Appreciating Nonverbal Communication

Nonverbal expression varies greatly among people, often leading to crosscultural misunderstanding. It is important for providers to be aware of differences and to be cautious in interpreting nonverbal communication. Nonverbal communication can be divided into several categories:

Facial expression. Although smiling is an expression of happiness in most cultures, it can also signify other emotions. Some Chinese, for example, may smile when they are discussing something sad or uncomfortable. Winking has very different connotations in different cultures. Many Chinese consider winking to be rude. In Hong Kong, it is important not to blink one's eyes conspicuously, as this may be seen as a sign of disrespect and boredom.

Crying. Expressions of pain or discomfort such as crying are also specific to various cultures; some cultures may value a stoic affect while others may encourage a more emotive state.

Gestures. The "OK" sign that is so often used in American culture is interpreted in Japan as the symbol for money, because the circular shape of the index finger and thumb together suggest the shape of a coin. Many Chinese people point with their entire hand; using the forefinger to point is viewed as rude. Some Filipinos will point to an object by shifting their eyes toward it or pursing their lips and point with their mouth, rather than using their hands.

Touching. In some cultures, light touching of the arm or a light kiss to the cheek is very common, even among people who have just met, but people from many Asian cultures may prefer less physical contact with acquaintances. Touching another person's head is considered offensive by some people from Asia. Although many Chinese will use a handshake to greet a Westerner, any other contact may be considered inappropriate. This is especially important to remember when dealing with older people or those in positions of authority.

Eye contact. Making direct eye contact is a sign of disrespect in some cultures. In other cultures, refusing to make direct eye contact is a sign of disrespect. Many Asians may be reluctant to make eye contact with an authority figure. For example, when greeting a Chinese, it is best to avoid prolonged eye contact as a sign of respect and deference. Hindu women traditionally avoid direct eye contact with men. Showing deference to elders and authority figures, including health care providers, may also dictate avoiding eye contact.

Shoes. In Asia, as in many other cultures throughout the world, it is impolite to show the bottom of the shoe, which is often dirty. Therefore, one should not sit with the foot resting on the opposite knee. Good posture is important to people from Taiwan; Taiwanese men will usually sit with both feet firmly on the floor.

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