Different use of medical terminology and culture-specific models of disease affecting communication between Xhosaspeaking patients and English-speaking doctors at a South African paediatric teaching hospital.

BACKGROUND: Language and cultural differences between patients and health care providers may have adverse health consequences. Red Cross War Memorial Children's Hospital is a paediatric teaching hospital in Cape Town where staff communicate mainly in English or Afrikaans, while many patients speak Xhosa as their first language.
OBJECTIVES: To examine whether differences in the definitions of common respiratory medical terminology by patients and doctors cause miscommunication and to explore culture-specific models if used by parents in their definitions.
DESIGN: In-depth, semi-structured interviews were conducted with three speech communities, viz. 8 English-speaking doctors and 33 Xhosa-speaking parents, educated to grade 12 level or less and recruited from two areas in the hospital, the short-stay ward (Xhosa s-s) and the allergy clinic (Xhosa allergy). The sum of both groups of Xhosa-speaking patients are referred to as 'Xhosa all'. Definitions were elicited for common respiratory terminology in both Xhosa and English. Contrastive linguistic analysis was used to identify the semantic properties for each group in order to condense the groups' definitions into representative 'core definitions'. Differences in the definitions of terminology were identified and words were classified as concordant (used in the same way) or discordant (used in different ways) by the three speech communities.
RESULTS: Parents experience difficulty in understanding terms used by doctors and words in common use were understood differently by these two groups. Most Xhosa words were not in the doctors' vocabulary, and some common English words were not in the parents' vocabulary. Where words were in the vocabulary of both groups, significant differences existed in the number and range of definitions, with many clinically significant discordances of definition being apparent. Some common examples relevant to paediatric respiratory problems are presented. Three culture-specific explanatory models of respiratory illness, ingqele, xakaxa and idliso, are illustrated.