How health risks are communicated can have a substantial impact on medical judgments and choice. Here, we examine whether the language used to process health-related information systematically changes bilinguals’ perceptions and preferences.
Methodology:
Chinese-English bilinguals were presented with 10 medical scenarios in either their native language (Mandarin Chinese; n = 76) or a second language (American English; n = 84) and made judgments regarding their familiarity with the medical conditions and the perceived severity of the possible symptoms (incurability, emotional distress, physical pain, social harm). Participants then rated their agreement with statements pertaining to beliefs about medical decision-making (trust in the good intentions of doctors, acceptability of challenging doctors, importance of involving family, preference for standard treatments, preference for experimental treatments).
Data and analysis:
Linear mixed-effects models were constructed for judgments of medical conditions and for beliefs regarding medical decision-making.
Findings and conclusions:
Medical conditions were perceived to be easier to cure, less physically painful, and less emotionally distressing when processed in the second language, English. Using English also increased endorsement of beliefs (such as challenging doctors’ opinions and accepting experimental treatments) that were more consistent with individualistic than with collectivistic norms. We propose that the activation of emotions and values is linked to language, with consequences for how individuals make decisions that impact their health and well-being.
Originality:
The present study is among the first to systematically examine the interactive psychological impact of language context and experience on judgments and beliefs in an applied medical domain.
Significance:
With millions of practitioners and patients worldwide making medical decisions in a combination of native and non-native languages, the present findings highlight the need to account for language, including language use, context, and experience, in order to optimize health-related communication and judgments.
AkkermansD.HarzingA. W.Van WitteloostuijnA. (2010). Cultural accommodation and language priming. Management International Review, 50(5), 559–583.
2.
AscherD.PolowczykJ.Wielicka-RegulskaA.da SilvaW. V.SouzaA. (2017, October). The foreign language effect in risk decision-making: A cross-country review of Brazilians and Poles behavior in a loss aversion experiment. In Proceedings of the 8th International Conference on E-business, Management and Economics (pp. 42–45), ICEME, Birmingham, United Kingdom.
3.
BesuglovE.CrasseltN. (2021). The effect of readability and language choice in management accounting reports on risk-taking: An experimental study. Journal of Business Economics, 91, 5–33.
4.
BrileyD. A.MorrisM. W.SimonsonI. (2005). Cultural chameleons: Biculturals, conformity motives, and decision making. Journal of Consumer Psychology, 15(4), 351–362.
5.
BrislinR. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216.
6.
BroniatowskiD. A.JamisonA. M.QiS.AlKulaibL.ChenT.BentonA.QuinnS. C.DredzeM. (2018). Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate. American Journal of Public Health, 108(10), 1378–1384.
7.
CoreyJ. D.HayakawaS.FoucartA.ApariciM.BotellaJ.CostaA.KeysarB. (2017). Our moral choices are foreign to us. Journal of Experimental Psychology: Learning, Memory, and Cognition, 43(7), 1109–1128.
8.
CostaA.FoucartA.ArnonI.ApariciM.ApesteguiaJ. (2014a). “Piensa” twice: On the foreign language effect in decision making. Cognition, 130(2), 236–254.
9.
CostaA.FoucartA.HayakawaS.ApariciM.ApesteguiaJ.HeafnerJ.KeysarB. (2014b). Your morals depend on language. PLoS One, 9(4), e94842.
10.
DaviesG. M.ThomsonD. M. (Eds.). (1988). Memory in context: Context in memory. John Wiley & Sons.
11.
De MeulenaerS.De PelsmackerP.DensN. (2015). Have no fear: How individuals differing in uncertainty avoidance, anxiety, and chance belief process health risk messages. Journal of Advertising, 44(2), 114–125.
12.
De MeulenaerS.De PelsmackerP.DensN. (2018). Power distance, uncertainty avoidance, and the effects of source credibility on health risk message compliance. Health Communication, 33(3), 291–298.
13.
DeschepperR.GrigoryanL.LundborgC. S.HofstedeG.CohenJ.Van Der KelenG.DeliensL.Haaijer-RuskampF. M. (2008). Are cultural dimensions relevant for explaining cross-national differences in antibiotic use in Europe?BMC Health Services Research, 8(1), 1–9.
14.
DewaeleJ. M. (2008). The emotional weight of I love you in multilinguals’ languages. Journal of Pragmatics, 40(10), 1753–1780.
15.
DewaeleJ. M.CostaB. (2013). Multilingual clients’ experience of psychotherapy. Language and Psychoanalysis, 2(2), 31–50.
16.
FinsetA.BosworthH.ButowP.GulbrandsenP.HulsmanR. L.PieterseA. H.StreetR.TschoetschelR.van WeertJ. (2020). Effective health communication – a key factor in fighting the COVID-19 pandemic. Patient Education and Counseling, 103(5), 873–876.
17.
GebbersT.De WitJ. B.AppelM. (2017). Health communication transportation into narrative worlds and the motivation to change health-related behavior. International Journal of Communication, 11, 4886–4906.
18.
GeipelJ.HadjichristidisC.KlesseA. K. (2018). Barriers to sustainable consumption attenuated by foreign language use. Nature Sustainability, 1(1), 31–33.
19.
GeipelJ.HadjichristidisC.SurianL. (2015). The foreign language effect on moral judgment: The role of emotions and norms. PloS One, 10(7), e0131529.
20.
HadjichristidisC.GeipelJ.SavadoriL. (2015). The effect of foreign language in judgments of risk and benefit: The role of affect. Journal of Experimental Psychology: Applied, 21(2), 117–129.
21.
HadjichristidisC.GeipelJ.SurianL. (2019). Breaking magic: Foreign language suppresses superstition. Quarterly Journal of Experimental Psychology, 72(1), 18–28.
22.
HarrisC. L.AycicegiA.GleasonJ. B. (2003). Taboo words and reprimands elicit greater autonomic reactivity in a first language than in a second language. Applied Psycholinguistics, 24(4), 561–579.
23.
HayakawaS.CostaA.FoucartA.KeysarB. (2016). Using a foreign language changes our choices. Trends in Cognitive Sciences, 20(11), 791–793.
24.
HayakawaS.KeysarB. (2018). Using a foreign language reduces mental imagery. Cognition, 173, 8–15.
25.
HayakawaS.LauB. K. Y.HoltzmannS.CostaA.KeysarB. (2019). On the reliability of the foreign language effect on risk-taking. Quarterly Journal of Experimental Psychology, 72(1), 29–40.
26.
HayakawaS.TannenbaumD.CostaA.CoreyJ. D.KeysarB. (2017). Thinking more or feeling less? Explaining the foreign-language effect on moral judgment. Psychological Science, 28(10), 1387–1397.
27.
HofstedeG. H. (1980). Culture’s consequences: International differences in work-related values. SAGE.
28.
HofstedeG. H. (1991). Cultures and organizations: Software of the mind. McGraw-Hill.
29.
HongY. Y.MallorieL. M. (2004). A dynamic constructivist approach to culture: Lessons learned from personality psychology. Journal of Research in Personality, 38, 59–67.
30.
HongY. Y.MorrisM. W.ChiuC. Y.Benet-MartinezV. (2000). Multicultural minds: A dynamic constructivist approach to culture and cognition. American Psychologist, 55(7), 709–720.
31.
HuynhT. L. D. (2020). Does culture matter social distancing under the COVID-19 pandemic?Safety Science, 130, 104872.
32.
HsuC. T.JacobsA. M.ConradM. (2015). Can Harry Potter still put a spell on us in a second language? An fMRI study on reading emotion-laden literature in late bilinguals. Cortex, 63, 282–295.
33.
JensenL. C.HarrisK.AndersonD. C. (1971). Retention following a change in ambient contextual stimuli for six age groups. Developmental Psychology, 4(3), 394–299.
34.
KemmelmeierM.ChengB. Y.-M. (2004). Language and self-construal priming: A replication and extension in a Hong Kong sample. Journal of Cross-cultural Psychology, 35(6), 705–712.
35.
KeysarB.HayakawaS. L.AnS. G. (2012). The foreign-language effect: Thinking in a foreign tongue reduces decision biases. Psychological Science, 23(6), 661–668.
36.
KimH. S.DroletA. (2003). Choice and self-expression: A cultural analysis of variety-seeking. Journal of Personality and Social Psychology, 85, 373–382.
37.
KimM. S.SmithD. H.YueguoG. (1999). Medical decision making and Chinese patients’ self-construals. Health Communication, 11(3), 249–260.
38.
KiteJ.FoleyB. C.GrunseitA. C.FreemanB. (2016). Please like me: Facebook and public health communication. PLoS One, 11(9), e0162765.
39.
KrishnaA.ThompsonT. L. (2019). Misinformation about health: A review of health communication and misinformation scholarship. American Behavioral Scientist, 65(2), 0002764219878223.
40.
KrollJ. F.de GrootA. M. (1997). Lexical and conceptual memory in the bilingual: Mapping form to meaning in two languages. In de GrootA.KrollJ. F. (Eds.), Tutorials in bilingualism: Psycholinguistic perspectives (pp. 169–199). Erlbaum.
41.
LunaD.RingbergT.PerrachioL. A. (2008). One individual, two identities: Frame switching among biculturals. Journal of Consumer Research, 35(2), 279–293.
42.
MarianV.BlumenfeldH. K.KaushanskayaM. (2007). The Language Experience and Proficiency Questionnaire (LEAP-Q): Assessing language profiles in bilinguals and multilinguals. Journal of Speech, Language, and Hearing Research, 50(4), 940–967.
43.
MarianV.FauseyC. M. (2006). Language-dependent memory in bilingual learning. Applied Cognitive Psychology, 20(8), 1025–1047.
44.
MarianV.KaushanskayaM. (2004). Self-construal and emotion in bicultural bilinguals. Journal of Memory and Language, 51(2), 190–201.
MarianV.NeisserU. (2000). Language-dependent recall of autobiographical memories. Journal of Experimental Psychology: General, 129(3), 361–368.
47.
MarkusH. R.KitayamaS. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98(2), 224–253.
48.
MarshB. U.KanayaT.PezdekK. (2015). The language dependent recall effect influences the number of items recalled in autobiographical memory reports. Journal of Cognitive Psychology, 27(7), 829–843.
49.
MatsumotoD. (1990). Cultural similarities and differences in display rules. Motivation and Emotion, 14(3), 195–214.
50.
MeeuwesenL.van den Brink-MuinenA.HofstedeG. (2009). Can dimensions of national culture predict cross-national differences in medical communication?Patient Education and Counseling, 75(1), 58–66.
51.
MerunkaD. R. (2013). Reinterpreting cultural priming effects in cross-cultural consumer research. AMS Review, 3(4), 232–248.
52.
NorasakkunkitV. (2003). Self-construal priming and emotional distress: Testing for cultural biases in the concept of distress. University of Massachusetts Boston.
53.
NorasakkunkitV.KalickS. M. (2002). Culture, ethnicity, and emotional distress measures: The role of self-construal and self-enhancement. Journal of Cross-Cultural Psychology, 33(1), 56–70.
54.
PanayiotouA. (2004). Switching codes, switching code: Bilinguals’ emotional responses in English and Greek. Journal of Multilingual and Multicultural Development, 25(2&3), 124–139.
55.
RalstonD. A.CunniffM. K.GustafsonD. J. (1995). Cultural accommodation: The effect of language on the response of bilingual Hong Kong Chinese managers. Journal of Cross-Cultural Psychology, 26(6), 714–727.
56.
Ramírez-EsparzaN.GoslingS. D.Benet-MartínezV.PotterJ. P.PennebakerJ. W. (2006). Do bilinguals have two personalities? A special case of cultural frame switching. Journal of Research in Personality, 40(2), 99–120.
57.
RossM.XunW. E.WilsonA. E. (2002). Language and the bicultural self. Personality and Social Psychology Bulletin, 28(8), 1040–1050.
58.
SmithS. M.VelaE. (2001). Environmental context-dependent memory: A review and meta-analysis. Psychonomic Bulletin & Review, 8(2), 203–220.
59.
TrafimowD.SilvermanE. S.FanR. M. T.Fun LawJ. S. (1997). The effects of language and priming on the relative accessibility of the private self and the collective self. Journal of Cross-Cultural Psychology, 28(1), 107–123.
60.
TriandisH. C. (2018). Individualism and collectivism. Routledge.
61.
TulvingE.ThomsonD. M. (1973). Encoding specificity and retrieval processes in episodic memory. Psychological Review, 80(5), 352–373.
62.
VerkuytenM.PouliasiK. (2002). Biculturalism among older children: Cultural frame switching, attributions, self-identification, and attitudes. Journal of Cross-Cultural Psychology, 33(6), 596–609.
WrightK. B. (2020). New technologies and health communication. In O’HairH. D.O’HairM. J. (Eds.), The handbook of applied communication research (pp. 863–878). Wiley.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
