Nondirectiveness and Its Lay Interpretations: The Effect of Counseling Style, Ethnicity and Culture on Attitudes Towards Genetic Counseling Among Jewish and Bedouin Respondents in Israel

Abstract

To evaluate the effects of ethnicity, culture, and counseling style on the interpretation of nondirectiveness in genetic counseling, a questionnaire containing premarital and prenatal case vignettes in two versions (pessimistic/optimistic) was administered to 281 Jewish and 133 Bedouin respondents. The first study population was comprised of Jewish students enrolled in a university and a community college in the Negev (southern part of Israel). The second study population was comprised of Muslim-Bedouin college students from the same area. The majority of Jewish respondents interpreted the nondirective message as intended by counselors, while the majority of Bedouin respondents did not. Counseling style was found to have a statistically significant effect on the interpretation of the general role of counseling. Gender and susceptibility were not found to have a significant effect on interpretation. Group differences are analyzed through a cultural lens in which different interpretive norms can generate expectations for either nondirectiveness or directiveness.

Identifying and Addressing Genetic Counseling Challenges among Indigenous People of Oaxaca—One Center's Experience with Two Immigrant Farmworker Families in the Central Valley of California

“…(2) Acculturation differences need to be taken into account, so that clinicians who are trained in the “Western style” of medicine can moderate their expectations of how the social and counseling interactions likely will proceed (Barragan et al 2011; Kelly 2009). In some instances, similar to those previously reported (Browner et al 2003; Kelly 2009; Mittman et al 1998; Raz and Atar 2003; Smoot III et al 1988), the medical and genetic staff may have to adapt to the deferential and unidirectional interactions that are a part of the family’s worldview, in which their desire may be for the providers to make the right decision on behalf of the family without any expectation of a non-directive decision-making process. Ideally, recruitment and utilization of a cultural broker (a relative with a greater degree of acculturation or a community leader or advocate) would incorporate both of these lessons and optimize the interactions with the family.…”

“…Even if the indigenous subpopulation is recognized, generally there is a broader unfamiliarity with their customs and beliefs. Additionally, the challenges can be greater when discussing the basic tenets of genetics because the concepts of “genes,” inheritance patterns, and other similar topics cannot be understood given the educational background and the fact that equivalent terms in many languages simply do not exist (Butler et al 2011; Dukepoo 1998; Kelly 2009; Kowal et al 2015; Mittman et al 1998; Penn et al 2010; Port et al 2008; Raz and Atar 2003; Solomon et al 2012). The widely varying dialects and severe lack of medically qualified interpreters present further communication barriers.…”

Genetic Clinics in Arab Communities: Meeting Individual, Family and Community Needs

“…Within Arab societies values such as authority, obligation, honor, and caring are all family-centered rather than based on individual needs, and a world view of this nature helps to generate an expectation for directiveness [30]. The low level of genetic literacy among the public and most health care providers in Arab countries has further resulted in the cultural misconception that referral to a genetic clinic will result in direct advice on issues such as the choice of a marriage partner, reproductive options, and selective abortion of an affected fetus.…”

Offering a choice between NIPT and invasive PND in prenatal genetic counseling: the impact of clinician characteristics on patients’ test uptake

“…However, this framing effect may be counterbalanced by skillful counseling. As a final remark, there are important individual and cultural differences among patients that may complicate the adoption of a non-directive attitude [22]. When facing such a clinical, statistical, and emotional complex decision, it may be that while some patients are self-directive and prefer to optimize their choice-relevant knowledge to make the most informed decision possible, others feel overwhelmed and are more inclined to rely on the clinicians expertise, consciously or unconsciously handing over the responsibility for their decision.…”