While human nature is inherited, culture is learned; however, individuals within all cultures vary based on differences, preferences, values, and experiences. Hofstede (2011) identifies cultural dimensions that are globally applicable and are reflected in all aspects of life, including family life, child-rearing practices, education, employment, and health care practices.
The individualism-collectivism dimension relates to a societal, not an individual's, characteristic and identifies the extent to which people in a society are integrated into groups. In an individualist society, there is an expectation that individuals look after themselves and connections between individuals are loose; while in a collectivist society, individuals are integrated into strong, cohesive groups, which may often involve extended family.
The individualism-collectivism dimension may also influence an individual's perceptions of disability.
After suffering an injury, an adult with a highly individualistic cultural background may be focused on self-sufficiency and independence. Caretakers may see their role as primarily to facilitate a return to self-care.
For individuals and caretakers with a collectivist background, the focus may be on providing ongoing assistance to an individual. Extended family may be very involved in caretaking.
Power distance refers to the extent to which less powerful members of organizations and institutions (including the family) accept and expect unequal power distributions. This dimension is measured not only from the perspective of the leaders, who hold power, but from the followers. In regard to power distribution, Hofstede notes, "all societies are unequal, but some are more unequal than others."
In a large power distance society, parents teach children obedience, while in a small power distance society parents treat children as equals. Subordinates expect to be consulted in small power distance societies, versus being told what to do in large power distance societies.
Clinicians may find that individuals from a high power distance cultural background may refrain from expressing disagreement with goals and/or therapy activities, even if they don't plan to implement suggested goals in the long term. Clients view the clinician as the expert and expect them to direct assessment and interventions.
Individuals with a low power distance cultural background may more openly express agreement and disagreement with clinician advice and suggestions, ask questions, and expect to be involved in the development of intervention plans.
Masculinity-femininity cultural dimension is addressed as a societal, not an individual's, characteristic and "refers to the distribution of values between the genders …" (Hofstede, 2011). A society is called feminine when there is not a strong differentiation between the genders for emotional and social roles—both men and women should be modest and caring and both boys and girls may cry, but neither should fight. In masculine societies, both men and women are assertive and competitive; however women are less so than men.
For individuals from a highly masculine cultural background, mothers may tend to feel more comfortable dealing with the emotional implications of a diagnosis from a clinician, while fathers may feel more comfortable handling the factual aspects of the situation and show less emotion in response to a diagnoses. In a clinical situation, this may include appointment scheduling, payment, and questions for the clinician.
In a feminine culture, these roles in clinical interactions may be more evenly split across the male and female members of a family, and emotional responses may be more clearly observed across both genders.
The uncertainty avoidance dimension indicates the level of comfort with unstructured situations, in which unstructured situations are "novel, unknown, surprising, and different from usual" (Hofstede 2011). The uncertainty avoidance dimension is different from "risk avoidance" (Hofstede 2011). It encompasses a culture's tolerance for ambiguity. Cultures high in uncertainty avoidance avoid unstructured situations with "strict behavior codes, laws and rules, disapproval of deviant opinions, and a belief in an absolute Truth …" (Hofstede, 2011).
Clinicians often encounter questions about prognosis and outcome when working with both children and adults.
Individuals from a strong uncertainty avoidance cultural background may feel a strong need for a definitive prognosis, time line, and outcomes expectations.
Individuals from a weak uncertaintiy avoidance cultural background may feel more comfortable with the unknown and have less need for a definitive prognosis.
The long- versus short-term orientation refers to whether a society exhibits a pragmatic future-oriented perspective or a conventional historic point of view. A long-term orientation fosters virtues directed toward the future—in particular, perseverance and thrift and ordering relationships by status. A short-term orientation fosters virtues related to the past and present—in particular, respect for tradition, preservation of "face," and personal steadiness and stability.
The short-term orientation cultures embrace of tradition and focus on "saving face" may influence how an individual and caretakers approach re/habilitation. Individuals may have a sense of shame or feel strongly that it is necessary to "hide" a disability.
Individuals from a long-term orientation culture tend to order relationships according to status, which may influence how an individual and caretakers respond to a diagnosis.
This dimension identifies the extent to which a society allows "relatively free gratification of basic and natural human desires related to enjoying life and having fun," as represented by the "indulgence" point on the continuum, relative to a society that "controls gratification of needs and regulates by means of strict social norms" (Hofstede 2011).
Indulgence as a cultural value also tends towards a perception of personal life control, while restraint as a cultural value tends towards a perception of helplessness and that what happens in one's life is beyond their own control.
Clinicians may find that, in response to a disability, individuals from a culture of indulgence feel that they have control over their future level of function and participation in life activities; meanwhile, individuals from a background of cultural restraint may have a sense of helplessness and be less actively involved in taking control over their involvement in functional activities outside of the clinic.
Additionally, in cultures valuing restraint, leisure activities are of lesser value, which may prove important to consider in selecting functional therapy activities. Cultures valuing indulgence place higher importance on leisure and so activities considered enjoyable may be more appropriate for individuals with this cultural trait.
Hofstede, G. (2011). Dimensionalizing cultures: The Hofstede model in context. Online Readings in Psychology and Culture, 2 (1). Retrieved from dx.doi.org/10.9707/2307-0919.1014.