11.1 Intercultural Communication

Learning Objectives

  • Define culture.
  • Distinguish between surface and deep culture in the context of the iceberg model.
  • Compare and contrast multicultural, cross-cultural and intercultural communication.
  • Explain the effects of ethnocentrism.

You may be tempted to think of intercultural communication as interacting with people from different countries. While distinct national passports communicate a key part of our identity nonverbally, what happens when people from two different parts of the same country communicate? Indeed, intercultural communication happens between subgroups of the same country. Whether it is distinctions between dialects in the same language, differences in perspective between Eastern Canadians and Western Canadians, or the rural- versus-urban dynamic, our geographic, linguistic, educational, sociological, and psychological traits influence our communication.

Culture is part of the very fabric of our thought, and you cannot separate yourself from it, even as you leave home and begin to define yourself in new ways through work and achievements. Every healthcare environment has a culture; within what may be considered a global culture, there are many subcultures or co-cultures. For example, consider the difference between the occupational therapy and human resource departments in healthcare organizations. You may see two distinct groups with symbols, vocabulary, and values. Within each group, there may also be smaller groups, and each department member comes from a distinct background that influences behaviour and interaction.

Suppose you have a group of students who are all similar in age and educational level. Do gender and societal expectations of roles influence interaction? Of course! There will be differences on multiple levels.

More than just the clothes you wear, the movies you watch, or the video games you play, all representations of our environment are part of our culture. Culture also involves the psychological aspects and behaviours expected of our group members. From the choice of words (message), to how you communicate (in person or by email), to how you acknowledge understanding with a nod or a glance (nonverbal feedback), to internal and external interferences, all aspects of communication are influenced by culture.

Defining Culture

Culture consists of the shared beliefs, values, and assumptions of a group of people who learn from one another and teach others that their behaviours, attitudes, and perspectives are the correct ways to think, act, and feel.

It is helpful to think about culture in the following five ways:

  • Culture is learned
  • Culture is shared
  • Culture is dynamic
  • Culture is systemic
  • Culture is symbolic

The iceberg is a commonly used metaphor to describe culture and is excellent for illustrating the tangible and the intangible. When discussing culture, most people focus on the “tip of the iceberg,” which is visible but makes up just 10 % of the object. The rest of the iceberg, 90 % of it, is below the waterline.


The cultural iceberg, 90% below water. Above water: surface culture i.e. food, fashion, language etc. Below water: deep culture i.e. communication styles, attitudes, approaches, concepts.
Figure 11.1.1. The cultural iceberg.

When addressing intercultural situations, many leaders pick up on the things they can see — things on the “tip of the iceberg.”  Such things as food, clothing, and language differences are easily and immediately apparent, but focusing only on these can mean missing or overlooking deeper cultural aspects, such as thought patterns, values, and beliefs that are under the surface. Solutions to any interpersonal miscommunication that results become temporary bandages covering deeply rooted conflicts.

Cultural Membership

How do you become a member of a culture, and how do you know when you are a full member? So much communication relies on shared understanding, that is, shared meanings of words, symbols, gestures, and other communication elements. Communication comes easily when you have a shared understanding, but when you assign different meanings to these elements, you experience communication challenges.

What shared understandings do people from the same culture have? Researchers studying cultures worldwide have identified certain characteristics that define a culture. These characteristics are expressed in different ways, but they tend to be present in nearly all cultures:

  • Rites of initiation
  • Common history and traditions
  • Values and principles
  • Purpose and mission
  • Symbols, boundaries, and status indicators
  • Rituals
  • Language

Multicultural, Cross-Cultural, and Intercultural Communication

Although they are often used interchangeably, it is essential to note the distinctions between multicultural, cross-cultural, and intercultural communication.

Multiculturalism is a surface approach to the coexistence and tolerance of different cultures. It takes the perspective of “us and the others.” It typically focuses on those tip-of-the-iceberg features of culture, thus highlighting and accepting some differences but maintaining a “safe” distance. If you have a multicultural day at work, for example, it will usually feature food, dance, dress, or maybe learning how to say a few words or greetings in a sampling of cultures.

Cross-cultural approaches typically go a bit deeper, the goal being to be more diplomatic or sensitive. They account for some interaction and recognition of difference through trade and cooperation, which builds some limited understanding, such as, for instance, bowing instead of shaking hands or giving small but meaningful gifts. A common drawback of cross-cultural comparisons is crossing into stereotyping and ethnocentric attitudes — judging other cultures by our cultural standards — if you are not mindful.

Lastly, intercultural approaches, are well beneath the iceberg, intentionally making efforts to understand other cultures and ourselves better. An intercultural approach is not easy and often messy, but when you get it right, it is far more rewarding than the other two approaches. The intercultural approach is challenging and effective because it acknowledges the complexity and aims to work through it to a positive, inclusive, and equitable outcome.

Whenever you encounter someone, you notice similarities and differences. While both are important, it is often the differences that contribute to communication troubles. You do not see similarities and differences only on an individual level. You also place people into in-groups and out-groups based on our perceived similarities and differences. You tend to react to someone you perceive as an out-group member based on the characteristics you attach to the group rather than the individual (Allen, 2010). In these situations, it is more likely that stereotypes and prejudice will influence our communication. This division of people into opposing groups has been the source of great conflict around the world, and learning about difference and why it matters will help us be more competent communicators and help to prevent conflict.

Many misunderstandings can be avoided by remembering that in whatever context you find yourself, factors that may not be readily evident may be at play in your interactions with others. Using this empathetic understanding will allow you to seek a more profound understanding while developing a mindful approach or response. Ethnocentrism is the tendency to view other cultures as inferior to one’s own. Having pride in your culture can be healthy. Still, history has taught us that having the predisposition to discount other cultures simply because they are different can be hurtful, damaging, and dangerous. Ethnocentrism, however, may make you far less likely to be able to bridge the gap with others and often increases intolerance of difference. The healthcare industry is no longer regional; in your career, you will cross borders, languages, and cultures. You will need tolerance, understanding, patience, and openness to difference. A skilled communicator knows that the learning process is never complete, and being open to new ideas is a crucial strategy for success.

Activity: Check Your Understanding

Key Takeaways

  • Intercultural communication is an aspect of all communication interactions, and attention to your perspective is critical to effectiveness.
  • Ethnocentrism is a significant obstacle to intercultural communication.


  1. Reflect on what to consider from the cultural iceberg essential to your professional practice.
  2. List five words to describe a dominant culture. Then list five words to describe a culture with which you are not a member, and have little to no contact or knowledge. Now compare and contrast the words, noting their inherent value statements.

Image Attributions

Figure 11.1.1. The cultural iceberg by Laura Underwood. Licensed under CC BY-SA 4.0.

Attribution Statement

Content adapted, with editorial changes, from:​

Anonymous (n.d.). Intercultural and International Group Communication. Libre Texts. https://socialsci.libretexts.org/Bookshelves/Communication/Public_Speaking/An_Introduction_to_Group_Communication/05%3A_Intercultural_and_International_Group_Communication

Dingwall, J. R., Labrie, C., McLennon., & Underwood, L. (2021). Cross-Cultural Communication. Olds College/Libre Texts. https://socialsci.libretexts.org/Bookshelves/Communication/Introduction_to_Communication/Remix%3A_Professional_Communications_Foundations_(Dingwall_Labrie_McLennon_and_Underwood)/04%3A_Interpersonal/04.4%3A_Cross-Cultural_Communication

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Professional Communication Skills for Health Studies Copyright © 2023 by Chute, A., Johnston, S., & Pawliuk, B. is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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