Colliding Realities: An Ethnographic Account of the Politics of Identity and Knowledge in Intercultural Communication in Child and Family Health

Author: Julian Maree Grant

Grant, Julian Maree, 2008 Colliding Realities: An Ethnographic Account of the Politics of Identity and Knowledge in Intercultural Communication in Child and Family Health, Flinders University, School of Nursing & Midwifery

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ABSTRACT Cultural beliefs and values implicitly shape every aspect of the way we parent our children and how we communicate about parenting. For parents who are migrants and experiencing parenting in a new country it is essential that child and family health professionals better understand how the cultural self influences practice. Child and family health professionals work with families who come from cultures other than their own on a daily basis. How they communicate with these families is the subject of this ethnographic study into culture and communication in child and family health. Taking culture as its starting point this study explored the everyday communication experiences of child health professionals including child and family health nurses, social workers and doctors in a statewide child and family health service in South Australia. Data included participant observation, video and in-depth interview data. Drawing on insights from cultural studies including postcolonial and feminist scholarship the analysis showed that child health professionals attempted to use contemporary discourses of service provision such as partnership with enthusiasm and with genuine intent. However their application of partnership was limited by unexamined binary constructs within dominant pedagogic tools of culture and communication. Analysis showed that four key binaries structured the communication practice of participants in this study; public or private knowledge, ideologies of sameness or difference, organisational or professional philosophies of practice and the expert or partner in intercultural communication. Three body analysis is introduced as a strategy to work with these binary challenges that seem to present when practice attempts to incorporate theory without consideration of the contexts of use. The combination of postcolonial feminist critique and three body analysis stimulates an explicit examination of health care inequalities as they intersect with the ongoing effects of colonisation. Current professional strategies for working with people who are new arrivals or migrants to Australia focus on understanding differences associated with particular ethic and cultural groups. Despite much work being undertaken to understand difference, in practice this culturalist approach underpinned by a belief in the essential nature of human kind, has resulted in people who are migrants or new arrivals continuing to report poor communication by health professionals as a primary barrier to their health care. Theoretical analysis suggests that this approach ignores differences in power relations among ethnic groups and ultimately manifests in racism. Further, contemporary communication pedagogies in child and family health reinforce this inattention to relations of power when health professionals are instructed to communicate in ways that are regardless of difference. By advocating that people are treated the same, historic and situated issues of gender, race, and socioeconomic inequalities are ignored. In this way binaries of sameness/difference are perpetuated. Those parents located in marginalised positions of difference experience inequities in health care. In this study, child and family health professionals frequently drew from their own personal experiences of parenting to determine the content of information given to new parents, and to inform their approach to intercultural communication. In doing so they unselfconsciously conflated their personal and professional pedagogies and presented all information as professional. Child and family health practices are deeply cultured. Many practices are not scientifically proven and as such do not fit comfortably with the rational scientific medical paradigm with which they are aligned. Where disciplinary knowledge can be assessed and evaluated, this study found that there was no equivalent place for the evaluation of understanding of cultural knowledge — it was assumed as universal. Deeply cultured personal information tendered by participants represents a normative world that is white, western, middle class and gendered. Participants did not recognise themselves as cultured, nor did they recognise the potential impact of bringing this unexamined cultural self into the professional encounter. This resulted in seepage of practice that was democratically racist. This is where outward commitments to justice equality and fairness paradoxically exist with conflicting personal ideologies of sameness. Challenged to find a place for these constructs to coexist participants outwardly identify with the organisationally preferred position of social justice or evidence-based practice. However, participant observation and discussion of practice demonstrated that when conflicting personal beliefs and values were left unattended they found ways of surreptitiously creeping into and shaping the consultation. It seems that modernist theories do not provide adequate ontological and epistemological understandings for working with, and valuing pluralism in multiculture. Rather they constrict and limit practice which leads to an unrecognised perpetuation of colonising agendas in child and family health. Findings from this study contribute to the growing need to find ways to work with and unsettle existing binaries of communication and culture. The methods also suggest ways forward to support change in practice leading to professional development that is mindful and regardful of plurality in culture and communication. Interweaving three body analyses with postcolonial feminism offers a decolonising strategy for application in the multiculture that is Australia. Due to the spatial and temporal spaces created by using three bodies alongside postcolonial feminism, this combination becomes a tangible approach to deconstruction, for child and family health professionals that is both theoretical and practical.

Keywords: intercultural communication,child and family health,cultual competence,identity,postcolonialism

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2008
School: School of Nursing & Midwifery
Supervisor: Professor Philip Darbyshire, Dr Yoni Luxford