Cross-cultural aspects of IBD
Culture is deﬁ ned as an integrated system of learned patterns of behaviour characteristic to a group of people; consequently, it guides beliefs, thoughts, decisions and actions. Cultural beliefs relating to health and illness have a signiﬁ cant effect on how patients manage disease, including perception of disease and pain, the clinician-patient relationship and attitudes towards therapy. Culture has broader implications on clinician-patient interactions, such as patient attitudes towards issues including the importance of family, personal space, eye contact and body language (Juckett 2005). There are also signiﬁ cant ethnic differences in the relationship between pain, emotional expression and disease (Dimsdale 2000). These factors are particularly relevant in inﬂ ammatory bowel disease (IBD) where there is a complex interplay between pain, psychological distress and disease activity.