terça-feira, 26 de março de 2013

Diferenças Interculturais


Cross-Cultural Qualitative Interviewing

In the ideal world, the primary language and culture of the qualitative interviewer matches that of the interviewee. But, as the diversity of our population increases, the likelihood that a white American researcher will be called upon to interview a person from a non-Western culture increases exponentially.

It’s happened to me several times: a client asks me to conduct qualitative interviews with people who speak a different language or have grown up in a culture different than my own. Though it’s a challenging assignment, it’s one I welcome and continue to learn to navigate.

In my last blog article, I featured 13 cultural norm differences between Americans and non-Westerners as described by Robert Kohls. Non-Westerners can easily be put off by the communication style of Americans, who they often perceive as outgoing, assertive, competitive, and extremely talkative. As a qualitative interviewer, it’s important to have some insight into these differences.

Context vs. content

So how does one effectively listen cross-culturally? How does one sensitively gather accurate information from someone who likely grew up in a culture in which a word, a look, a question, or a comment can easily take on a very different meaning?

Beyond a basic understanding of cultural communication differences, context is key. Cultures can be distinguished as being either “high context” or “low context.”
  • Low context cultures pay more attention to the content of what is said and less to the context in which the expression is made.
  • High context cultures pay less attention to what is actually said than to how it is said, who said it, or the circumstance within which it was verbalized.
In general, Americans are characterized as a low context culture, and many non-Western cultures as high-context cultures.

When listening cross-culturally, a qualitative interviewer from a low context culture must take into account not only language differences, but contextual variations as well. Some of the things we as qualitative interviewers must consider include: who best to ask the questions, how questions should be posed, who should or should not be present, what questions to ask, the most appropriate setting for the interview, the type of introduction and ground rules, the tenor/pace of the questioning, and how to read cues that something isn’t working.

Preparing for an intercultural interview

Preparing for an intercultural interview requires additional consideration beyond customary question design and delivery protocols. At a minimum, it involves consulting with someone from the interviewee’s culture to gain contextual understanding and awareness of cultural-specific communication norms. It might also mean making changes in the study design—everything from recruitment strategies to question development to interview structure—to accommodate important cultural expectations. Very often it means hiring an interpreter/translator or training someone from the interviewee’s culture to conduct the interview.

Strategies for bridging cross-cultural differences

When I am not able to contract with a culturally appropriate professional interviewer or train a person indigenous to the culture, I work through an interpreter to conduct the interviews myself. It takes patience and extra time, but I appreciate the opportunity to look into the faces of those I am interviewing, even if I cannot understand their words. I pretend as if they are speaking directly to me.

Though I’m far from an expert on intercultural interviewing, I have gleaned several insights from these experiences. I’ve included a few here that you might want to consider:

Personal control over environment 

Unlike self-empowered Americans, some cultures believe many things happen for reasons beyond their own intervention. As interviewers, we must listen closely for these cultural differences to avoid judgment and inappropriate questions.

I once asked a focus group of Russian women (through an interpreter) how their health care providers might empower them to live healthier lives. They were befuddled. They had no context for the question. One of the women said, “How can you even ask us such questions? We are to listen to the doctor and do what he tells us to do. We are grateful for whatever advice he gives us.” 

Until I understood better that active and conscious disease prevention is more of an upper middle class Western value, I was not able to understand their response. If I had it to do over,  I would have elicited input on the question guide from a Russian native prior to the focus group. Having done that, I imagine I would have either eliminated the question or changed it to a more basic question like, “Where does health come from?” or “How do you and your family stay healthy?”

Time boundaries

Many other cultures are less time-bound than Americans, who highly value time—we don’t like to waste or “kill” time. Cultures that don’t live by the watch, especially those that value listening more than speaking, may need more time or flexibility to accommodate what they have to say or how they want to say it.

Focus groups, the way we Americans run them, are scheduled for a 60 to 90-minute time slot at a public location. That usually works well for most participants, but not as well for some Latino and African American sub-groups whose cultural identity is deeply grounded in family, inclusion, and vibrant dialogue. 

To accommodate participants from these high context cultures, I try to host focus groups in a private home and allow other family members to be present. When I am not able to do that, I schedule longer, more flexible groups (to allow for latecomers) in a familiar public location (church, community center, etc.). I also provide on-site childcare, a waiting area for spouses and older children, and a full meal for participants and their families. When I make the contextual accommodations, I find that participants are able to share more fully. From the gratitude they express afterward, I sense that they feel they’ve genuinely been heard. 

Directness, Openness, Honesty 

When asking interviewees from other cultures to evaluate services, performance or other individuals, it is important to listen for subtle hints and signals. Non-Westerners can feel threatened by frank openness about these issues, particularly if their responses are negative. To help our interviewees save face, we must sometimes listen between the words.

One of the first questions I asked a group of Vietnamese focus group participants was how they would rate their last doctor’s visit. Two mistakes I made were: 1.) Asking the question so directly; and 2.) Asking it as the first question, before building their trust. 

 As it was, every one of the participants claimed their last visit was excellent or very good. I couldn’t elicit one untoward comment no matter how I prompted or probed. It’s not to say that the question should not have been asked, but I could have reframed it in a way that gave respondents permission to offer less than a complimentary remark. Something like: “Doctors in the U.S. are always wanting to improve patient care and sincerely want to hear your feedback. Your comments will not affect your care or offend the doctor in any way.” I could also have asked the question closer to the end of the group, at which time I might have gained the interviewees’ confidence and would also have generated more knowledge with which to listen between the lines for hints of dissatisfaction.

Practicality and Efficiency

In general, it’s American to value efficiency and rationality. But it’s not always the best approach during cross-cultural interviews. Here, efficiency can ultimately short-circuit the quality or depth of data.

A few years ago, I conducted a focus group of low-income African American women for a community needs assessment sponsored by a local health care organization. I’m white, but since we were all women, and Americans, and I was on a short timeline and budget it seemed like the most efficient thing to do. About 15 minutes into the group I started feeling like the African American women were really connecting with me—the discussion was flowing and they were really opening up (or so it seemed). Many of the women even gave me a little hug on their way out. I was confident it all went well until I ran it past my African American friend, Cheryl. She shared the following insight:
You can feel like you connected and people were pleasant and forthcoming but you don’t know if, as an outsider, there were things that you should’ve heard about and didn’t—things that are common to this group that you could not know about, could not know to ask. When you’re an outsider, things will go over your head and you’ll miss an opportunity to follow up on something. You can miss something very important [and not know it].

Cheryl really got me thinking about what I might have missed. Would these women have shared a particular health issue if they though I might have judged or blamed them for it? Would they be as forthcoming about health care access issues if they thought, as a white middle class woman, I couldn’t possibly understand? Or did they just not bother to speak up because they sensed I wouldn’t understand anyway. I’ll never know.

As you can see, though I’ve learned a lot about cross-cultural interviewing, I still have a long way to go. I want to keep learning how to bridge the context-content gap. I know the quality of the data I collect will only intensify as the respect and understanding I convey increases between my culture and theirs.

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