Team Cultural Competency Assignment 1

Team Cultural Competency Assignment

Barbie Bonilla, Samantha Ardon, Sydney Jeans, Linda Ortega Sandoval

Mesa Community College Dental Hygiene Program

DHE 232: Theory

Instructor: Dawn Brause

April 29, 2024

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Abstract

As healthcare providers, Dental Hygienists will encounter a variety of cultures throughout their

career. It is important to understand different customs and communication styles to provide

adequate care and be able to build trustful relationships. Cultural competency is necessary to

create a welcoming environment. A culture not commonly seen and known within the United

States is Thai. Religion, cultural customs, and oral health is further analyzed to understand

important characteristics, how to communicate, and possible topics to be explained with patients.

Two interviews were set up including an older and younger generation within Thai culture to

gather more information. In addition, a possible dialogue was created between a patient and

clinician describing how to interact with Thai culture on the specific topic of early childhood

caries.
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As oral health care providers, one may encounter a diverse population of patients with

cultural beliefs and values different from ones own. Due to this reason, being culturally

competent can help to better understand patients and the reason behind their decisions. A

non-common culture that was chosen to research for our team's cultural competency was the

country of Thailand. The reason behind choosing this specific country is to explore beyond

common populations seen in the United States and gain an understanding of other countries

besides popular cultures such as Chinese and Japanese.

The country of Thailand is located in the center of Southeast Asia, its capital is Bangkok,

and is surrounded by other countries such as Burma, Laos, and Cambodia. It borders the

Andaman sea as well as the Gulf of Thailand. Central Thai and English are common languages

spoken, however, many people often speak Chinese and Malay. The interesting fact about the

language of Central Thai is that it specifically has 5 different tones. Meaning that a tone of a

syllable can have different meanings depending on how it is pronounced. The culture of Thailand

in regards to success depends on an individual's wealth and education, a wealthy person is

reflected with high virtue, or high moral standards (Thailand | Culture, Facts & Travel |, n.d.).

The personal attire of people of Thailand consists of long tube skirts made of silk for

women and sandals worn the majority of the time with shoes only on formal occasions. As a top,

women will often wear what is called a “Sabai,” which is an elegant shawl-like garment covering

just one shoulder wrapping around the upper body. Men on the other hand will often wear A

“Suea phraratchathan” which is a buttoned shirt with a long collar and a sash along the waist.

People will often wear straw hats on the regular due to the hot weather conditions in Thailand

(History and Types of Traditional Thai Dresses, 2021).

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Family traditions include complying with advice given by elders such as grandparents,

although with time, modernization has changed this. A typical family will include 2-3 children,

in which the youngest daughter will keep her parents home and in return will care for her parents

with the support of the husband. A marriage tradition in the country of Thailand is that if a man

desires to marry a woman he must first go through a process in which he should become

acquainted with the entire family to be accepted. Once accepted, a man’s family would then go to

make his wishes known and as a groom he would pay the parents as a “compensation” for raising

her. Thai families follow a patriarchal in which the oldest living man will make the decisions in

the household (Thailand | Culture, Facts & Travel |, n.d.).

The religion of Thailand revolves around Theravada Buddhism, in which 93.6% of the

population follow and see it more as a way of life rather than a religion (Scroope, 2016).

Although the majority of people practice Buddhism as a religion, there is a small percentage of

people who practice other religions such as Muslim and Christianity among others. Buddha is

not seen as a god to them but rather as respect given as a student to a teacher. Buddhism

principles as a way of life include tolerance, calmness and merit which are values to the culture

of Thai people (Scroope, 2016). An elephant, as the animal of Thailand, contributes to their

religion and is associated with Buddhism in which it is seen as a symbol of strength and

intelligence (Elephant In Thai Tradition - #1 Amazing Thailand Elephants, n.d.).

Health traditions of Thailand consist of 4 important elements that make an individual

healthy, elements include earth, wind, water and fire. A holistic approach is followed to evaluate

the overall health of a person to where they depend on massage therapy and herbal remedies over

hospitals and doctors (Blake & Johnson, 2019). According to this population, massage therapy is

seen as an important form of treatment to relieve spiritual possession, fear, problems, and an
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imbalance of elements in the body . It is believed that in order to bring an individual back to

health, their soul must be returned back to their body to be completely healed and harmony must

be present between the mind and the body (HEALTH AND HEALTH CARE IN

THAILAND, n.d.).

Most Thai families share evening meals together. They eat in a communal style, meaning

each person has a bowl of rice while other dishes are placed in the center of the table to be shared

amongst everyone. Rice is Thailand's staple food and is often served with spicy dishes that

consist of meat, vegetables, fish, eggs, and fruits. Curries and pepper sauces are popular choices

for flavoring. Typical meats include beef, chicken, and pork. Thai cuisine combines cultural

influences and is renowned for its delicate flavors. Popular dishes include pad Thai (pan-fried

noodles), yam (spiced salad), and tom yum kung (lemon-flavored soup with shrimp). Thais use

forks and spoons at mealtime. They hold the fork in their left hand and the spoon in their right.

The spoon is the primary utensil, while the fork is used when foods need to be manipulated and

for this reason you won’t see knives at the table. If they are having a dish that consists of

noodles, they will often utilize chopsticks. Water, the standard mealtime drink, is typically drunk

at the end of the meal. When one is finished, try to consolidate leftover food to one side of the

plate but preferably try not to leave food left on the plate, utensils are placed by each other on the

plate (Thailand Culture, Facts & Travel n.d.). Before eating, one must wait for the

highest-ranking or most senior person to let them know it is time to eat. If they don't say

anything for some reason, wait for that person to begin their meal. If out at a restaurant and it’s

time to pay, per custom, the host or most senior person will pay the bill. If offering to help pay,

do not insist on paying once the offer is declined.

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Following an interview with two Thailand individuals it was revealed that both value the

older population. They are seen as the most respectful, honorable family member. Both parties

follow the Thai custom in which the oldest man is seen as the one making decisions and rules in

the household. Regarding oral health, the older generation interviewee mentioned how she

remembers a lot of Thai people with betel nut staining from frequent chewing usage. The

younger interviewee remembers going to the dentist at least once a year and mentioned how he’s

never had a cavity. Upon further questioning he explained how this could be from their

traditional diet of home cooked meals always including white rice and water. The younger

interviewee hardly remembers eating fast food or processed food, “When cooking we try to use a

lot of natural ingredients”(Older interviewee). In addition, they use bamboo leaves and banana

leaves to wrap their food in before steaming. “My favorite snack was sticky rice roasted in

bamboo sections” mentioned the older interviewee. The younger interviewee described how his

grandmother would make sure all food was finished at meal times because someone worked hard

to provide it. Neither of them emphasized on the religion/spiritual practice but that it was well

known the top of the head is considered sacred and the feet is the dirtiest part of the body.

The global burden of oral disease affects nearly half of the world's population-3.5 billion

people. Although oral disease is preventable, many are still suffering from oral health conditions

due to barriers such as quality oral healthcare because of accessibility and affordability.

Treatment for oral diseases is not usually included in universal health coverage, complicating

access to care even more. Universal Health Coverage gives everyone access to high-quality

health care services without the financial hardship. Thailand is a prime example of a country

committed to providing accessible oral healthcare. They do so by integrating oral health

interventions into their health benefits package. The benefits package includes routine and
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preventative oral healthcare, essential curative oral healthcare, and advanced curative oral

healthcare (Thailand prioritizes oral health through integration in universal health coverage n.d.).

Eighty percent of Thailand's population has access to health benefits packages.

However, preventative measures are not effective if the population is unaware of the

significance of oral health, in addition to the negative implications of current habits. Betel nut

chewing, for example, has been a long time practice of those in Thailand and surrounding

regions of Asia. Betel nut is from an Areca palm tree that acts as a stimulant that can be quite

addicting. Culturally it is acceptable to chew the seeds following meal times and throughout the

day as early as childhood. Sometimes it will be mixed with tobacco or other flavorings. Some

oral implications include oral ulcers, gingivitis, periodontitis, tooth staining, decay and oral

cancer (Betel Nut, n.d.).

Additionally, the older populations in Thailand endure oral health complications with

age. According to BMC Oral Health, many adults in Thailand measure oral health by the

presence, or lack of, pain. With age, it is common for Thai adults to lose teeth and experience

complications such as difficulty chewing and malnutrition. Elders with lower income experience

these undesirable outcomes more frequently, especially those located in more rural areas

(Kaewkamnerdpong et al., 2023).

Although Thailand has an Universal Health Coverage system, many children suffer from

early childhood caries. These individuals might be at greater risk in the US without the proper

coverage they are accustomed to from Thailand. As a healthcare provider we must be careful

when communicating with different cultures from our own. According to Sitthisettapong, “only

5.8% of Thai children receive oral health services annually.” Therefore as dental hygienists being
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the #1 preventative specialist we must know how to address this issue and educate. Below is a

potential conversation with a Thai parent and their child with early childhood caries.

RDH: Hello, welcome Mrs. Anog. How may I help you today?

Mrs. Anog: Hello, I’ve noticed some dark areas on my daughter’s teeth

RDH: Alright, do you mind if the doctor and I take a look?

RDH: Mrs. Anog. After careful examination the doctor confirmed your daughter has

cavities along the front of her top front teeth.

Mrs. Anog: Perhaps it might be from not brushing enough?

RDH: Mrs. Anog, you are so correct that could be a factor. Cavities also form when there

is too much sugar and snack consumption.

Mrs. Anog: It couldn’t be as we aren't accustomed to eating candy.

RDH: I understand. This type of cavity presentation perhaps is a result of sleeping with a

bottle at nap times or night.

Mrs. Anog: I do that. So I should not put her to bed with a bottle?

RDH: The reason being of not having her go to bed with a bottle is because the milk will

coat her teeth all night for the period of time which allows bacteria to harvest.

Mrs. Anog: Thank you for letting me know. I tell her to brush twice a day, she’s 5 years

old so I let her do it herself.

RDH: Brushing twice a day is highly recommended, very nice job!! She may try it

herself along with your guided help, that way we can ensure proper brushing with

fluoridated toothpaste. Possibly lift her lip up and brush along her gum line in circles

which is where a lot of bacteria is present. If she prefers milk before bed, allow her to

rinse with water and brush after drinking milk.

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Mrs. Anog: Ok I will do that.

RDH: I want to readdress myself that these types of cavities are from not adequate

brushing and sugar staying on the teeth for too long.

Mrs. Anog: Would I need to come back?

RDH: It is highly recommended to come in regularly for routine visits every 6 months to

avoid progression of her cavities, along with your assistance at home. If they progress

there are some services we can provide. With your approval, we can do silver diamine

fluoride today.

Mrs. Anog: What is that?

RDH: Multiple silver diamine fluoride applications can aid in stopping cavities and

deteriorating the tooth further. However, it does present as a darker, black color.

Mrs. Anog: *nodding* Let’s apply it today and we will come back for future

appointments.

RDH: Great to hear, what additional questions do you have for me?

Mrs. Anog: None at the moment, thank you.

The specific way in which the people of Thailand greet each other comes in various

forms but will always say “wai” when greeting. When greeting they will place the palms together

with fingers extended at chest level and a slight bow. In an occasion where it is a younger person,

and an older person greeting each other, the younger person will greet first and the older person

would respond with “wai,” However, the higher the hands are placed, the more respect is being

shown. As for gestures, when gifts are given they should be received by the right hand only and

when passing by someone older, one should lower the upper body slightly (Thailand | Culture,

Facts & Travel |, n.d.).

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In continuation, when conversing with Thai culture, we must avoid criticism. This

includes facts as they can be taken personally and to a deep offense. This reason is why Thai

people use indirect communication as they follow Buddhist values: “The fear of losing face and

a great need for harmony” (Communication in Thailand, 2023). If needing to criticize we must

not do so in public, instead in a private setting and balanced with a lot of praise. When a conflict

exists, don’t try to assign blame but try to look for a joint solution to a problem. Don’t try to say

a direct “no” to something as this can offend others as a rejection. Therefore try to express “no”

by other phrases such as “perhaps, later, maybe, possibly” (Communication in Thailand, 2023).

When asking questions, stay away from any that can end with a yes or no answer but instead ask

changing the wording each time. The circular conversation method is useful in which topics are

introduced, dropped, but later resurfaced. This type of method can be used when discussing

disagreements or during an uncomfortable topic in which difficult feelings are exchanged.

Furthermore, repetition of topics demonstrates particular importance to continue engagement of

such topics (Communication in Thailand,2023). Lastly, avoid strong nodding with many “yeses”

as this can come off that the discussion is not understood and simply trying to end the

conversation; smiling and nodding gives acknowledgement but not necessarily agreement. When

conversing with Thai culture, “The more concrete and detailed the Thai side formulates its

statements, the sooner you can rate this as approval” (Communication in Thailand, 2023). In

other words, the more detailed and respectful the conversation to allow for understanding, the

more agreement from the Thai side.

Scroope, 2016 explains a some quick communication details clinicians can remember

when communicating with the Thai culture:

-Ask about what one does for work as an icebreaker, this is a welcoming topic.
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-Show appreciation for good deeds to build trust

-Avoid embarrassment (criticizing/correcting) in public

-Show great respect for elders

-Remain a soft and calm voice when conversing as raised voices and anger can result in

less respect and admiration

-Never assume all Southeast Asian people are the same.

-Have eye contact as this can show attentiveness, but divert contact throughout to soften

the interaction as continuous eye contact can be viewed as a challenge.

-Show respect by lowering your head as shadowing above someone can be taken as

aggressive and never touch someone’s top of head (this is the most sacred part of the

body).

-In contrast, the feet are considered to be the dirtiest on the body and they should not be

used to point or touch things/others.

Although cultural differences and upbringing amongst patients will vary, oral health

disparities are a universal problem. Understanding these oral health issues at large can help

Dental Hygienists target these problems in the operatory and for the general public, regardless of

origin, through advocating and lobbying for policy change. Access to care is important for all

populations. Preventative measures and education are the forefront of the paradigm shift on oral

health. Hygienists offer a unique and crucial role implementing oral health knowledge as

prevention is a large part of the profession’s expertise and scope of practice.

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References

Betel Nut. Betel Nut - Alcohol and Drug Foundation. (n.d.).

https://adf.org.au/drug-facts/betel-nut/

Blake, S., & Johnson, C. (2019, May 7). Thai Traditional Medicine – May Term Thailand. May

Term Thailand. Retrieved April 26, 2024, from

https://maytermthailand.org/2019/05/07/thai-traditional-medicine-3/

Communication in Thailand. crossculture2go. (2023, March 21).

https://crossculture2go.com/communication-in-thailand/

Elephant In Thai Tradition - #1 Amazing Thailand Elephants. (n.d.). Elephant Hills. Retrieved

April 26, 2024, from https://www.elephanthills.com/elephant-in-thai/

HEALTH AND HEALTH CARE IN THAILAND. (n.d.). Facts and Details. Retrieved April 26,

2024, from https://factsanddetails.com/southeast-asia/Thailand/sub5_8g/entry-3299.html

History and Types of Traditional Thai Dresses. (2021, March 6). Thailand Insider. Retrieved

April 28, 2024, from

https://thailandinsider.com/everything-you-need-to-know-about-traditional-thai-dresses/

Kaewkamnerdpong, I., Harirugsakul, P., Prasertsom, P., Vejvithee, W., Niyomsilp, K., &

Gururatana, O. (2023). Oral status is associated with chewing difficulty in Thai older

adults: Data from a National Oral Health Survey. BMC Oral Health, 23(1).

https://doi.org/10.1186/s12903-023-02742-4

Scroope, C. (2016, January 1). Thai - Do's and Don'ts — Cultural Atlas. Cultural Atlas.

Retrieved April 26, 2024, from

https://culturalatlas.sbs.com.au/thai-culture/thai-culture-do-s-and-don-ts
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References

Sitthisettapong, T., Tasanarong, P., & Phantumvanit, P. (2021). Strategic

Management of Early Childhood Caries in Thailand: A Critical Overview. Frontiers in

public health, 9, 664541. https://doi.org/10.3389/fpubh.2021.664541

Symons, A. (2024, April 8). What is Songkran? Everything you need to know about Thailand's

wet and wild New Year celebrations. Euronews.com. Retrieved April 28, 2024, from

https://www.euronews.com/travel/2024/04/08/what-is-songkran-everything-you-need-to-

know-about-thailands-wet-and-wild-new-year-celebra

Thailand | Culture, Facts & Travel |. (n.d.). CountryReports.org. Retrieved April 26, 2024, from

https://www.countryreports.org/country/Thailand/facts.htm

Thailand prioritizes oral health through integration in universal health coverage. FDI. (2023,

April 6).

https://www.fdiworlddental.org/thailand-prioritizes-oral-health-through-integration-unive

rsal-health-coverage