According a statement made by the American Speech and Hearing Association (ASHA) in 2019, professional competence requires that speech language pathologists (SLPs) develop cultural competence which includes the knowledge of cultural variables and their potential impact on communication in their practice. Development of cultural competence requires clinicians to be able to self-assess their knowledge of cultural factors and have an understanding of how they influence their perceptions of communication and affect their service delivery. Clinicians with cultural competence demonstrate understanding and respond appropriately to a combination of different cultural factors and dimensions in order to properly identify, assess, treat and manage clinically and linguistically diverse (CLD) clients. 

By actively learning about Hofstede’s cultural dimensions, SLPs can develop and demonstrate clinical and cultural competence and learn to explore cultural factors during their assessment/treatment of CLD clients. Clinically competence clinicians demonstrate sufficient knowledge of a client’s cultural and linguistic background and therefore can avoid assuming that a communication pattern constitutes a disorder, when in fact, the pattern could be a result of a cultural and linguistic variation.

During my externship on the Bilingual Assessment Team at an Elementary School, we were asked to evaluate a 4-year-old male that was referred by child find for concerns about their expressive language abilities. This child was born in Japan into a bilingual Arabic/English family and had resided in the USA for the previous 3 months. His mother was concerned that he was not socializing or talking enough for his age. Upon meeting this child, he appeared very timid and shy and needed multiple prompts in order to engage with the clinicians. However, it was noted that whenever this child spoke to his mother, he became more verbal and more engaged. If this was your case, what approach would you use in order to explore cultural factors that could be influencing your assessment and/or treatment? We will explore how learning Hofstede’s cultural dimensions can help clinicians in identifying pertinent information about cultural factors related to their CLD clients.  

“Culturally competent clinicians avoid assuming that a communication pattern constitutes a disorder when the pattern could be a result of a cultural and linguistic variation.”

What is Culture? Culture can be defined as a learned behavior and individuals within a culture can vary on differences, preferences, values and experiences. Hofstede (2011) identifies 6 dimensions of cultural variability, by becoming familiar with these dimensions’ clinicians will be able to learn and formulate culturally sensitive diagnostic questions that can help guide assessment, treatment and analyze information about current client performance. Ultimately, Hofstede’s cultural dimensions can provide clinicians with a tool that can assist in deciding if what they are experiencing with their CLD client is a disorder or a cultural difference. Hofstede further identifies the following six cultural dimensions; power distance, uncertainty avoidance, individualism versus collectivism, masculinity versus femininity, long term versus short term orientation and indulgence versus restraint. 

“I’ve learned Hofstede’s cultural dimensions, but how can I apply these to my clinical practice?” 

Returning to our Case Study: 

After learning about Hofstede’s Cultural Dimensions we will be able to apply the knowledge of cultural dimensions to our assessment and treatment of future CLD clients. Using Hofstede’s Country Data, obtained from  from the website https://www.hofstede-insights.com/product/compare-countries/, we can compared cultural dimensions between countries of interest and compare multiple countries at the same time. The United States was used as a point of reference for clinicians. Using the website we obtained the  graph below, we can instantly see considerable differences between all three countries, Japan, Saudi Arabia and the United States on every cultural dimension. Let’s further investigate each dimension and learn about its clinical importance. 

HOFSTEDE’S CULTURAL DIMENSIONS

Power Distance (high versus low)

Power distance refers to how a culture views superior/subordinate relationship and the power equality/inequality among its members. Cultures that demonstrate a high-power distance will accept hierarchical order and unequal distribution of power. In contrast, cultures with a low power distance will question authority and strive to equalize power, demanding justification for any perceived inequalities. Saudi Arabia has a high-power distance when compared to both the USA and Japan. This suggests that Saudi Arabia follows a more hierarchical structure where parents might emphasize that all members in the family have a specific role and that authority should not be questioned. In clinical practice, this becomes important because clinicians are automatically put in a position of power as the expert. In this scenario, a family could rely on you to make important decisions and not question you because of your power position, whereas families who have a low-power distance might want you to discuss options with them and come to an agreement together on the best plan for them.  

Uncertainty Avoidance (high versus low)

Uncertainty avoidance describes how a culture views ambiguity and how they feel about unstructured situations. Cultures with a high uncertainty avoidance will try to make life as routine as possible, making life controllable and therefore avoiding risks. These cultures will abide by strict behavioral codes, laws, rules and will disapprove of deviant opinions while believing in an absolute truth. In contrast, cultures with low uncertainty avoidance will be more open to change, will engage in open ended learning and are more tolerant of differing opinions. They tend to have fewer rules and will display a lower overall sense of urgency. Japan and Saudi Arabia were high for uncertainty avoidance when compared to the USA. This could be clinically relevant and demonstrated through our clients need for clarity, structure, rules and concise expectations and goals. Whereas, cultures with a low uncertainty avoidance might be more willing to “go with the flow” and may want a more dynamic session where schedules and time is not the main focus. 

Individualism versus Collectivism 

This cultural dimension refers to how individual members of a certain culture group themselves together and their level of overall interdependence among each other. In individualistic cultures people will tend to look out more for themselves and their direct family. They will take less responsibility for other’s actions and outcomes and focus on “I”. In contrast, collectivist cultures prefer to be integrated into cohesive groups with their extended family that offer protection in exchange for loyalty. Collectivist cultures stress “we” and their belonging to that group. Saudi Arabia scored lower in terms of individualism in comparison to the USA. This could manifest itself clinically as your clients need to first confer with their family or group members before making important decisions regarding treatment. They might place importance on consulting the rest of their family and extended family before reaching. In addition, it might be important for them to include the rest of their group or family in therapy goals and planning. In contrast an individualistic culture might focus more on making their own decisions and will rely more on immediate family when discussing plans for treatment. 

Masculinity versus Femininity

Masculinity versus femininity is how a culture views gender differences and how they distribute roles between men and women. Cultures with a higher masculinity dimension are driven by competition, achievement, success and will have clear gender roles. In contrast, a feminine culture will place value on caring for others, cooperation, modesty and their gender roles will overlap. Masculinity was high for Japan in comparison to both the USA and Saudi Arabia, meaning they tend to have more defined gender roles. This could be important clinically when considering differing gender roles in regard to child rearing. You might want to consider talking to the mother if her role is taking care of the children and consider that the dad might have a different role other than being involved with the children. In addition, more masculine cultures are motivated by precise targets and achievement, therefore it would be important to have a clear plan of action.

Long-term versus Short-term Orientation

Long term versus short term orientation references the importance a culture has towards the past, present and future.  Cultures with long-term orientation place emphasis on the future and are more modest and thriftier. They practice persistence, perseverance and encourage modern education as a way to prepare for the future. Students attribute their success to their efforts and failure as a lack of effort. In contrast, short term orientation cultures place emphasis on the past and present. They focus on tradition, stability, principles, consistency and truth. They view change with suspicion and will attribute a student’s success and failure with luck. Japan demonstrated a long-term orientation compared to Saudi Arabia and USA. This could present as our client being more focused on long term goals and praising effort, exercising perseverance. It would be beneficial to focus on long term goals with this client. Clients with a short-term orientation will also benefit with focusing on how and what they are doing during therapy in contrast to long term orientation which might want to focus on why they are performing a task. If your client is more geared towards short-term orientation you should consider that they attribute success and failure to luck and how you can implement their views during intervention and treatment. 

Indulgence versus Restraint 

Indulgence versus restraint refers to how a culture practices control over their desires and impulses. Cultures that are indulgent will allow free gratification of basic and natural human desires related to enjoying life and having fun. They tend to be more optimistic and focus on personal happiness and freedom of speech. They can display an internal locus of control and might believe in personal life control. In contrast, cultures that practice restraint might control gratification of needs and will regulate them through strict social norms. They can be more pessimistic, cynical and rigid in their behaviors. They might display a more external locus of control and therefore might not believe that behaviors are under their immediate control. Japan and Saudi Arabia scored lower on Indulgence when compared to the USA. Clinically this could be presented as your client having a “let’s get to work” attitude and therefore avoid jokes and want to engage in more formal sessions. Also, a consideration that will be important for clinicians is whether your client displays an internal or external locus of control and how this could impact that type of therapy you’re performing and their views on therapy. 

By using Hofstede’s Cultural Dimensions, I was able to navigate a complicated assessment and use this framework in order to obtain more information about my client’s communication profile. Hofstede’s Cultural Dimensions allowed me to delve deeper into cultural factors that were influencing my assessment. I learned that in fact my client was staying quiet because in his culture, you did not respond to questions that you thought might be wrong out of respect for authority. I also learned that staying quiet was viewed as form of respect.  

In conclusion, it was important for me to remember to use Hofstede’s cultural dimensions as general guidelines in order to guide my clinical judgement and decision-making process. It is however important to remember that these are only guidelines and cultural dimensions occur on a continuum. I’ve had many clients that do not subscribe to their cultures norms and demonstrate behavior outside of their own cultural norms. It is important to remember that each dimension can vary and can shape therapy to fit each individual’s needs.

Learning and becoming aware of Hofstede’s cultural dimensions aided me in becoming a better and more competent clinician because I was aware of the variation that can occur and the uniqueness that every person brings to the table in terms of culture. Hofstede’s cultural dimensions provided me with a took to avoid miscommunications and address situations during therapy with CLD clients that were out of my comfort zone. Learning Hofstede’s cultural dimensions was an important tool I learned during my Cultural and Linguistic Diversity Emphasis Training and was something I could apply to all of my clinical work with all of my clients. Hofstede’s Cultural Dimensions gave me a tool to investigate if cultural factors were influencing the services and interactions I was having with my clients. Lastly, in order to become a culturally competent clinician, clinicians must have knowledge of cultural factors and their influence on their own perceptions of communication and how they impact delivery of services to CLD clients.

By learning and applying Hofstede’s cultural dimensions, clinicians will become more aware, self-assess, and ultimately through cultural competence, provide adequate and appropriate services to the CLD clients they serve. 

See where you own culture falls on Hofstede’s cultural dimensions: use the graph below! 

Please see these resources I’ve gathered below to print and use as a reference. 

Resources: 

Compare different countries using Hofstede’s Cultural Dimensions: 

Handout of Hofstede’s Cultural Dimensions

Hofstede’s Cultural Dimensions: USA

Reference: The Hofstede centre (2016) What about the USA?. Retrieved from https://dial.uclouvain.be/memoire/ucl/fr/object/thesis%3A4011/datastream/PDF_04/view

References: 

ASHA (2019) Cultural Competence. Retrieved from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935230&section=Key_Issues

ASHA (2019) Scope of Practice in Speech-Language Pathology. Retrieved from https://www.asha.org/policy/SP2016-00343/

The Hofstede centre (2016) What about the USA ?. Retrieved from https://dial.uclouvain.be/memoire/ucl/fr/object/thesis%3A4011/datastream/PDF_04/view

Hofstede Insights (2019) Country Comparison. Retrieved from https://www.hofstede-insights.com/country-comparison/the-usa/

Hofstede, G. (2011) Dimensionalizing Cultures: The Hofstede Model in Context. Online Readings in Psychology and Culture, 2(1). https://doi.org/10.9707/2307-0919.1014

Mind Tools Ltd. (2019) Hofstede’s Cultural Dimensions Understanding Different Countries. Retrieved from https://www.mindtools.com/pages/article/newLDR_66.htm

CQFluency (2016) Long term orientation vs. Short term orientation (LTO). Retrieved from https://www.cqfluency.com/blog/long-term-orientation-versus-short-term-orientation/

Cleverism (2019) Understanding Cultures & People with Hofstede Dimensions. Retrieved from https://www.cleverism.com/understanding-cultures-people-hofstede-dimensions/

Rosa Lemus is part of the the Cultural and Linguistic Diversity program for Speech-Language Pathology students at the University of Maryland. The program aims to broaden students’ understanding of culture and language in order to minimize disparities in service delivery to culturally and linguistically diverse populations.