The connection between health and culture is profound and multifaceted. According to Onuoha et al. (2024) Culture shapes how individuals perceive illness, seek treatment, and engage with health systems. This implies that diagnosis through complete treatment plans is deemed comprehensive and successful only when they reflect the cultural requirements of patients. Recent literature emphasizes that health is not just biological-it’s deeply embedded in social and cultural contexts (Oman, 2025). The significance of culture in understanding health communication is crucial and intricate.

Rehfeldt et al. (2021) define culture as a complex system that includes language, religion, cuisine, social habits, music, and art. Lansford (2022) also states that culture includes the behaviors, norms, beliefs, and social practices that characterize a group of people. This implies that all areas of an individual are covered by culture and for communication to take place, individuals must be culturally competent. Individuals are defined by their culture, and according to Phinney et al. (2022), cultural identity refers to the sense of belonging to a particular culture or ethnicity. Culture plays an important role in shaping an individual’s self-perception and worldview. Studies have emphasized the importance of cultural diversity in fostering creativity and innovation in society (Mahama, 2024). Qorib and Afandi (2024) assert that culture provides shared meanings and values that facilitate communication and cooperation among members of a society. In short, culture is a multifaceted construct that shapes human experiences in many different aspects. To understand its complexity, we must appreciate both its stability and its dynamics in the face of internal and external influences. Cultural beliefs and practices largely influence how patients perceive health and illness. Individuals from different cultures may have different attitudes toward seeking medical care, adherence to treatment, and the role of health care providers (Tanaka et al., 2023). For example, some cultures may favor traditional healing methods over modern medicine, which can place unnecessary stress on the patient-provider relationship and lead to ineffective communication (Cutler et al., 2019).

Panjaitan et al. (2023) assert that health communication, which includes information sharing and the encouragement of health-related behaviours, is an essential component of public health. Cultural norms, values, and beliefs are among the many factors that influence it (Higueras-Castillo, et al., 2024). Creating successful health treatments and guaranteeing fair access to medical care depend on an understanding of how culture affects health communication. By identifying important themes, difficulties, and practical implications, this literature review seeks to throw light on the relationship between culture and health communication. Again, people’s views of health and illness are shaped by their culture, which also affects how people interact with healthcare professionals and understand health messaging. Similarly, cultural attitudes could influence health behaviours including following medical advice or taking part in preventative care programs (Kale et al., 2023; Galesic et al., 2020). For example, some cultures may value traditional healing methods more than biomedical ones, which could cause problems between patients and medical professionals (Kleinman & Benson, 2006). Furthermore, communication about health might be greatly impacted by language limitations. Patients who are not proficient in the dominant language may find it more difficult to comprehend medical information and to properly communicate their symptoms or concerns to healthcare practitioners (Ortega et al., 2022). The significance of culturally sensitive communication techniques that take language differences into account is highlighted by this difficulty. The ability of healthcare professionals to comprehend and effectively address patients’ cultural demands is known as cultural competency (Antón-Solanas, et al., 2022). Nwosu et al. (2025) claim that culturally competent care lowers health outcome disparities, increases treatment adherence, and improves patient satisfaction. Fostering successful communication with diverse communities requires healthcare practitioners to receive training in cultural competence. Culturally appropriate interventions have been linked to improved health outcomes, according to research (Griffith et al., 2024). For instance, a study conducted by Griffith et al. (2024) showed that, in contrast to traditional instructional materials, culturally tailored materials improved African American patients’ understanding of diabetes care. These results emphasize how important it is to incorporate cultural factors into health communication plans.

As stated earlier, this study is also situated within the constructivist approach of culture and health. The constructivist theory holds that knowledge is created via social interactions and experiences rather than passively received (Yakubu, 2025). This theory highlights how people actively interpret health information and meaning based on their experiences, beliefs, and social situations (Sykes et al., 2025).

Constructivism is distinguished by several fundamental ideas: one of the constructivist’s theories of culture this study employed is the Andrian Holliday‘s concept of small and large culture and the Onion metaphor of culture (Holliday, 2022). Adrian Holliday’s concept of small and large culture aligns well with this study because, the study seeks to examines the lived experiences of patients and healthcare professionals regarding communication breakdowns in healthcare delivery in the Northern Region of Ghana. Considering this, large culture refers to broad, often stereotypical national or ethnic identities that are typically reified and static (Kariya and Rappleye, 2020). Holliday critiques this view for promoting essentialism and overlooking the complexity of human interaction (Holliday, 2022). In contrast, small culture emphasizes dynamic, localized, and emergent cultural practices formed within specific social groups, such as classrooms, workplaces, or communities (Tiwari and Fahrudin, 2024). These are fluid and shaped by interpersonal relationships and shared experiences. In the context of this study, the concept of small culture will be utilized to examine the influence of culture on effective communication between patients and health care providers in the Northern Region of Ghana. To this end, it will cast light on how the cultural beliefs, values and norms of health service providers and patients influence the meanings they attached to the signs and symbols used between healthcare providers and patients.

This shift from static to dynamic cultural models encourages educators, researchers, and global citizens to move beyond simplistic cultural binaries and engage with the rich, evolving tapestry of human experience.

Also, the onion metaphor of culture has been applied in this study to explain the nuanced lived experiences of both patients and providers in the day-to-day interactions. The idea of the onion metaphor was first conceived by eminent anthropologist Edward T. Hall, who is well-known for his contributions to the field of intercultural communication (Nguyen-Phuong-Mai, 2019). In 1976, Hall presented a conceptualization of culture as a multi-layered onion in his groundbreaking book “Beyond Culture.” The author suggests that culture is made up of both visible and invisible layers that affect people’s behavior, viewpoints, and social interactions (Bettache, 2025). According to Fishman’s (2017), the most visible aspects of culture include things like dress, food, and language usage. As the researcher digs deeper into the investigation, they encounter ever deeper layers spanning social norms, values, beliefs, and viewpoints.

Building on the groundbreaking work of Hall, later researchers have developed the onion metaphor to explore various aspects of culture. The concept was further developed by renowned psychologist and cross-cultural studies expert Geert Hofstede in his landmark work “Cultures and Organisations: Software of the Mind” (1991).

This idea offers a paradigm that is very helpful in understanding cultural dynamics and the complex nature of cross-cultural relationships. By investigating the several levels of cultural dynamics, researchers can gain a more profound comprehension of the underlying ideas, beliefs, and customs that shape people’s behaviours and viewpoints (Nguyen-Phuong-Mai, 2017).

All things considered, the application of the onion metaphor in cultural studies provides a useful framework for understanding the complex and multifaceted nature of cultural processes. This emphasizes the idea that culture is more than just outward manifestations; it has deeper aspects that shape people’s behavior and worldview. In the field of healthcare delivery, effective communication between patients and healthcare providers is critical to ensuring that patients receive high-quality care and achieve positive health outcomes. However, cultural differences may make it more difficult to understand and provide healthcare, which could result in communication barriers (Grandpierre et al, 2018).

To sum up, the onion metaphor of culture is a representation of the layered nature of human culture, spanning from the visible through to the invisible cultures that shape interpretation and meaning making within the broader tapestry of quality healthcare delivery.