Cultural Diversity
ELDER Project
Fairfield University School of Nursing
African American Culture
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Objectives: Upon completion of this session, the
participants will be able to ….
 Discuss the role of religion, traditional health care beliefs,
social values, and family structure of African Americans
and the impact these factors have on health care.
 Identify specific culturally sensitive practices that can be
incorporated into your work with African American
patients.
 Examine historical influences that shape the attitudes of
some African Americans in relation to current day
healthcare.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Introduction:
 Today the African American population is comprised of
individuals of mixed ethnicity and cultural heritage. The
slave trade brought people from Africa to many parts of the
world, including the West Indies, South America, Central
America and the United States. In America, intermixing
has been largely with American Indians and European
Americans.
 The African American population is an extremely varied
group on almost any dimension, including income,
profession, location, religion and education.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Introduction:
 Many are low income, but there are very large and growing
segments in the middle and upper income categories.
 Some are retired professionals; many others have children
with professional careers.
 Education levels vary from almost no years of school to
doctorates.
 While many in their 70s and 80s are dependent on care
from children, grandchildren or fictive kin, others are
raising grandchildren or great-grandchildren.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Communication:
 The use of formal titles such as Mr., Ms. or Miss is used
to show respect and establish ease and rapport.
 For example, many people will refer to a teacher as Ms.
or Miss Monica
 Oral communication is viewed as more important than
written communication.
 Acceptable nomenclature of this culture group
includes African American, Black American or Peopleof-Color.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Family and Social Structure:
 Family supports behavior grounded in respect for each
generation.
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High levels of respect for the elderly can be related to
ancestral worship: the belief that older adults are closest to
their ancestors.
High levels of social interaction and strong emotional
bonds exist between the elderly and their extended
families.
 Quality of life and life satisfaction are enriched by contact
with family and friends.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Family and Social Structure:
 Intergenerational family support and support from the
extended family is the hallmark of healthcare in the
African American community.

These intergenerational and interfamily relationships take
precedence and are of high importance. As a result, one
may see many family members visiting and or being
involved in care.
 Family members support each other in healthcare rather
than formal support providers. The family is primarily
supported by family, church and community.
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Care giving for relatives is a traditional female role and
considered an act of love.
One primary caregiver becomes the sole decision-maker.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
View of Illness:
 Good health is viewed as a state of individual well being
and sustained through internal bodily processes and life
style choices. This includes good health practices like
exercise and diet and being in harmony with nature.
 Illness can be viewed as an expression of divine
punishment for sinful behaviors; others consider illness a
result of exposure to cold air or various environmental
impurities.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
View of Illness:
 Three types of illnesses:
 Natural illnesses - the result of a physical cause, such as an
infection, disease, weather, or environmental factors. They
are generally treated with herbs, barks and teas.
 Occult illnesses - the result of supernatural forces, such as
evil spirits, not physical causes.
 Spiritual illnesses - the result of willful violation of sacred
beliefs or of sin, such as adultery, theft or murder. They are
treated by the power of God through religious healers.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Folk Medicine:
 Use of home remedies, such as salves, teas, herbs and over-
the-counter medications for self treatment before seeking
medical advice.
 Use of faith or spiritual healers (vessels through which
divine will is manifested)
 Two types of healers:
 Those who learned the ability to heal from others.
 Those who receive the gift of healing and operate through
the laying on of hands, prayer and incantations.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Folk Medicine:
 Traditional healers believe spiritual forces can intervene in
human affairs to influence sustaining and restoring the
health of an individual.
 Root and herb doctors are types of conjurers (magician)
 They can put a hex or induce illness or ward off evil.
 They are also sought to change a person’s luck especially in
interpersonal relationships.
 It is believed that roots have magical powers and take many forms.
 Others use more of a crisis oriented approach to healthcare
services, such as using the emergency room instead of a
primary care provider.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Time Orientation:
 While it will vary from individual to individual, lower
socioeconomic class African Americans tend to have a
present time orientation.
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This does not mean that they do not recognize the past or the
future, but that living in the present is more important to
them.
For example, African Americans are more likely to say "I'll see
you" than "I'll see you tomorrow." The former implies the
future but is not specific. The future arrives in its own time.
From this point of view, one cannot be late. Conflict may
occur in interactions with others for whom time is very
specific.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Time Orientation:
 African Americans with a present-time orientation may not
see the need to take preventative medication (e.g. for
hypertension) or to finish antibiotics when symptoms
disappear. Detailed explanations may be particularly
important.
 Another result of a present time orientation is that some
individuals may delay seeing a physician until symptoms
are severe, and begin interfering with their work or life.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Dietary Habits:
 African American food is diverse and flavorful.
 There are many dietary similarities to the Puerto Rican,
Haitian, Dominican and all Caribbean cultures; this is
primarily due to the slave routes as described previously.
 Many popular foods in the African American diet are directly
associated with foods in Africa.
 African yams are very similar to American sweet potatoes.
 White rice is popular in West Africa and has remained a
staple food of the African American.
 Okra, sesame seeds, peanuts and black-eyed peas were also
brought to this country.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Dietary Habits:
 Popular term for African American cooking is “soul food”.
 “Soul food” traditionally represents Southern roots and
African American ancestral experience.
 Many of these foods are rich in nutrients, such as
 Collard greens, legumes, beans, rice, potatoes
 Other parts of the diet are low in fiber, calcium and
potassium and high in fat.
 Soul food typically involves fried foods and fatty meats
prepared with rich gravies and sweetened with molasses.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Dietary Habits:
 African Americans have dietary preferences born from
cultural influences and necessity.
 African Americans associate their foods with social
interactions and their history of slavery. Food is about
preserving cultural traditions and fostering strong familial
ties.
 Efforts to get them to change their dietary habits are
perceived as efforts to eradicate the Black culture.
 Their diet has contributed to increased rates of obesity and
cardiovascular disease.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Religious Beliefs:
 Black religion provides significant insights into the social
condition of black people in U.S. society. Black churches
function as centers of social life, ethnic identity and
cultural expression in the African American community.
 African Americans practice a variety of religions such as
Protestantism, Catholicism and Islam.
 Religion, reading religious materials, listening to religious
programs and prayer are important aspects of life.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Religious Beliefs:
 African religious concepts and rituals are enlivened by
rhythmic dancing, drumming and singing.
 These practices are found in African American religion
blended with diverse European American elements, such
as:
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Ancestor worship
Initiation rites
Spirit possession
Healing and funeral rituals
Magical rituals for obtaining spiritual power
Jubilant ceremonies
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Religious Beliefs:
 Church based programs enhance the social integration for
the older African American and building community-based
infrastructure of supportive and health related services.
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In many communities, the church is the site for senior
nutrition and medical day care programs, health
screenings, outreach programs, homecare services or
subsidized housing.
Churches act as supplement to informal family care giving
and referrals to other community-based agencies.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Religious Beliefs:
 Many of their personal histories and experiences have
shaped their view of receiving healthcare as a degrading,
demeaning or humiliating experience.
 Some fear or resent clinics due to long waits, medical
jargon, feelings of racism or segregation, loss of identity
and feelings of powerlessness and alienation in the system.
 Historical events have also influenced their attitudes, such
as the Tuskegee Syphilis Study.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Tuskegee Syphilis Study:
 This study is the most important reason why many African
Americans distrust the institutions of medicine and public
health.
 This 40 year government study took place from 1932-1972 in
which 399 Black men from Macon County Alabama were
deliberately denied effective treatment for syphilis in order
to document the natural history of the disease.
 It has come to symbolize racism in medicine, misconduct
in human research and the arrogance of physicians and
government abuse of Black people.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Tuskegee Syphilis Study:
 African American fear of exploitation by the medical
profession dates back to slavery. Slaves found themselves as
subjects of medical experiments because doctors needed
bodies and the state considered them property and denied
them legal right to refuse to participate.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Examples of Medical Abuse:
 A Black man was taken and forced to sit naked on a
stool in a pit that was heated to a high temperature
with only his head above the ground. Over a period of
2-3 weeks, he was placed in this pit 5-6 times to
determine what enabled him best to withstand the
heat. Each ordeal ended with him fainting and
needing to be revived. The purpose was to make it
possible for masters to force slaves to work longer
hours on the hottest of days.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Examples of Medical Abuse:
 Gynecological surgeries were being performed on Black
women before the days of anesthetics to perfect procedures
to repair vesicovaginal fistulas. Slaves would go through
numerous surgeries that were extremely painful in order for
the doctor to perfect his technique before he would
perform them on white women.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Tuskegee Syphilis Study:
 In recent years there have been links made between
Tuskegee, AIDS and genocide. It has been questioned by
some in the Black community if AIDS was manufactured to
erase their people.
 Racism can influence the practice of medicine. Social
disparities may be occurring despite the lack of any intent
or purposeful efforts to treat patients differently on the
basis of race.
 Healthcare providers should examine their own practices to
ensure that inappropriate considerations do not affect their
clinical judgments.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Holidays – Kwanza:
 Cultural holiday conceived and developed by Dr. Maulana
Ron Karenga in 1966.
 Celebrated from December 26-January 1.
 Derived from Swahili phrase “matunda ya kwanza” (first
fruits) as well as from Christian beliefs from the Old
Testament (first fruits) a term related to an offering to God.
 Rooted in first harvest celebrations practiced in various
cultures in Africa.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Holidays – Kwanza:
 Each day focuses on the seven principles:
 Mkeka(the Mat): foundation on which we build
 Muhindi (the Corn): embodiment of the future
 Kinara (the Candle-holder): roots of our people
 Kikombe Cha Umoja (the Unity Cup): the practice of unity
 Mshumaa (the Seven Candles): sets of values by which we live
 Zawadi (the Gifts): symbols of labor, love of parents and
commitments
 Karamu (the Feast): rewards or fruits of productive labor
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
African American Culture
Holidays – Kwanza:
 Seeks to enforce a connectedness to African cultural
identity; celebration of the oneness and goodness of life.
 Practiced by African Americans of all religious faiths and
backgrounds.
Conclusion:
 It is important to recognize the vast array of characteristics
represented in all ages of Black culture as the beliefs are
embedded in their daily life.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Reference
 Baer, H. African American Religious Experience.
Retrieved December 16, 2010 from
http://hirr.hartsem.edu/ency/african.htm.
 Hargrave, R. (2010). Health and Healthcare of African
American Older Adults. Retrieved December 16, 2010
from
http://geriatrics.stanford.edu/ethnomed/african_ame
rican.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Power Point Presentation
Created by:
Joyce Cunneen, MSN, RN
Fairfield University School of Nursing
ELDER Project Education Coordinator
Monica Starr, BSN, RN
Fairfield University School of Nursing
ELDER Project Program Coordinator
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858