Introduction

Thrombocytopenia is a disease which might potentially have an impact not only on patients’ routine but also on the health related quality of life. Based on such assumption a vignette was to enable better understanding of the impact of the disease symptoms on patients’ daily life activities [1]. The TSIDAV vignette (Thrombocytopenia Symptoms and their Impact on patients Daily Activities assessment Vignette) was primarily designed and tested in Poland with further translation and adaptation to Ukrainian [2].

There are multiple definitions of what culture is, however experts in areas like sociology, psychology or anthropology have not yet reached an agreement on the universal one.

Probably one of the first definitions was provided by sir Edward Tylor, with the statement that culture is  “that complex whole which includes knowledge, belief, art, morals, law, custom and any other capabilities and habits acquired by man as a member of society” [3].

Searching for other definitions we found numerous different ones and e.g. according to the Center for Advance Research on Language Acquisitions (CARLA) what defines culture are the shared patterns of behaviours and interactions, cognitive constructs and understanding that are learned by socialization. According to CARLA, culture can be seen as the growth of a group identity fostered by social patterns unique to the group [4].

Culture may  also be treated as a reality determined by symbols. That is the approach of Ruth Benedict and according to her opinion, the values that bind societies are symbols and a way of life typical of them. The cultural process of passing on traditions is ensuring the sustainability of societies and cultures [5].

An interesting comparison has been made by Fons Trompenaars, together with Charles Hampden Turner, who  compare culture to gravity: we don't realize how tightly we are bound to Earth until we try to break away from it. Culture is invisible, but we unconsciously cultivate its values [6].

However the best known for developing one of the earliest and most popular frameworks for measuring cultural dimensions in a global perspective  is Professor Geert Hofstede who defines culture as:  “the collective programming of the mind distinguishing the members of one group or category of people from others” [7,8].

Being aware of the complexity of what culture is and the impact it can have on the study results, we decided to compare  those from Poland and Ukraine taking into account cultural influences and using the Hofstede dimensions.

Objective

The aim of the study was to compare the results obtained using TSIDAV vignette in Poland and Ukraine and to analyze the impact of cultural dimensions’ influence on those results.

Material and methods

In order to asses to what extend the symptoms of thrombocytopenia disease can impact patients’ daily activities the TSIDAV vignette was developed. It consists of two parts: the first being a descriptive one where patients have to provide qualitative information about what are the symptoms affecting their activities and are the most bothersome, while the second part is quantitative and it is based on Likert scale enabling patients to rate the specific, listed symptoms’ impact on their daily activities. The scale range is between -2 to +2 (from “very high impact on daily activities” to “very low impact” respectively). The vignette was developed and validated in Poland with further translation and validation to Ukrainian language as well as adapted to a different culture. Both studies data were already published and the current manuscript is focused on the impact of the two cultures on the obtained results [1,2]. The analysis is based on the Hofstede national culture model [8].

The model consists of five cultural dimensions which represent independent preferences for one state of affairs over another. It is the reason for the differences between the countries. The dimensional performance of countries is relative because we are all human and at the same time we are all unique. In other words, culture can only be meaningfully used by comparison. The dimensions are as follows:

Power distance INDEX (PDI) - expresses the degree to which the less powerful members of a society accept and expect that power is distributed unequally. The fundamental is handling inequalities among people by the society.

Individualism versus Collectivism (IDV) - the high side of this dimension, called Individualism, can be defined as a preference for a loosely-knit social framework in which individuals are expected to take care of only themselves and their immediate families.

Masculinity versus Feminity (MAS) – the two opposite dimensions have different meaning. Masculinity side represents societal preference towards achieving, heroic attitude, assertive attitude, and material rewards for success. The society as a whole is more competitive., Femininity dimension, as opposite to Masculinity stands for a preference for cooperation, modest behaviour, altruistic attitude, i.e. caring for disable  and quality of life. The society in general is more consensus-oriented.

Uncertainty avoidance INDEX (UAI) - this dimension reflects and manifests to what degree the society members feel uncomfortable with uncertainty and ambiguity. The primary issue in relation to the uncertainty avoidance dimension is what are the ways the society is managing the fact of an unknown future. The basic question is about the correct attitude, which is either trying to control the future or accepting it and allowing to happen.

Long Term Orientation versus Short Term Orientation (LTO) – each society, independently of its characteristics has to preserve some connections with its own past while managing the challenges of the present and the future. Those objectives are prioritized by the societies in different ways. Low scoring societies in relation to the described dimension, demonstrate rather preferences to respect traditions, those considered as sacred as well as the norms and  they demonstrate suspicious attitude towards societal changes. On the contrary the societies scoring highly have a more pragmatic approach by encouraging thrift and taking efforts towards a modern education as a way to prepare for the future.

The Ethics Committee approvals were granted for the basic studies performed in Poland and in Ukraine respectively by the Lublin University and Lviv National Medical University. All the data collected and analyzed during the study were anonymous.

Results

In total in Ukraine, 49 patients with thrombocytopenia provided answers to the TSIDAV questions (25 male, 24 female) while the outcomes from Polish study were based on 61 responded questionnaires (the total consisted of 31 female, 17 male, 13 children caregivers) [2,1].

In relation to the qualitative data from Ukraine obtained from TSIDAV, 12% men and 25% women marked weakness and excessive fatigue as the major impact of subjective symptoms on daily activities (total of 18.4% of respondents). The second mostly mentioned by a total of 10.2% respondents was anxiety and fear associated with thrombocytopenia (12% men and 8.3% women) [2].

In the Polish study, 41% of men reported weakness, fatigue and lack of strength as those affecting them the most, while 47% of men had no concerns related to the disease symptoms. Within the women group the major concern declared in the descriptive part was weakness, reported by 35% of women [1]. Table 1 provides the details related to the main differences by gender and by country.

Table 1. Quantitative results of the assessment of thrombocytopenia symptoms impact with TSIDAV in Ukraine and Poland – main differences by women and men in percentages

Interesting difference we noticed is that none of the women respondents in Ukraine indicated that menstruation impacted significantly on the performance of their daily activities. 41.7% of women declared that this specific symptom does not affect their daily activities, while within the female group who provided answers in Poland 35% assessed the impact as significant.  

When analyzing the calculated mean values of TSIDAV scale for Ukraine the range was 0.31 (SD 0.83). All the obtained values by gender ranged <0 to -1.0 what should be interpreted that the symptoms of the disease have a high impact on patients’ daily activities. It has to be mentioned that the results obtained among men to a considerably degree indicate the impact of the disease on their daily activities, significantly more than among women (mean TSIDAV value in female group 0.18, SD 0.95; mean in male group 0.44, SD 0.69) [2]. The TDSIDAV mean value for Poland (male and female group) was 0.68 (SD 0.69). The Polish gender specific results were the opposite to the Ukrainian results.  Among women in Poland the mean value was -0.85  (SD 0.54), while within men the mean value was -0.35 (SD 0.83) [1].

Cultural characteristics based on the cultural dimensions by G. Hofstede

The scoring for cultural characteristics following G. Hofstede cultural dimensions is presented for both countries in table 2.

Table 2. Cultural characteristics by country (based on G. Hofstede dimensions)

Having analysed the results for Ukraine we found that regarding the Power Distance the scoring value is 92. Ukraine is a country characterized by a distance between power holders and the society. Considering the country’s history, which has been for almost hundred years a part of the Soviet Union and considering that currently it is the largest country within Europe, Ukraine evolved as a very centralized country. There can be observed a differences between those citizens having the most of the power and those having less power. Such discrepancy results in the great importance of status symbols. The status roles should be reflected and represented by the behaviour and that concerns all the areas of business interactions, e.g. related to visits, negotiations or cooperation. The attitude of controlling and directing from the top level and precise orders for any task are required as mandatory.

Regarding the Individualism dimension in Ukraine the score is relatively low and it is related to the fact that family, friends and often also neighbours are extremely important factors that help to face the challenges of everyday life. In order to be informed, to get up to date knowledge related to significant issues, to build new connections or to have successful negotiations it is critical to maintain good relationships. The relationships should be personal, authentic and trustful. This requirement must be met before people can fully devote themselves to the task at the same time creating a style of communication that is attentive to the recipient, but remains rather unexpressed.

The Masculinity dimension in Ukraine obtained a relatively low score of 27. Such result might be surprising with regards to Ukrainian citizens preference for status symbols. However it should be noticed that in case of this country those symbols remain associated with high Power Distance index. It is worth mentioning that Ukrainians, both in the workplace and in situations when they meet someone they don't know, tend to underestimate their personal accomplishments, their input, opportunities or capabilities. They present a modest  attitude about themselves and scientists, researchers or doctors are most often expected to live on a very modest standard. Dominant behaviour might be accepted when it comes from the boss or executives, however it is not acknowledged among colleagues.

Uncertainty avoidance in Ukraine with the scoring of 95 can be interpreted as that people feel a significant threat in situations that are ambiguous. An example can be the case of business situations where presentations for the meetings are either unprepared, e.g. when negotiations are at early phase, recently initiated and the main focus is on building relationships, or the case when slides are very detailed and extremely well prepared. Also detailed planning, preparation meetings or rehearsals are very common. Ukrainians have preference to know the context and the background information. Worth to mention is that formality is perceived as a sign of esteem and as long as they interact with others, whom they do not know usually they might be perceived as formal and distant.

Score at level 86 for the Long term orientation dimension means that the Ukrainian culture is immensely pragmatic. In the case of societies characterized by a pragmatic orientation, individuals believe that truth strongly depends on the circumstances, influencing factors, surrounding environment and time. They manifest great adaptation ability of traditions in relation to changed conditions. It is visible a strong tendency for saving and investing, for thriftiness, as well as determination to achieve results.

Analysing the results in individual dimensions for Poland we found that the Power Distance obtained a score of 58, meaning that Poland is a hierarchical society. People accept a hierarchical order in which every individual has a place and which needs no further justification.  Within the society centralization is accepted and the subordinates expect to obtain instructions for their tasks and the ideal supervisor or executive is a kind autocrat.

The dimension of Individualism in Poland obtained a score of 60 and it can be interpreted as Poland being  an Individualist society. This means there is a strong predilection for social framework and in that case each one is expected to protect and look after themselves and their closest family only. In case of Polish culture it encloses some “contradiction”: although it is highly Individualist, people still have need for hierarchy. The obtained combination of a high score on Power Distance and same for Individualism dimension is the cause of an observed “tension” in regards to this culture. That results in a delicate relationship which turns intense and fruitful once it is managed properly.

Regarding the Masculinity dimension the score for Poland is 64 and it is considered as a Masculine society. In Masculine countries people “live in order to work”, managers are expected to be decisive and assertive, the emphasis is on competition and performance and conflicts are resolved by struggling with them.

Uncertainty Avoidance dimension scores 93 in Poland and thus has a very high preference for avoiding uncertainty. Countries exhibiting high Uncertainty Avoidance maintain rigid codes of belief and behaviour and are intolerant of unorthodox behaviour and ideas. In these cultures, exists an emotional need to have rules (even though in reality these rules are unlikely to work).

When we analysed the Long Term Orientation dimension in Poland the result was a low score of 38. This means that Polish society is rather normative than pragmatic. What can be observed in similar societies is a significant concern related to establishing the absolute Truth. Being normative in their thinking people also maintain and demonstrate great respect for traditions. It can be noticed a relatively small propensity to save for the future, and a focus on achieving rapid results.

Discussion

In the context of this article and the comparative analysis of the results, the dimensions of G. Hofstede's culture which deserve special attention are: Individualism vs Collectivism and Masculinity vs Femininity. Poland's score in the Individualism vs Collectivism dimension is 60 points, and the Ukrainian one is only 25 points. Poland's much higher score in this dimension may explain the higher indications of Poles participating in the study in the case of visible symptoms of the disease and their impact on the daily activities.

Hofstede's Individualism is related to the perception of oneself and others through the prism of one's own success and through all its manifestations, such as appearance - every element of our appearance, possessions we own - make up the image of a successful person or the opposite. The visible symptoms of the disease may, in the opinion of the respondents, significantly reduce their sense of success and their attractiveness.

The difference in the results related to a symptom such as bleeding from nose and gums (Ukraine 40%, Poland only 24%) may be related to the high result of Ukraine on the Long term orientation dimension, because these are the symptoms that do not affect the perception of the achieved success or attractiveness here and now, and may have an impact on your perception of your own opportunities in the future and complications that they may cause in the long term.

The differences in the results achieved by women in the studied group are even more significant, and they can be explained by analysing the results of both countries in terms of Masculinity vs Femininity, where Poland achieved 64 points, while Ukraine only 27 points. Such results suggest that Poland is a much more country masculine than Ukraine. This dimension determines the social division of gender roles, and thus not only which gender does what, who takes care of the house, who is responsible for maintaining the house or taking care of material goods, but also what each gender should look like. So when we are dealing with visible symptoms of the disease, Poles will be more annoyed than Ukrainian women, because it is related to the lack of adjustment to social expectations.

Analyzing other researchers work there was not identified a research with similar scope to the study with TSIDAV vignette use however still it is worth to mention the analysis performed by  O.Prokopenko and L. Kryvoruchko related to Polish and Ukrainian cultures [9]. The authors performed the comparison based on a survey inspired by Hofstede and Hall cultural models and for the Polish sample the distance of power had only a slightly higher score. That was interpreted by the authors that both countries have esteem for their supervisors at work and also initiative and rational thinking in subordinate employees are appreciated, however the boss is the final decisionmaker. In relation to collectivism  for Ukraine the rating was 73, and for Poland 71, meaning that for both countries’ representatives the others interest is important and that has impact on ways of working and business decision-making.

In regards to individualism authors found that for both countries men were more individualistic. Analyzing respondents age young Ukrainians show more individualism, while in Poland individualism was observed more in older respondents [9].

With relation to young population a study by Korczynski and Stefanek analyzed the level of cultural sensitivity of Polish, Ukrainian and Belarusian students, however the used tool was  the Intercultural Sensitivity Scale with a different approach based on the assumption that the cultural sensitivity is related to cognitive, affective and behavioral aspects of interactive situations and that the key factor is the connection to emotions [10]. Authors based on their research shown that the Ukrainian students, among the participating are the most willing to engage in conversation with a person of different culture, however  in general  irrespectively of their nationality all respondents results demonstrate cautious attitude in relation to cross-cultural interactions [10].

Individualism and collectivism as well as universalism and particularism, high and low power distance were also in scope of a study performed in 2016 comparing Poland and Ukraine based on an original questionnaire created by the study author [11]. The study confirmed that in case of both countries the hierarchical organizational structures dominate however, while in Ukraine 41% of respondents declared it as very hierarchical, in Poland it was at much lower level, reaching only 8%. Authors also confirmed Hofstede’s findings in regards to managerial styles characterizing Ukrainian population by a very high level of distance to power [11].

Conclusions

Comparing TSIDAV results between Poland and Ukraine it can be observed how the gender influences the declared impact of the disease symptoms on patients’ daily activities. Regarding cultural impact we found that Individualism vs Collectivism and Masculinity vs Femininity are those deserving special attention among G. Hofstede's cultural dimensions. Further research on a larger group of respondents is needed.

Since the G. Hofstede's cultural dimensions are only one of the selected theories, it seems extremely interesting to check whether the differences in the results achieved by the respondents from Poland and Ukraine will be different regarding other theories of cultural dimensions.

What is new?

The authors compared the results obtained with the Polish version of the TSIDAV vignette and the Ukrainian one and analyzed the impact of cross – cultural influence on the obtained results.

The used tool is new and innovative, it was already tested in Poland and Ukraine and with this project our aim was to identify the cross-country differences and to make an attempt for better understanding and explaining those differences from the psychological perspective, taking into account the impact of different cultures.

Statement of Ethics

Authors declare: “All procedures performed in studies involving human participants were in accordance with the ethical standards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Ethics Committee approvals were granted for the basic studies performed in Poland and in Ukraine respectively by the Lublin University (protocol № KE-0254/65/2016) and Lviv National Medical University (protocol №4 20th April 2015). ” Written informed consent was obtained from participants to participate in the study.

Conflict of Interest Statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding Sources

This research did not receive any specific grand from any founding agencies in the public, commercial, or not for profit sectors.

Authorship Contributions

MSzD and MB contributed equally to this study. MSzD, MB and MD developed the project. MB, MSzD and MD analyzed the results. OB shared the analyzed UKR data. MSzD, MD and MB wrote the manuscript. MSzD, MB, MD and OB have reviewed the manuscript.