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Communication and Cultural Competence 159

delivery of health care services. The importance of developing listening and speaking
skills can not be overemphasized for all those involved in health care delivery services.
Health care providers (including health educators) must demonstrate skill in listening,
speaking, empathizing, probing, advocating, confronting, conveying immediacy, car-
ing, and showing concern while responding to the health care needs of their clients
and clients ’ families. They must understand the literacy levels of their clients and pro-
mote cross - cultural understanding. They should be prepared to recognize and meet the
physical, social, emotional, mental, and spiritual needs of their clients.
Client confidentiality (as set out in the Health Insurance Portability and Account-

ability Act, or HIPAA), informed consent, and client rights are extremely important in
the delivery of care. The more effective the communication that occurs between the
provider and the client, the better the care provided and the healing process. To stimu-
late health care discussions between provider and client, a brief introduction of the

provider with reference to his or her qualifications, care philosophy, cultural back-
ground, and interests and also some introduction to health topics important to the
client ’ s well-being are in order. Communication barriers impede the delivery of care
and the healing process.
In order to serve culturally diverse clients, interpreters (translators) may be needed.
Currently, thirteen U.S. states require reimbursement for the use of interpreters. This is
one step toward fighting the communication problem faced by minority groups. It ap-

pears that the problem is now getting more national attention, but yet more needs to be
accomplished. The literature reveals that more research and action are needed to ad-

dress this problem (Lang, 2004). We are in the beginning steps of fighting it, and the
only way to beat it is to identify and take action on each component of the problem,
including communication and language patterns and barriers, health literacy, and the
roles of culture, poverty, and educational opportunities.
In conclusion, the language barrier among minorities needs to be addressed. The
issue is getting more attention, but it appears that rural and underserved areas and spe-
cial populations in particular need help urgently. Despite the fact that this is a rela-
tively small population, these people are the ones who need health care the most.
A greater percentage of minorities live in metropolitan areas, but they are the ones
mainly being targeted by existing interventions. It may seem impossible, but this issue
must be addressed everywhere in the world, in large cities like New York and in small
towns in rural America, Southeast Asia, Africa, and elsewhere. Additionally, efforts
should be directed toward helping all minorities — whatever their difference, disability,
or ethnic or racial identity — to overcome their language barriers.

CONCLUSION

The chapter highlights health educator guidelines for effective communication and cul-
tural competence in the planning, implementation, and evaluation of health education
intervention programs. Health educators working with clients whose health knowledge,
beliefs, practices, and attitudes differ significantly from those of the health educator

should be aware that such cultural factors infl uence clients ’ responses to health and health

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