Cultural Characteristics Related to Health Care African-American (Blacks) Health beliefs Illness classified as: (1) Natural – affected by forces of nature without adequate protection (e.g. cold air, pollution, food and water. (2) Unnatural – evil influences (e.g. witchcraft, voodoo, hoodoo, hex, fix, root-w0rk; symptoms are often associated with eating. Believe serious illness sent by God as punishment (e.g. parents punished by illness or death of a child). Believe serious illness can be avoided. May resist health care because illness is will of God. Health & diet practices Self-care and folk medicine very prevalent. Folk therapies usually religious in origin. Attempt home remedies first; poorer people do not seek help until illness is serious. Usually seek help from: (1) “Old lady” – woman in community with a common knowledge of herbs; consults regarding pediatric care; (2) Spiritualist – has received gift from God for healing incurable disease or solving personal problems; strongly based in Christianity; (3) Priest (voodoo priest/priestess – most powerful healer; (4) Root doctor – meets need for herbs, oils, candles, and ointments. Prayer is common means for prevention and treatment. Family relationships Strong kinship bonds in extended family; members come to aid of others in crises. Less likely to view illness as a burden. Augmented families common (unrelated persons living in same household). Place strong emphasis on work and ambition. Sex-role sharing among parents. Communication Alert to any evidence of discrimination. Place importance on nonverbal behavior. May use nonstandard English or “Black English”. Use “testing” behaviors to assess personnel in health care facilities before seeking active care. Best to use simple, direct, but caring approach. Also High level of caution and distrust of majority group. Social anxiety related to tradition of humiliation, oppression and loss of dignity. Will elect to retain dignity rather than seek care if values are compromised. Strong sense of peoplehood. High incidence of poverty. African American minister/ clergy strong influence. Visits by family minister/clergy are sought, expected and valued in helping to cope with illness and suffering. Asian Americans – Chinese A healthy body viewed as a gift from parents & ancestors and must be cared for. Health is one of the results of balance between the forces of yin (cold) and yang (hot) energy forces that rule the world. Illness caused by imbalance. Believe that blood is the source of life and is not regenerated. Chi is innate energy. Lack of chi and blood results in deficiency that produces fatigue, poor constitution and long illness.The goal of therapy is to restore the balance of yin and yang. Acupuncturist applies needles to appropriate meridians identified in terms of yin and yang. Acupressure and tai chi replacing acupuncture in some areas. Moxibustion is the application of heat to the skin over specific meridians. It is essentially a form of heat therapy in which a stick of dried plant material called “moxa” is held 1-2 inches over the skin and is held there until the skin reddens and becomes warm. Wide use of medicinal herbs procured and applied in prescribed ways. Folk healers are herbalist, spiritual healer, temple healer, and fortune healer. Meals may or may not be planned to balance hot and cold. Milk intolerance is fairly common. Use of condiments (e.g. monosodium glutamate and soy sauce) may create disability with some diet regimens such as low salt diets.Extended family pattern common. Strong concepts of loyalty of young to old. Respect for elders taught at early age – acceptance without questioning or talking back.Children’s behavior is a reflection on the family. Family and individual honor and “face” important.Males valued more highly than females; women are submissive to men in family Open expression of emotions are unacceptable. Often smile when one does not comprehend what is being said. Do not react well to painful diagnostic testing; are especially upset by drawing of blood. Deep respect for their bodies and believe it is best to diet with the body intact; therefore many refuse surgery. Believe in reincarnation. Children sometimes breast-fed for up to 4-5 years. Asian Americans (Japanese) Health beliefs Three major belief systems. Shinto: religious influence; humans inherently good; evil caused by outside spirits. Illness caused by contact with polluting agents such as blood, corpses and skin diseases. Chinese & Korean influences: health achieved through harmony and balance between self and society. Disease caused by disharmony with society and not caring for the body. Portuguese influence: upholds germ theory of disease. Health and diet practices Believe evil removed by purification. Energy is restored by means of acupuncture, acupressure, massage and moxibustion along affected meridians. Kampo medicine - involves use of natural herbs. Kampo medicine is based on Chinese medicine but adapted to the Japanese culture. Believe in removal of diseased parts. The trend is to use both ‘Western and Oriental healing methods. Care for disabled viewed as the family’s responsibility. Take pride in child’s good health. Seek preventive care, medical care for illness. Older persons avoid some food combinations such as milk and cherries, watermelon and crab and also believe that pickled plums have special properties. Family relationship Close intergenerational relationships. Family provide anchor. Family tend to keep problems to self. Value self-control and self-sufficiency. Concept of haji (shame) imposes strong control; unacceptable behavior of children reflects on the family. Many adopt practices of contemporary middle class. Concern for child’s missing school may result in sending the child to school before full recovery from illness. Communication Issei – born in Japan, usually speaks Japanese only Nisei, Sansei & Yonsei – have a few language difficulties. New immigrants able to read and write English better than to speak or understand it. Make significant use of nonverbal communication with subtle gestures and facial expression. Tend to suppress emotions. Will often wait silently Also Issei – 1st generation to live in US Nisei – 2nd generation Sanseri – 3rd generation Yonsei – 4th generation Issei and Nisei – tolerant and permissive childrearing until 5 or 6 when emphasis is on emotional control and reserve. Cleanliness is highly valued; Time is considered valuable and to be used wisely. Tendency to practice emotional control may make assessment of pain more difficult. Asian American (Vietnamese) Health beliefs Good heath considered to be a balance between yin (cold) and yang (hot). Believe person’s life has been predisposed towards certain phenomena by cosmic forces. Health believed to be the result of harmony with existing universal order, harmony attained by pleasing good spirits and avoiding ones. May use rituals to prevent illness. Practice some restrictions to prevent incurring wrath or evil spirits. Health and diet practices Family uses all means possible before using outside agencies for health care. Fortune-tellers determine event that caused disturbance. May visit temple to procure divine instruction. Use astrology to calculate cyclical changes and forces. Regard health as family responsibility; outside aid sought when resources run out. Certain illnesses considered only temporary such as pustules and open wounds and are ignored. May seek generalist health healers. May use special diets to prevent illness and promote health. Lactose intolerance is prevalent. Family Relationships The family is a revered institution. Multigenerational families. Family chief social network. Children are highly valued. Individual needs and interests are subordinate to those of family group. The father is the main decision maker. Women are taught to be submissive to men. Parents expect respect and obedience from their children. Also Consider status more important than money. Children taught emotional control. Time concept more relaxed – consider punctuality less significant than other values such as propriety. Place high value on social harmony Asian American (Filipino) Health beliefs Believe God’s will and supernatural forces govern universe. Illness, accidents, and other misfortunes are God’s punishment for violations of His will. Widely accept “hot” and cold” balance and imbalance as cause of health and illness. Health and diet practices Some use amulets as a shield from witchcraft or as a good luck piece. Catholics substitute religious metals and other items. Family relationships Family highly valued with strong family ties. Multigenerational family structure common; often with collateral members as well. Personal interests are subordinated to family interests and needs. Members avoid any behavior that would bring shame on family. Communications Immigrants and older persons may not be able to speak or understand English. Also Tend to have a fatalistic outlook on life. Believe time and Providence will solve all Hispanic American, Mexican American (Latino, Chicano, Raza-Latino) Health beliefs Health beliefs have strong religious association. Believe in body imbalance as a cause of illness, especially imbalance between caliente (hot) and frio (cold) or “wet” or “dry” Traditional hot and cold illnesses – cold conditions - cancer, colic, indigestion, decreased libido, headache, menstrual changes, pneumonia, upper respiratory infections. Hot condition – anger. Some maintain that good health is a result of “good luck” – a reward for good behavior. Illness prevented by performing properly, eating proper foods and working proper amounts of time; accomplished through prayer, wearing religious medals or amulets, and sleeping with relics at home. Ma de ojo (evil eye) – a hex cast on children, sometimes unconsciously, that is thought to be caused by the admiring glance of someone more powerful. Health and diet practices. Seek help from curandero or curandera, especially in rural areas. Curandero (a) receives his/her position by birth, apprenticeship or a “calling” by dream or vision. Treatments involve use of herbs, rituals and religious artifacts. For severe illness – make promises, visit shrines, offer medals and candles, offer prayers. Adhere to “hot” and “cold” food prescriptions and prohibitions and treatment of illness. Family relationships Traditionally men considered breadwinners; women are home-makers. Males are considered big and strong (macho). Strong kinship: extended families include compadres (god parents_ established by ritual kinship. Children valued highly and desired, taken everywhere with the family. Many homes contain shrines with statues and pictures of saints. Communication May use nonstandard English. Most bilingual; many speak only Spanish. May have a strong preference for native language and revert to it in times of stress. Also High rates of diabetes mellitus, hypertension and obesity High degree of modesty – often a deterrent to seeking medical care. Youngsters often reluctant to shared communal showers in school. Relaxed concept of time – may be late for appointments. Magico-religious practices are common. May view a hospital as a place to go to die. Hispanic American (Puerto Rican) Health beliefs Health is a state of balance, harmony and equilibrium Subscribe to the “hot-cold” theory of causation of illness Believe some illness caused by evil spirits and forces. Spiritism belief system. Includes the belief that spirits and saints can have effect on one’s life. Illness may be caused by: common biomedical causes, humoral imbalance, social disharmony or spiritual (between a person and either the guardian saint or a spirit of a deceased person) Health and diet practices Rich tradition of fold remedies for many ailments. Often use these along with biomedical therapy. Folk healers – using herbs, rituals. Consults spiritualist medium for mental disorders Santeria is a system and practitioners are called santeros. Treatments are classified as “hot” or “cold” Treatment for a hot illness are remedies and foods that are cold; treatment for cold illness are remedies and foods that are hot. Family relationships Family usually large and home centered Father has complete authority in the family (provider and decision maker) Wife and children are subordinate to father Children are valued – seen as gift from God Children are taught to obey and respect parents, corporal punishment used to ensure obedience Communication May use nonstandard English Spanish speaking or bilingual Strong sense of family privacy – may view questions regarding family as impudent. Also Has a relaxed sense of time Pay little attention to exact time of day. Suspicious and fearful of hospitals. Hispanic Americans (Cuban-Americans) Health beliefs Prevention and good nutrition are related to good health Health and diet practices Diligent users of the medical model. Eclectic health-seeking practices, including preventive measures, extensive use of the medical model, and in some instances, fold medicine of both religious and nonreligious origins. Home remedies used - in many instances seek assistance of santeros (Afro-Cuban healers) and spiritualists to compliment medical treatment. Nutrition is important; parents show concern with eating habits of their children and spend a significant amount of the budget on food. Traditional Cuban diet is rich in meat and starch. Consumption of fresh vegetables added in the US. Family relationships Strong family ties with mother and father kinships. Children supported and assisted by parents long after becoming adults The elderly are cared for at home. Communications. Most are bilingual (English Spanish) for segments of the senior populations. Also In less than 30 years, Cubans have been able to obtain a higher standard of living than other Hispanic groups in US Have been able to retain many of their former social institutions – bilingual and private schools, clinics, social clubs, the family as an extended network of support. Many do not feel discriminated against or harbor feelings of inferiority with respect to AngeloAmericans or “mainstream” population. Native Americans (numerous tribes) Health beliefs Believe that health is a state of harmony with nature and universe Respect of bodies through proper management All disorders believed to be aspects of the supernatural. Violation of a restriction or prohibition is thought to cause disease. Fear of witchcraft May carry objects believed to guard against witchcraft Theology and medicine strongly interwoven Health and diet practice Medicine persons: altruistic persons who must us powers in purely positive ways. They are capable of both good and evil – performs negative acts against enemies. Diviner diagnosticians – diagnose but do not have powers or skills to implement medical treatment. Specialists – using herbs and curative but not sacred medical procedures. Medicine persons use herb and rituals. Singers cure by the power of their song obtained from supernatural beings, effect cures by laying on of hands Family relationships Extended family structure – usually includes relatives from both sides of the family Elder members assume leadership positions Communication Most continue to speak their Indian language as well as English Nonverbal communication is important Also The time orientation is the present Significant respect for age Going to the hospital is associated with illness or disease. Therefore they do not seek prenatal care and pregnancy is considered a natural process.
