How to Use the Culture Iceberg Model in Health and Social Care

The Culture Iceberg model is a visual framework that helps people understand cultural differences and similarities. It likens culture to an iceberg. Only a small part, such as customs and behaviours, is visible above the surface. Most of what makes up a culture, including values, beliefs, and assumptions, remains unseen beneath the waterline.

In health and social care, this model helps professionals reflect on how culture influences interaction, care, and service delivery. Recognising all parts of culture increases awareness and improves relationships with service users, families, and colleagues.

The Visible and Invisible Parts of Culture

Culture shows itself in two main ways:

• Visible aspects: These are the behaviours, ways of dressing, language, and rituals you notice in daily life.
• Invisible aspects: These include beliefs, values, communication styles, worldviews, and attitudes. These characteristics are harder to spot, but they strongly influence how people behave and what they expect from care.

Ignoring what lies beneath the surface can lead to misunderstandings. Focusing only on visible parts risks stereotyping or missing crucial points that affect health, well-being, and trust.

Applying the Model with Service Users

Using the Culture Iceberg model with service users involves active listening, observation, and respectful conversations. Whether providing support at home, in residential settings, or hospitals, staff need to move beyond first impressions.

Start by acknowledging what you see and hear, but aim to understand the less visible factors affecting decisions. For example, someone may refuse medication or therapy because of particular beliefs about illness or healing. Open questions can help:

• “Is there anything about your background that affects the sort of care you want?”
• “Do you have any practices or values you would like us to respect?”

Here are some responses you may encounter buried under the surface:

• Religious fasting during Ramadan or Lent
• Practices around touch, gender, or privacy
• Family structures and their involvement in decision-making

By exploring these factors, staff offer better support that fits the person.

Supporting Families Using the Iceberg Approach

Families play an important role in many people’s lives, especially in cultures where the family is the main support network. The visible aspects may include family members attending appointments or providing meals. The invisible factors include expectations on who makes health decisions, views on hospital care versus home care, and feelings about particular medical interventions.

Work with families by:

• Acknowledging their role and asking for their views
• Discussing cultural expectations in a non-judgemental way
• Understanding how beliefs affect consent and information sharing

Bringing the invisible into the open helps build trust and avoids misunderstandings.

Understanding Communication Styles

Communication goes far beyond language. The way people communicate, both verbally and non-verbally, reflects cultural background. You might see:

• Direct or indirect speech
• Differences in eye contact
• Variations in personal space
• Tone of voice and gestures

Some cultures value blunt honesty; others see indirectness or deference as respectful. If you only pay attention to the words, you might misinterpret someone’s feelings or intentions.

Key steps include:

• Observing body language, pauses, and volume
• Checking understanding by asking open-ended questions
• Being willing to adapt your style to help the person feel safe

These practices steer conversations in a positive, respectful direction.

Policy and Organisational Impact

The Culture Iceberg model is useful at a policy and organisational level too. Services that think only about visible or surface-level diversity—such as food or prayer spaces—risk missing what truly matters to those they support. Deeper change comes from recognising how hidden beliefs and values influence the way people experience care.

Organisations can improve inclusivity by:

• Providing cultural competence training that covers both visible and invisible aspects of culture
• Encouraging reflective practice and peer discussion
• Reviewing policies to make sure they support tailored care, not just one-size-fits-all solutions

Staff who develop this awareness respond more flexibly to the needs of diverse communities.

Addressing Stereotyping and Assumptions

Stereotyping happens when staff assume they understand someone’s needs based only on visible behaviour or their perception of a person’s background. This can lead to misunderstandings and even harm.

The Culture Iceberg model provides a reminder to look beneath the surface. Every person is unique. Culture shapes identity, but not everyone from a particular group will feel or behave the same way.

Combat stereotypes by:

• Taking time to learn about individual preferences
• Asking, not assuming
• Clarifying with each person and avoiding generalisations

This approach maintains dignity and respect for all.

Case Study: End of Life Care

Consider a scenario in a hospice. A team supports a woman from a South Asian background who is dying. The visible signs of culture include her traditional dress and the presence of extended family. Staff might offer appropriate food or arrange for spiritual care. Still, deeper cultural factors determine her wishes about pain relief, her family’s expectations around communication of diagnosis and prognosis, and her spiritual beliefs about the meaning of suffering.

By drawing on the Culture Iceberg model, the team moves beyond surface-level adjustments. They create space for honest discussion about end-of-life decisions, respect rituals around illness and death, and include family in care planning, as the woman prefers.

Such sensitive, thoughtful use of the model leads to care that respects the person’s whole identity.

Supporting Colleagues in a Diverse Team

Modern health and social care teams often bring staff together from many cultures. The visible signs include language differences or festivals celebrated in the workplace. But how colleagues relate to authority, express opinions, or handle disagreements may be shaped by deeper cultural values.

Managers and staff can use the model to reflect on areas for team growth, including:

• Respecting different communication styles and decision-making approaches
• Understanding that people might not feel comfortable speaking up immediately
• Learning from each other through open dialogue and curiosity

This awareness helps teams flourish, reduces conflict, and leads to creative problem-solving.

Training and Education

Training about diversity and equality often starts with what’s seen—a person’s appearance or the food in the canteen. The Culture Iceberg model encourages a broader and richer approach.

Effective training sessions:

• Help staff distinguish between surface-level and deep cultural features
• Use real-world scenarios for discussion
• Practise reflective listening and questioning

Role-play and case studies allow staff to try out new skills in safe environments, building confidence for real-life application.

Steps for Everyday Use

Applying the Culture Iceberg model in everyday practice becomes second nature with a few clear steps:

• Pause and notice: Recognise your own expectations and reactions
• Explore with curiosity: Ask questions that invite people to share what matters to them
• Reflect and record: Keep notes about what you learn, within confidentiality rules
• Continue learning: Attend courses or read about cultural differences in your area
• Provide feedback: Support colleagues in doing the same

Small changes in attitude and behaviour lead to bigger improvements in care quality.

Sample Questions to Bring Hidden Factors to Light

The right questions encourage people to share invisible aspects of their culture.

You could use questions like:

• “Are there traditions or routines you’d like us to respect?”
• “Who would you like to be involved in decisions about your care?”
• “Are there foods, medicines, or treatments you prefer to avoid?”
• “How can we support your needs for privacy or spiritual practice?”

These questions should always be asked with warmth and respect. They give the message that everyone’s needs and identity matter.

Possible Challenges and Solutions

Some staff worry about causing offence or saying the wrong thing. The Culture Iceberg model reassures them that curiosity and openness matter more than having all the answers.

If someone does not wish to discuss their culture, their wishes should be respected. Building trust may take time.

Language differences can cause complications. Use of professional interpreters or translators reduces the risk of misunderstanding.

Documentation needs care. Staff should record only relevant details about a person’s preferences, never making assumptions or including stereotypes.

Benefits for Service Users and Staff

Working with the Culture Iceberg model leads to:

• Improved relationships between staff, users, and families
• Better health and care outcomes, as people feel seen and respected
• Fewer conflicts or misunderstandings
• Higher staff confidence and satisfaction

People who feel understood and respected are more likely to engage fully with care, trust staff, and follow recommended treatments.

Linking with Values and Legislation

The Care Act 2014, Equality Act 2010 and the Human Rights Act 1998 set expectations for person-centred care and equal treatment. The Culture Iceberg model adds another practical layer, helping services meet legal and ethical responsibilities to treat everyone with dignity and acceptance.

Final Thoughts

The Culture Iceberg model offers a useful way to think about culture in health and social care. By recognising what lies both above and beneath the surface, professionals give care that suits each individual, family, and situation. It reminds staff to look deeper than what they first see and hear and to value the unique experiences and needs every person brings. Using this model makes services more welcoming, effective, and respectful for all.