52.Google Scholar
  5. 5.
    Bartholdson C, Lutzen K, Blomgren K, Pergert P. Experiences of ethical issues when caring for children with cancer. Cancer Nurs. 2015;38(2):125–32. Scholar
  6. 6.
    Bartholdson C, Lutzen K, Blomgren K, Pergert P. Clarifying perspectives: ethics case reflection sessions in childhood cancer care. Nurs Ethics. 2016;23(4):421–31. Scholar
  7. 7.
    Bartholdson C, Pergert P, Helgesson G. Procedures for clinical ethics case reflections: an example from childhood cancer care. Clin Ethics. 2014;9(2–3):87–95. Scholar
  8. 8.
    Bischoff A, Denhaerynck K. What do language barriers cost? An exploratory study among asylum seekers in Switzerland. BMC Health Serv Res. 2010;10:248. Scholar
  9. 9.
    Bischoff A, Hudelson P. Communicating with foreign language-speaking patients: is access to professional interpreters enough? J Travel Med. 2010;17(1):15–20. Scholar
  10. 10.
    Blanchet Garneau A, Pepin J. Cultural competence: a constructivist definition. J Transcult Nurs. 2015;26(1):9–15. Scholar
  11. 11.
    Butow PN, Goldstein D, Bell ML, Sze M, Aldridge LJ, Abdo S, Tanious M, Dong S, Iedema R, Vardy J, Ashgari R, Hui R, Eisenbruch M. Interpretation in consultations with immigrant patients with cancer: how accurate is it? J Clin Oncol. 2011;29(20):2801–7. Scholar
  12. 12.
    Campinha-Bacote J. The process of cultural competence in the delivery of healthcare services: a model of care. J Transcult Nurs. 2002;13(3):181–4; discussion 200–181.CrossRefGoogle Scholar
  13. 13.
    Campinha-Bacote J. Cultural desire: ‘caught’ or ‘taught’? Contemp Nurse. 2008;28(1–2):141–8.CrossRefGoogle Scholar
  14. 14.
    Campinha-Bacote J. Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. Online J Issues Nurs. 2011;16(2):5.PubMedGoogle Scholar
  15. 15.
    Carpenter-Song EA, Nordquest Schwallie M, Longhofer J. Cultural competence reexamined: critique and directions for the future. Psychiatr Serv. 2007;58(10):1362–5. Scholar
  16. 16.
    Cunningham BA, Marsteller JA, Romano MJ, Carson KA, Noronha GJ, McGuire MJ, Yu A, Cooper LA. Perceptions of health system orientation: quality, patient centeredness, and cultural competency. Med Care Res Rev. 2014;71(6):559–79. Scholar
  17. 17.
    Davies B, Contro N, Larson J, Widger K. Culturally-sensitive information-sharing in pediatric palliative care. Pediatrics. 2010;125(4):e859–65. Scholar
  18. 18.
    Esscher A, Binder-Finnema P, Bodker B, Hogberg U, Mulic-Lutvica A, Essen B. Suboptimal care and maternal mortality among foreign-born women in Sweden: maternal death audit with application of the ‘migration three delays’ model. BMC Pregnancy Childbirth. 2014;14:141. Scholar
  19. 19.
    Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–99. Scholar
  20. 20.
    Granhagen Jungner J, Tiselius E, Lutzen K, Blomgren K, Pergert P. Creating a meeting point of understanding: interpreters’ experiences in Swedish childhood cancer care. J Pediatr Oncol Nurs. 2016;33(2):137–45. Scholar
  21. 21.
    Gudykunst WB. Theorizing about intercultural communication. Thousand Oaks: Sage; 2005.Google Scholar
  22. 22.
    Gulati S, Watt L, Shaw N, Sung L, Poureslami IM, Klaassen R, Dix D, Klassen AF. Communication and language challenges experienced by Chinese and South Asian immigrant parents of children with cancer in Canada: implications for health services delivery. Pediatr Blood Cancer. 2012;58(4):572–8. Scholar
  23. 23.
    Helse- og omsorgsdepartementet. Lov om pasient- og brukerrettigheter (Kapittel 3, § 3-1). 1999. Accessed 10 Jan 2017.
  24. 24.
    Hernandez RG, Cowden JD, Moon M, Brands CK, Sisson SD, Thompson DA. Predictors of resident satisfaction in caring for limited English proficient families: a multisite study. Acad Pediatr. 2014;14(2):173–80. Scholar
  25. 25.
    Jaramillo J, Snyder E, Dunlap JL, Wright R, Mendoza F, Bruzoni M. The Hispanic clinic for pediatric surgery: a model to improve parent-provider communication for Hispanic pediatric surgery patients. J Pediatr Surg. 2016;51(4):670–4. Scholar
  26. 26.
    Jirwe M, Gerrish K, Emami A. Student nurses’ experiences of communication in cross-cultural care encounters. Scand J Caring Sci. 2010;24(3):436–44. Scholar
  27. 27.
    Johansson A, Touhidy L. [Some experiences of cultural and religious differences and their impact in nursing care in inpatient care for children.] Några uppfattningar kring kulturella och religiösa skillnader och dess påverkan på omvårdnaden inom slutenvården för barn. Karolinska Institutet, Stockholm; 2016.Google Scholar
  28. 28.
    Kirmayer LJ. Rethinking cultural competence. Transcult Psychiatry. 2012;49(2):149–64. Scholar
  29. 29.
    Klassen AF, Gulati S, Watt L, Banerjee AT, Sung L, Klaassen RJ, Dix D, Poureslami IM, Shaw N. Immigrant to Canada, newcomer to childhood cancer: a qualitative study of challenges faced by immigrant parents. Psycho-Oncology. 2012;21(5):558–62. Scholar
  30. 30.
    Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88(2):251–8.CrossRefGoogle Scholar
  31. 31.
    Leininger MM. Leininger’s theory of nursing: cultural care diversity and universality. Nurs Sci Q. 1988;1(4):152–60.CrossRefGoogle Scholar
  32. 32.
    Leininger MM. Essential transcultural nursing care concepts, principles, examples, and policy statements. In: Leininger MM, McFarland MR, editors. Transcultural nursing: concepts, theories, research and practice. 3rd ed. New York: McGraw-Hill, Medical Pub. Division; 2002. p. 45–69.Google Scholar
  33. 33.
    Lion KC, Brown JC, Ebel BE, Klein EJ, Strelitz B, Gutman CK, Hencz P, Fernandez J, Mangione-Smith R. Effect of telephone vs video interpretation on parent comprehension, communication, and utilization in the pediatric emergency department: a randomized clinical trial. JAMA Pediatr. 2015;169(12):1117–25. Scholar
  34. 34.
    Margolis R, Ludi E, Pao M, Wiener L. International adaptation: psychosocial and parenting experiences of caregivers who travel to the United States to obtain acute medical care for their seriously ill child. Soc Work Health Care. 2013;52(7):669–83.CrossRefGoogle Scholar
  35. 35.
    Massimo LM, Wiley TJ, Caprino D. Health emigration: a challenge in paediatric oncology. J Child Health Care. 2008;12(2):106–15. Scholar
  36. 36.
    Nationalencyklopedin. Nationalencyklopedin, interkulturell. NE Nationalencyklopedin AB.ång/interkulturell. Accessed 6 Aug 2019.
  37. 37.
    Orellana MF. Translating childhoods: immigrant youth, language, and culture. New Brunswick: Rutgers University Press; 2009.Google Scholar
  38. 38.
    Patil S, Davies P. Use of Google Translate in medical communication: evaluation of accuracy. BMJ. 2014;349:g7392. Scholar
  39. 39.
    Pergert P. Facading in transcultural interactions: examples from pediatric cancer care in Sweden. Psychooncology. 2016;26:1013. Scholar
  40. 40.
    Pergert P, Ekblad S, Bjork O, Enskar K, Andrews T. Protecting family-interests: an interview study with foreign-born parents struggling on in childhood cancer care. Int J Pediatr. 2012;2012:681301. Scholar
  41. 41.
    Pergert P, Ekblad S, Bjork O, Enskar K, Andrews T. Resourcing: an approach used by foreign-born parents struggling on in childhood cancer care. Eur J Oncol Nurs. 2016;23:1–7. Scholar
  42. 42.
    Pergert P, Ekblad S, Enskar K, Bjork O. Obstacles to transcultural caring relationships: experiences of health care staff in pediatric oncology. J Pediatr Oncol Nurs. 2007;24(6):314–28.CrossRefGoogle Scholar
  43. 43.
    Pergert P, Ekblad S, Enskar K, Bjork O. Bridging obstacles to transcultural caring relationships—tools discovered through interviews with staff in pediatric oncology care. Eur J Oncol Nurs. 2008a;12(1):35–43.CrossRefGoogle Scholar
  44. 44.
    Pergert P, Ekblad S, Enskar K, Bjork O. Protecting professional composure in transcultural pediatric nursing. Qual Health Res. 2008b;18(5):647–57.CrossRefGoogle Scholar
  45. 45.
    Pergert P, Lützén K. Balancing truth-telling in the preservation of hope: a relational ethics approach. Nurs Ethics. 2012;19(1):21–9. Scholar
  46. 46.
    Piller I. Linguistics and intercultural communication. Lang Linguist Compass. 2007;1(3):208–26.CrossRefGoogle Scholar
  47. 47.
    Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008;100(11):1275–85.CrossRefGoogle Scholar
  48. 48.
    Schenker Y, Perez-Stable EJ, Nickleach D, Karliner LS. Patterns of interpreter use for hospitalized patients with limited English proficiency. J Gen Intern Med. 2011;26(7):712–7. Scholar
  49. 49.
    Scollon R, Scollon SW. Intercultural communication: a discourse approach. Oxford, UK: Blackwell; 2000.Google Scholar
  50. 50.
    Senge PM. The fifth discipline fieldbook: strategies and tools for building a learning organization. London: Crown Business; 2014.Google Scholar
  51. 51.
    South Australia Legislation. Health Care Act 2008 (Version 1.9.2016). 2008. Accessed 10 Jan 2017.
  52. 52.
    Steinberg EM, Valenzuela-Araujo D, Zickafoose JS, Kieffer E, DeCamp LR. The “battle” of managing language barriers in health care. Clin Pediatr (Phila). 2016;55:1318. Scholar
  53. 53.
    Swedish Statute Book. Patientsäkerhetslagen [Patient Safety Act] 2010:659. 2010. Accessed 10 Jan 2017.
  54. 54.
    Tate RC, Hodkinson PW, Meehan-Coussee K, Cooperstein N. Strategies used by prehospital providers to overcome language barriers. Prehosp Emerg Care. 2016;20(3):404–14. Scholar
  55. 55.
    Thibodeaux AG, Deatrick JA. Cultural influence on family management of children with cancer. J Pediatr Oncol Nurs. 2007;24(4):227–33.CrossRefGoogle Scholar
  56. 56.
    Tse L. Language brokering among Latino adolescents: prevalence, attitudes, and school performance. Hisp J Behav Sci. 1995;17(2):180–93.CrossRefGoogle Scholar
  57. 57.
    United Nations. Universal declaration of human rights. 1948. Accessed 10 Jan 2017.
  58. 58.
    Wadensjö C. Interpreting as interaction. London: Routledge; 1998.Google Scholar
  59. 59.
    Valdes G. Expanding definitions of giftedness: the case of young interpreters from immigrant communities. Mahwah: The Educational Psychology Series; 2003.Google Scholar
  60. 60.
    van Rosse F, de Bruijne M, Suurmond J, Essink-Bot ML, Wagner C. Language barriers and patient safety risks in hospital care. A mixed methods study. Int J Nurs Stud. 2016;54:45–53. Scholar
  61. 61.
    Westerholm K. Encountering the other through ongoing cultural learning: a teaching-learning model from the humanbecoming perspective. Nurs Sci Q. 2009;22(3):221–7. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Women’s and Children’s HealthKarolinska InstitutetStockholmSweden
  2. 2.Paediatric Oncology, Karolinska University HospitalStockholmSweden
  3. 3.Institute for Interpreting and Translation Studies, Department of Swedish Language and MultilingualismStockholm UniversityStockholmSweden

Personalised recommendations