Towards culturally appropriate speech-language and hearing services : exploring the cultural narrative in initial consultations with Xhosa-speaking patients

Master Thesis


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University of Cape Town

Transformation of the existing health care system to one relevant to the needs of all its people, is the vision to which South African health providers aspire. This move towards more culturally and linguistically appropriate services is in line with the worldwide trend away from the biomedical to a more biopsychosocial and patient-centered approach to health care. Within the field of Speech-Language and Hearing Therapy (SLHT), the provision of more culturally appropriate services has been emphasized and research has focused on the new field of Cultural Speech-Language Pathology, interpreter-mediated consultations, and the use of more appropriate assessment and rehabilitation procedures. Penn (2000) proposed the use of the cultural narrative as a more appropriate means of gathering information from patients in initial consultations. Research into the use of narratives has been conducted in a number of health related disciplines, however, to date, this area has been under-researched within the field of SLHT and in the South African context. In this study, the researcher explored and documented the cultural narrative within multilingual, multicultural consultations in the field of SLHT in South Africa. The cultural narrative was compared to traditional methods of obtaining case history information in initial consultations across interpreter-mediated consultations with a white, English-speaking clinician and a black Xhosa-speaking clinician with Xhosa-speaking patients. In addition, post-consultation interviews using semi-structured questionnaires were carried out. Both the initial consultations and the post-consultation interviews were recorded and transcribed verbatim. The analysis of the initial consultation transcripts included an in-depth analysis of the interpreting practices. The post-consultation interview transcripts were thematically analyzed. The analysis included an analysis of interpreting and thematic analysis of the post-consultation interviews in which the participants also took part. The major finding of this study was that the cultural narrative method is more culturally appropriate, patient-centered and in line with a biopsychosocial approach to health care than the traditional case history method in both monolingual and multilingual, multicultural, interpreted consultations. This study has numerous theoretical, clinical and future research implications. It is hoped that these findings will be used to inform the training of clinicians and in practical application in clinical encounters. Although this study was conducted within the field of SLHT, the findings are believed to be applicable across all disciplines in health care.

Bibliography : leaves 177-190.