Commentary from Patient Engagement Co-Editor
Lode Dewulf

his month’s Patient Engagement article by Tsukamoto and Monteath highlights the often overlooked or underestimated issue of cultural diversity. While everyone knows the buzzword, the reality is that too many of us suffer the results of this blind spot.

Over my 30 years of working in different countries, continents, companies, and languages, one element has indeed remained constant: one’s own cultural perspective serves as the norm for the rest of the world. This attitude has become evident in documents, presentations, discussions, images, and even strategies, despite the best possible intent to truly help or add value. This cultural mismatch, however, probably remains as one of the main reasons why operations (or affiliates) located in different countries often resist or ignore guidelines or suggestions that come from the company’s headquarters, or vice versa. The same is true for collaborations between companies and external partners as well as other stakeholders such as healthcare providers (HCPs) and patients.

All too often, reluctance or refusal “on the other side” is then incorrectly labeled as an issue of intent, assuming that the “Not Invented Here” syndrome is the ultimate culprit. It is well known in psychology that we like to judge ourselves on our (invariably good) intent behind an action: “I am sorry I messed up, but I was only trying to help. So you should forgive me!” At the same time, we easily judge others by their actions rather than the intention behind them: “I do not really care what you wanted; you hurt me or let me down, and I feel angry.” The following quote really captures the essence: “The wise judges others on intent and oneself on actions; the fool the other way.”

At least in my experience, cultural mismatch is a problem of action, not intent. Sadly, this does not diminish the harmful effects of a cultural mismatch blind spot, as described in this month’s invited article.

So, what is the solution? As the authors propose (and intend), the key first step is to become aware of this issue and its negative effect on relations and performance. The second step is to try and understand the cultural needs of the person or the party you wish to engage. Obviously, the ideal is to experience that culture, but in reality, no one has the time or resources to do so. In practice, one should think of these three golden rules to tackling cultural diversity needs:

1. Stop assuming.
2. Start (and keep) asking.
3. Never judge.

A final thought: The importance of cultural diversity cannot be underestimated, but it should also not be overestimated. Patient experiences and needs are not driven uniquely or mainly by culture. Having looked at this issue in the past across some diseases and countries, we found that about 40 percent of the patient experience was linked to the disease itself, about 40 percent to the person (including personality type), and about 15 percent to the culture (the remaining five percent were contributed to “other” factors). The first two categories justify global work to find solutions that are scalable and thus both valuable and economically viable.