Culture, Language and Health: A Linguistic Investigation of Communication Strategies in Gynaecological Consultations in Accra, Ghana.

Abstract

The essential role of effective doctor-patient communication in patients' healthcare outcomes is well established in the literature. Numerous studies have shown that language, communication, and cultural barriers can negatively affect patients' health outcomes. However, in many countries in Africa, communication in healthcare has faced neglect and is grossly understudied, likely due to socioeconomic, cultural, and physical hindrances. The need for studies is underscored by the increasingly multiethnic, multicultural, and multilingual societies in many cities in sub-Saharan Africa, including Ghana. Of particular interest is communication in sexual healthcare, given its private and intimate nature and the cultural prohibition on sexual expressions. As a result, gynaecological encounters present a particularly challenging situation for healthcare communication in Ghana. Adding to the apparent discomfort is the overwhelming male dominance of professionals, presenting an even more complex situation from cultural and religious perspectives. Consequently, gynaecological encounters become daunting for most women, a situation heightened by the high sexual and reproductive health needs of most women in Ghana. This study investigated communication strategies female patients and male/female doctors employed during sexual healthcare encounters to overcome possible language and cultural barriers. Furthermore, the study explored doctor-patient communication and doctor-patient perceptions of the communication relationship through their use of English. To achieve this, 35 doctor-patient interactions were recorded from the University of Ghana Health Services (UHS) and Korle-Bu Teaching Hospital in Accra. Audio recordings of doctor-outpatient face-to-face encounters served as the main data sources, augmented by data from individual semi-structured interviews and participant observations that contributed to the triangulation of results. NVivo 12.6 and Discursis were employed as f a e used in the analysis of data. The study adopted Communication Accommodation Theory (CAT) as its theoretical lens. CAT highlighted the doctor-patient gynaecological communicative adjustments being negotiated under culturally sensitive and restrictive health interactions. The findings from the study established the doctors and patients employed several communication strategies in their interactions, such as using medical jargon (M. J), avoidance (AVO), code-switching (C-S), and low tones (L-T) to promote communication, enhance understanding and in all the interactive processes accommodated bilaterally to each he c ica i eed . English only or English with a local language (mostly Twi) were predominantly employed. The local language often utilised was to enhance a ie de a di g f ech ical edical c ce . The results from this study point to paternalism as the dominant model of the doctor-patient relationship, promoted by patients. This was reflected in the overwhelming verbal dominance of doctors during the interactions. Patients' preferences and satisfaction were primarily based on effective communication strategies, choice (s) of language, continuity of care with a doctor, and the d c level of expertise. Given the vital role of sexual health, the findings from this study may contribute to policies aimed at enhancing patient experiences in this area of healthcare by promoting access and quality of care. The findings are particularly significant in a country such as Ghana, where language, sexual, and reproductive healthcare needs are compelling.