Cultural Competency - Generalizations & Facts
Cultural generalizations can be an effective tool to learning about the health care beliefs and practices of patients. It is important to remember these generalizations are a starting point in your cross-cultural interactions. Every encounter is a cross-cultural encounter.
- Basic Differences
- Six Ways to Recognize Cultural Differences
- Comparing Cultural Norms and Values
- 3 Patient Behavioral Patterns
- Cultural Generalizations
- Cultural Health Facts for Women
Everybody is different, and these differences take many forms which include, but are not limited to:
- Ethnicity and Culture - the sources of the customs, language and sense of identity that people with similar roots often share.
- Geographic background - the neighborhood, city, region or country that shapes an individual's life and values.
- Life experiences - which include family backgrounds, values and traditions, as well as school, work, travel, recreation, and hobbies.
- Beliefs - including one's religion, outlook and philosophy of life.
- Physiology - which determines gender and physical abilities.
- Working styles - the importance of teamwork and conflict resolution, leadership qualities and communication styles.
How we respond to these differences will determine the success of our patient provider relationships and the value we bring to our medical practice.
Source:
Hearts & Hands. Edition No. XIII. 2000, April. Ronald
McDonald House Charities.
Six Ways to Recognize Cultural Differences
1. Communication:
Communication forms the bases of thought for all cultural groups. Our cultural background greatly influences the way in which we communicate with others.
2. Spatial Needs
A person's comfort level is directly related to personal space. Understanding these differences can greatly minimize misunderstandings. For instance, Latinos tend to stand closer to each other, whereas white Europeans seem to prefer more space.
3. Social Organizations
These are groups with whom we interact and assicate ourselves that directly affect our behavior. Their influence helps us become who and what we are.
4. Time Considerations
People are either past, present, or future oriented.
- Past oriented individuals hold on to old values, traditions, and/or beliefs.
- Present oriented people may find it difficult to keep a schedule. They may be late, or miss appointments. They feel they can recover at a later time.
- Future oriented individuals use the present to achieve future goals. They believe that what is done today affects their future.
5. Environmental Control
Environmental control can be divided into two categories.
- External focus: Individuals believe that fate, luck, and/or chance play a great part in their controlling environment. Italians tend to have an external focus: "if I'm predestined to live a shorter life, my smoking won't shorten my life span."
- Internal focus: Individuals believe their behavior will affect their future environment. White Europeans tend to have an internal focus: "if I quit smoking now, I may have the chance to live a longer life."
6. Biological Variations
These variations distinguish the ways in which the genetic makeup of members from a certain culture makes them more susceptible to certain illnesses. For instance, many African Americans over the age of 40 are more susceptible to hypertension, HIspanics to diabetes, and American Indians to tuberculosis.
Source:
"Cultural Diversity in Health Care: A Different Point
of View". [Motion picture, 2000] United States: Envision,
Inc.
Comparing Cultural Norms and Values
Aspects
of Culture |
U.S.
Health Care Culture |
Other Cultures |
| 1. Sense of self class="subheadblue" |
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| 2. Communication and language |
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| 3. Dress and appearance |
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| 4. Food and eating and habits |
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| 5. Time and time consciousness |
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| 6. Relationship, family, friends |
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| 7. Values and norms |
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| 8. Beliefs and attitudes |
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| 9. Mental processes and learning style |
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| 10. Work habits and practices |
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| Source: Lee Gardenswartz and Anita Rowe, Managing Diversity: A Complete Desk Reference and Planning Guide (Burr Ridge, III.: Irwin, 1993), p. 57. Reprinted by permission of the Western Journal of Medicine |
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Regardless of cultural background, behavioral patterns are identifiable in all patients.
Efficacious: healthcare practices may be beneficial even though they may be different from modern Western practices. For example, using acupuncture to treat reduce and reduce pain.
Neutral: healthcare practices may offer no physiological benefit to the patient, but rather an emotional and/or mental benefit. For instance, a woman from the rural south when delivering a baby may put a knife underneath the bed to cut the pain. The woman believes this will help; so psychologically, this belief does help the patient.
Dysfunctional: an obvious dysfunctional practice is eating the wrong food. For instance, consuming over refined sugar and flour is definitely not healthy.
Keeping in mind both behavioral patterns and cultural beliefs can aid in determining the necessity of a patient-provider negotiated treatment plan.
Source:
"Cultural Diversity in Health Care: A Different Point of View".
[Motion picture, 2000]. United States: Envision, Inc.
Cultural Generalizations
The following cultural generalizations may assist clinicians
in interacting with patients from these cultures.
African American
- Address patients by their formal name, not by their first name, especially for elderly patients.
- Make direct eye contact.
- Explain reason for obtaining information, since there may be reluctance to engage in personal disclosure.
- Be cognizant of historic & basic distrust of health professionals by some African Americans.
Amish
- Amish as patients prefer to be on a first-name basis. They also prefer health care providers who will sit with them and discuss their health care questions one-on-one.
- Speaking with the community’s bishop or bishop’s representative may be necessary when making decisions about costs/benefits of care options.
- The Amish may be using herbal products and remedies, both for prevention and treatment.
- The Amish generally stop school at eighth-grade. Use appropriate reading level materials and consider teaching with demonstrations, picture stories, and role-modeling
Chinese
- Ask his/her last name and how to address him/her (husband and wife do not necessarily have the same last name).
- People from China may tend to be more formal than Americans.
- Inquire about food choices.
- Some Chinese patients believe in hot and cold food items to treat disease.
- Treatment decisions are often made by family, rather than by the individual patient.
- The patient may want conversations about treatment to take place when family is present.
- Ask the patient if this is his/her preference.
- Patients believe symptom relief should happen quickly, but they may also think the illness is cured when the symptoms go away.
- Pointing out progress or improvement may make results more obvious and act as an incentive for the patient to continue treatment.
- Be aware of the importance to Chinese patients in "saving face".
- A response to yes/no questions is likely to be "yes", a nod, or "I know."
- These responses may not indicate understanding; they may simply mean that the patient has heard you.
- Ask the patient or family to repeat the information.
- Explain why blood drawing for tests is important.
- Some Chinese patients believe that blood is the source of life for the entire body and is not regenerated.
Muslim
- Be aware that Muslim patients may tend to demonstrate passivity in the presence of an authority figure.
- Explain the need for requesting patients to disclose personal information.
- Muslim patients may be reluctant to share such content with others.
- Consider sharing some bit of personal information to gain the patient's trust.
- Ask about including a family spokesperson rather than only communicating with the patient.
- Control the tendency to be "frank" when communicating a grave diagnosis or a poor prognosis.
Japanese
- Doctors are seen as authority figures and patients and their families may hesitate to ask questions.
- Ask the patient or family members more than once if they have questions.
- Treatment decisions are often made by the family rather than by the individual patient.
- The patient may want conversations about treatment to take place when the family is present.
- Ask the patient if this is his/her preference.
- Patients, particularly the elderly, may not be accustomed to verbalizing their emotions.
- However, they appreciate empathy, respect, and kindness.
- Nonverbal communication is important.
Mexican American
- Traditionally present-oriented.
- Time viewed as relative to the situation.
- This flexibility allows for a feeling of punctuality even when 15-20 minutes late.
- Tendency to feel that something is very wrong if oxygen is required.
- Some spiritual amulets, religious medallions, or rosary beads may be present near the patient.
- Prayers are commonly practiced at the bedside of a dying patient.
Russian
- In Russia, bad news is not given to patients.
- Patients may demand to hear the truth but they do not want to hear the bad news.
- Talk to their relatives first.
- Be aware that Russian patients and families may ask for new treatments or procedures.
- Patients expect doctors to explain, in detail, new tests or new medicines.
- When explaining possible risks, complications and side effects of different procedures, be cautious and optimistic.
- Some Russian patients may overreact.
- Russian patients may be distrustful of doctors.
- They may tend to disobey doctor's orders such as not taking medications as prescribed or combining them with Russian treatments.
- Russian patients may prefer alternative methods or treatment such as massage or mud-therapy, a popular treatment in Russia.
- Some Russian patients may be more likely to follow through with a homeopathic remedy versus traditional Western medicine.
- Psychiatric disease is viewed as disgraceful in Russia.
- Russian patients often do not provide answers regarding any family history of psychiatric illness or past psychiatric treatments.
- The same holds true for sexual history.
Cultural Health Facts for Women
Cultural Competency: A Critical
Component to Address Racial and Ethnic Health Disparities
for Women
A webcast held on 7/14/2005. Includes
the video, transcript, presentation material and additional
resources.
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=
detail&hc=1480
African American: Cerebrovascular Diseases
The mortality rate for cerebrovascular
diseases, primarily strokes, among black women is nearly twice
that of all other women regardless of age.
Source: http://coatopa.com/fi-afram.html
Brazilian: HIV/AIDS
Brazil has the fourth highest number
of reported AIDS cases in the world. The rate of HIV infection
has increased dramatically among women. In 1984, the ratio
of women to men with HIV was 1:100. Today it is estimated
at 1:3. Brazilian women have found it very difficult to convince
partners to use condoms or other barrier methods.
Source: International Women's Health Coalition (2000). http://www.iwhc.org/
Chinese: Breast Cancer
Although Chinese women residing in the
United States have a lower incidence of breast cancer compared
to Caucasian women living in the United States, their incidence
is higher than for Chinese women living in Asia.
Source: Hoeman, S.P., Ku, Y.L., & Ohl, D.R. (1996). Health Beliefs
and Detection among Chinese Women [Electronic version]. Western
Journal of Nursing Research, 18 , 518-33. http://ccbs.ntu.edu.tw/FULLTEXT/JR-MDL/hoeman.htm
French :
Smoking Will Kill You
Until recently, the incidence of smoking-related
diseases among women in France was relatively low and female
mortality accounted for only 3.7 percent of all tobacco-related
deaths in the country. However, if the smoking trend continues
to attract younger French women, female mortality rates attributable
to smoking are projected to increase ten-fold.
Source: The Population Research Institute of the Social Science Research
Institute of the Pennsylvania State University (2000). http://www.pop.psu.edu/searchable/press/nov2098.htm
Hispanic: Alcohol and Drugs
Alcohol consumption is greater among
more acculturated, younger Hispanic women than among their
less acculturated counterparts. Highly acculturated Hispanic
women also are more likely to be intravenous drug users.
Source: Minority Women's Health from The National Women's Health Information
Center of the U.S. Department of Health and Human Services
Office of Women's Health (2000). http://www.4woman.gov/minority/hispanicamerican/drugs.cfm
Muslim: Concerning
Fasting
In the Islamic faith, a woman is exempt
from the daily prayers and from fasting during her menstrual
periods and forty days after childbirth. She is also exempt
from fasting during her pregnancy and when she is nursing
her baby if there is any threat to her or her baby's health.
If the missed fasting is obligatory (during the month of Ramadan),
she can make up for the missed days whenever she can. Source: M. Amir Ali, Ph.D. The Institute of Islamic Information &
Education Chicago, Illinois http://www.iiie.net/Articles/tabid/54/TID/24/cid/1/Default.aspx
Japanese: Menopause
A cross-cultural study of menopause
found that women in Japan rarely reported symptoms of perimenopause
which are common in the west. Post-menopausal Japanese women,
as compared to women in the west, also have lower rates of
osteoporosis and heart disease and a longer life expectancy
(2000).
Source: http://www.pslgroup.com/dg/9020e.htm
Korean: Health Insurance
Compared to the total U.S. population,
more Asian & Pacific Islanders lack health insurance,
with Korean Americans being the least likely to be insured.
Approximately two million Asian & Pacific Islanders (21%)
are uninsured.
Source: Asian and Pacific Islander Health Forum (2000).
http://www.apiahf.org/
Native American: Diabetes
Diabetes rates range from 5% to as much
as 50% in different Indian tribes. Diabetes is the fourth-ranked
cause of death in Native American Women.
Source: Diabetes Statistics for Native Americans, American Diabetes
Association (2004).
http://www.diabetes.org/communityprograms-and localevents/nativeamericans.jsp
Romanian: Struggle Against the Odds on Women's Health
Seven out of ten Romanian women have
never had a Pap smear; eight out of ten have never had a mammogram.
Only 15 percent use modern contraceptive devices. And in a
country where women are ten times more likely to die from
abortion procedures than in the United States, 63 out of every
100 pregnancies end in abortionÑthe second highest
rate in the world, after Vietnam.
Source: International Women's Media Foundation (1999). http://www.iwmf.org/ewire/
Russian: Family Planning Services and STDs
The health of Russian women has suffered
during the economic crisis of recent years. Russian women's
reproductive health has been compromised by a lack of access
to up-to-date, high quality maternity and family planning
services and an increase in the incidence of sexually transmitted
diseases.
Source: http://ideas.repec.org/p/fth/wobate/404.html
Vietnamese: No More Than Two
As good citizens, Vietnamese women are
expected to choose abortion, if necessary, in order to comply
with the two-child policy.
Source: http://www.qweb.kvinnoforum.se/papers/nwec96.html (disabled)
