Interactional foundations of trust and presence in intercultural health care encounters

Trust in health professionals to ‘act in one’s best interests’ (O’Grady et al., 2013, p. 9) is foundational for effective treatment, and central to patient/family centred care. It has been linked to fewer symptoms, improved quality of life, and more beneficial health behaviours (Birkhauer et al, 2017). A trusting relationship is an outcome of a co-constructed, interactive and dynamic process built through communication, where interlocutors respect and understand each other’s needs and concerns. Rapport, and therefore trust, is built through small talk, humour, reassurance and being ‘present’ with the patient (Crawford et al., 2017; Rayan-Gharra et al., 2018), however communication barriers created by cultural and linguistic diversity (CALD) have been shown to hinder the development of trust, resulting in poorer health outcomes (Hamilton & Woodward-Kron, 2010). Discourse analysis of interactions makes evident the strategic interactional work that builds rapport and trust with patients. This chapter presents case studies of clinical encounters from two different domains in the Australian hospital setting (nursing and speech pathology) where at least one of the professionals involved is from a CALD background. Analysis of these interactions illustrates the consequences of whether or not trust is built, and provides evidence of how it is built. Awareness of how trust is built can enhance communication skills that strengthen professional practice, and therefore the provision of safer patient care.