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University of Michigan Health System

Multicultural Health Program

Cultural Competency - Multicultural Health Generalizations: Health Beliefs and Practices

Buddhism and Health Care

Asian American and Pacific Islanders

Asian Indian Culture and Health Beliefs

Cambodian Culture and Health Beliefs

Baha'i Health Beliefs

Caring for Patients from Somalia

African American Health Beliefs

Some African Americans believe in a direct connection between their health and God's plan. Good health is the product of keeping spiritual harmony between mind, body and soul. While illnesses can be treated not only with medical intervention but also with spiritual approaches such as prayer and supportive visits from church ministers and members. Asking patients what they think caused their illness and what treatments they plan to or have already used can help with understanding their health beliefs and practices.

Source: Diversity and Health Care Resource Center (1999). Culture-Sensitive Health Care: African Americans. http://www.diversityresources.com/health2k/health/indexaf.html (disabled) (2004, Feb. 2) Redirected to: http://www.diversityresources.com/rc_sample/
african.html (disabled) Redirected on 2/06 to:
http://depts.washington.edu/pfes/pdf/AfricanAmericanCultureClue4_05.pdf

American Indian Elders

Amish Health Care Beliefs and Practices

The Amish believe all life is given and taken by God and their beliefs tell them to accept God's will as it is.
The Amish prefer to give birth at home and to die at home.
The elderly believe in rationing care near the end of life because they do not want to waste the community's/church's money.
Disability is generally feared more than death. If treatment is refused by the Amish patient, be sure to thoroughly educate him/her if disability from his/her illness is a potential possibility.
Amish couples are usually not deterred from having more children when they have a child with a heredity defect. A child with disabilities is referred to as a special child and is accepted as God's will.
The Amish do not forbid the use of modern medical care. If deemed necessary, they can have surgical procedures, dental work, anesthesia and blood transfusions.
Organ transplants are permitted with the exception of heart transplants (the heart is the soul of the body).
They usually do not have health insurance as it is a "worldly product" and may show a lack of faith in God.
Most Amish need to have church (bishop, community) permission to be hospitalized, as it is the community who will come together to help pay the costs.
The Amish generally do not like to be seen by a health care provider who is in the "learning process". The Amish believe if they are going to pay out-of-pocket for their care, they want to be seen by an experienced practicing provider.
Speak to both the husband and wife regarding health care decisions; they consider themselves as partners in family life.

Source: Lee, D. (2005) Our Amish Neighbors: Providing Culturally Competent Care Multicultural Health Series. Videotape and handout available from the UMHS, PMCH, Cultural Competency Division.

Buddhism and Healing

The Buddhist understanding of good health is a balanced interaction between mind and body, as well as between life and its environment. When such interactions are out-of-balance, illness tends to arise. Buddhist theory and practice are then aimed to restore and strengthen the balance.
In the treatment of illness, Buddhism does not reject modern medicine and its powerful array of diagnostic and therapeutic tools. Rather, it states that these can be put to most effective use in combating illness when based on, and reinforced by, a deeper understanding of the inner, subjective processes of life.
Central to the Buddhist health and healing approach is an emphasis on spiritual strength and an overriding sense of purpose in life, based on compassionate action for others.
While the therapeutic efficacy of these attributes is still not widely recognized by today's medical profession, Buddhism asserts that they make it possible for an individual not only to create value from severe adversity, including sickness, but to also forge an opportunity for personal growth from this adversity.

Source: "Buddhism and Health: Healing the Ills of Body and Spirit." Soka Gakkai International Quarterly. Oct. 1996. Retrieved on Feb. 2, 2007.
http://sokagakkai.info/html1/viewpoint1/today1/budd_health1.html

Cambodian Health Beliefs and Practices

In general, Cambodians (or Khmer) are comfortable with western medicine and with traditional healing practices.

Some of the following traditional healings are carried out by family members and some by traditional healers or kruu Khmer. Some kruu Khmer specialize in medicinal practice with a spiritual component, while others specialize in magic with a medicinal component. Regardless of who carries out the below or other procedures, they are often accompanied by prayer and other spiritual activities.

Koo' (rub) kchall (wind) is used to treat a variety of ailments, including fever, upper respiratory infection, nausea, weak heart, and malaise. A coin is dipped in a mentholated medicine and rubbed in one direction (away from the center of the body) in a symmetric pattern on the patient's chest, back, and/or extremities. This is referred to in western literature as "coining" or "dermabrasion."
Jup (pinch) kchall is used to treat headache and malaise. Jup includes pinching and thus bruising the bridge of the nose, neck, or chest or the practice of "cupping" or placing a small candle on the forehead, lighting the candle, and placing a small jar over the candle. The flame consumes the oxygen and creates a vacuum, thus causing a circular contusion.
Oyt pleung (known as "moxibustion" in the literature) is used to treat gastrointestinal and other disorders. Oyt pleung is seldom done in the U.S., but the abdomens of some Cambodian adults might have four to six 1-2 cm round scars resulting from the procedure.
Massage or manipulation is practiced by kruu Khmer and others.

There often are both spiritual and medicinal elements in healing practices. Magico-religious articles such as amulets, strings, and Buddha images are commonly part of treatment or prevention of illness. Other spiritual or magical means of treating illness include blowing on the sick person's body in a prescribed manner and showering or rubbing with lustral water. As noted earlier, many Khmer see no conflict in practicing or using traditional or magic means of treating illness simultaneously with western medicine. Many would further see no conflict in adding Christian prayer to the mix.

Most Khmer are oriented more to illness than prevention of illness. Childhood immunizations are accepted, but adult immunizations (influenza, pneumonia) are of little interest until illness strikes. Most Khmer do not value early detection or disease screening.

As with most other cultures, respect is essential. Communication is often indirect and requests or questions may be couched in seemingly vague terms. It is unusual for older people to make a direct "no" response to a question or request.

Source: http://www3.baylor.edu/~Charles_Kemp/cambodian_health.html
Accessed October 20, 2005.

Cuban Health Beliefs and Practices

The following information describes some Cuban health beliefs and practices:

Traditional Cuban culture holds that mind, body, and spirit are
inextricably intertwined.
While biomedical or allopathic medical practices are widespread in Cuba and germ theory is accepted and understood by most Cubans, traditional and other theories of illness causality are also incorporated in health beliefs and practices.
Stress is thought to cause a variety of physical and mental health problems.
Supernatural forces (e.g., mal de ojo or evil eye) or a lack of
balance are thought by some to cause or contribute to physical and mental health problems.
Amulets may be worn as protection against supernatural harm.
Regardless of a person's faith, spiritual care/belief is often
incorporated in treatment or explanation of illness.
Persons who are sick may tend to take on a passive and dependent role.
The physician is highly respected and expected to be in a more directive than partnership role.
Decision-making usually includes older or more respected family members.
Hospitalized patients are likely to be attended by family around the clock.

Source: http://www3.baylor.edu/~Charles_Kemp/cuban_refugees.htm

Hinduism and Health

Honduran Healing Beliefs:

Some Hondurans believe that foods and herbs are either "hot" or "cold." When someone is ill, "hot" or "cold" foods or herbs may be prescribed, depending on the illness. Some of the "hot" foods are coffee, oranges and beef. "Cold" foods include coconuts, bananas, salt and seafood.
Some towns may have a traditional healer who prescribes herbal treatments.
Some Hondurans use folk remedies such as tying a cloth filled with sliced raw tomatoes around the neck to treat mumps, placing mashed eggs on plantain leaves on the stomach to relieve an upset, and drinking herbal tea to rid of parasites.
Massage and purging are other traditional healing techniques.

Source: Honduras: Looking at health care. Cultural Profiles Project. Retrieved July 18, 2005.
http://www.settlement.org/cp/English/honduras/health.html

Hindu Healthcare Customs and Beliefs

Hindu healthcare customs and beliefs often contribute to the decision for medical care and choice of healthcare services. The actions of supernatural forces and certain human excesses may be considered important in illness causation among Hindus, regardless of education level. Furthermore, regional variations in the intensity and strength of the belief system are significant. For example, some believe that excessive consumption of sweets causes round worms and that too much sexual activity and worry are associated with tuberculosis. In addition, diarrhea and cholera may be perceived to be caused by a variety of improper eating habits (Taylor, 1976, as cited in Purnell, L. D., & Paulanka, B. J., 1998). Therefore, healthcare providers should not take for granted that all Hindu immigrants, who come from different regions of India, have the same belief systems with the same degree of intensity. Deep-rooted beliefs about illnesses can inhibit the acceptance of scientific causes for disease, resulting in treatment challenges.

Source: Purnell, L. D., & Paulanka, B. J. (1998). Transcultural Health Care: A Culturally Competent Approach . Philadelphia, PA: F. A. Davis Company.

Islamic Health Care Beliefs

Japanese Culture and Health

Jewish Health Practices

There are three major categories of Judaism: Orthodox, Conservative, and Reform. The difference is primarily dependent upon the degree of adherence to ancient law and practice as opposed to acceptance of more modern ways.
In Jewish culture, it is expected that people will be very attentive to a person in distress. Family members will often make sure someone stays with the patient, especially a child.
Expect family members to be very interested in diagnosis, treatment, and personal care of the patient.
If possible, avoid performing surgery or medical procedures on the Sabbath or holy days. Weekly observance of the Sabbath, for example, begins at sundown on Friday evening and ends at sundown on Saturday. Observance of holy days begins at sunset of the evening before.
On the Sabbath and days of religion observance, Orthodox Jews will not touch money, will not write, and will not use electrical appliances, including: hospital bed controls, call buttons, light switches, elevators, automatic door openers, cars, etc. A non-Jewish person can operate these controls for the patient.
Fasting on Yom Kippur (Day or Atonement; most solemn Jewish holy day devoted to prayer, fasting, and repentance; usually 24 hours) is not required of those who are ill, under the age of 13, or with special dietary needs, such as diabetics. Those who need medicine should continue to take it during Yom Kippur.
Prohibiting the shaving of facial hair is observed by Orthodox Jews who conform most strictly to Jewish law.
During discharge planning, know that Orthodox Jews should not travel on the Sabbath.

Source:
Ethnic Resource Guide (1999). Workforce Development and Diversity Strategies Division, Corporate Human Resources, Henry Ford Health System.

Jewish-American Health-seeking Beliefs

According to people who interpret Jewish law, each person has a duty to keep themselves in good health (Latner, 1981, as cited in Purnell & Paulanka, 1998). This encompasses physical and mental well-being, as well as early treatment for illness and prevention.
"Judaism does not permit refusing medication and treatment if there is any chance that it will make the patient well" (Latner, 1982, p.313, as cited in Purnell & Paulanka, 1998).
In ultra-Orthodox denominations of Judaism, the taking of medication on the Sabbath, that is not necessary to preserve life, may be viewed as "work" (i.e., an action performed with intention of bringing about a change in existing conditions), and would therefore be unacceptable.
Halakhah (Jewish Law) differentiates a non-life-threatening illness from a "slight illness" or "mere discomfort." For the non-life-threatening illness, the commandments may be modified (Schwartz & Spero, 1983).
All Jewish denominations recognize that religious requirements may be laid aside if a life is at stake or if an individual has a life-threatening illness.
"Hospice care is fully consonant with Jewish ethics, Jewish customs, and Jewish law" (Rosner, 1993, p. 9).
All individuals are considered to have value regardless of their condition. This includes individuals with developmental disabilities and AIDS. Judaism opposes discrimination against persons with AIDS (Vorspan, 1992).

Source: Purnell, L. D., & Paulanka, B. J. (1998). Transcultural Health Care: A Culturally Competent Approach . Philadelphia, PA: F. A. Davis Company.

Jehovah Witness Health Beliefs & Practices

Jehovah's Witnesses do not accept blood transfusions. Instead, they request nonblood alternatives. Jehovah's Witnesses carry on their person a Durable Power of Attorney for healthcare document that provides a written statement of an individual's medical choices and wishes.
Autotransfusion techniques such as hemodilution and cell salvage are a personal decision.
A Witness may accept immune globulins or serums made with a blood fraction based on personal conscience.
In a rare situation, if court advice is deemed necessary, the patient, the parents or the guardian should be notified as soon as possible of such intended action. This will allow for due process of law and for the court to hear both sides so as to weigh all factors in reaching a decision, including alternative medical nonblood management.
Jehovah's Witnesses provide spiritual comfort and practical assistance to fellow Witnesses during periods of illness or hospitalization.
The use of tobacco and addictive drugs is prohibited. However, the medical use of drugs, including narcotics for severe pain, under the supervision of a physician is a personal decision.
Jehovah Witnesses are opposed to eating foods that contain blood, such as certain types of lunch meats and sausages.
Birth control is acceptable. Gestational surrogacy is considered to be unacceptable.
Abortion is unacceptable. If, at the time of childbirth, a choice must be made between the life of the mother and the life of the child, it is up to the individuals involved to make that decision
Circumcision is acceptable.
Organ transplantation is an individual decision.
Autopsies are acceptable.
Body donation is acceptable and is an individual decision.

Sources: Detroit Hospital Liaison Committee for Jehovah Witnesses (2005).
Watch Tower Bible and Tract Society of Pennsylvania (2001). "Jehovah's Witnesses Religious and Ethical Position on Medical Therapy, Child Care, and Related Matters."
Dobbins Andrews, J. (1995). Cultural, Ethnic & Religious Reference Manual for Health Care Providers (2nd ed.). Winston-Salem, NC: JAMARDA Resources, Inc.

Japanese Religions and Health Practices

Japanese religions play a significant role in health-care practices.
Traditional Japanese culture has derived many of its values and customs from the indigenous belief system of Shintoism and the major religions of Buddhism and Confucianism.
The Shinto belief system is unique to Japan and does not have a specific scripture or dogma, but is based on centuries-old beliefs in a variety of gods. Shinto beliefs include:

Illness is caused by evil spirits, which can be purged with purification rites.
Cleanliness is essential.
Disease may be caused by contact with blood, dead bodies, another’s skin disorder, or other unclean sources.

Buddhism is based on the teachings of Buddha who identified the four noble truths:

Life is full of suffering.
Suffering is caused by desire, or craving.
The end of suffering will come with the end of desire.
An eight-fold path leads to the end of desire:

Right thinking
Right attitude
Right speech
Right conduct
Right livelihood
Right effort
Right mindfulness
Right contemplation

Teachings of Confucius include:

Emphasis on duty and familial loyalty.
Acceptance of one’s place in life.
Performing one’s duties with discipline and grace.

Many people of Japanese ancestry in the U.S. are also practicing Catholics or Protestants
Many Japanese patients believe in the mind/body/spirit influence on health and the need for balance of bodily energies (the Kampo system).
To accomplish this balance, Japanese patients may use typical alternative remedies that include:

Acupuncture
Herbal teas and remedies
Therapeutic massage
Dietary changes to balance “hot” and “cold” energies
Extended rest to alleviate stress and restore mental harmony, perhaps in quiet, solitary surroundings.

Source: "Japanese and Japanese Americans". Ethnic Resource Guide, 3rd. Edition, Copyright Fall 1999. p.38. Workforce Development and Diversity Strategies Division, Corporate Human Resources, Henry Ford Health System.

Polish-Americans: Healthcare-seeking Practices

Many Polish-American patients often seek self-help groups before seeing a healthcare provider. When a healthcare provider is contacted, a family physician might be preferred over a specialist (Fandetti & Gelfand, 1977, as cited in Purnell & Paulanka, 1998). Some Polish-Americans only go to healthcare providers when their symptoms begin to interfere with their lifestyle, and then might still carefully consider the healthcare provider's advice before complying (Kolarska-Bobinska, 1989, as cited in Purnell & Paulanka, 1998). Such patients might also look to other family members and the community to assess the appropriateness of the treatments advised. However, other patients may just accept the treatment plan and follow as requested, choosing not to discuss their options and concerns with their healthcare provider. When it comes to mental illness, some Polish-American patients might look for a physical cause of disease before considering a mental disorder. If mental health problems do exist, home visits are preferred instead of clinic visits, and talk therapy with psychosocial and action-oriented interventions could be preferred. (McGoldrick, Pearce, & Giordano, 1982, as cited in Purnell & Paulanka, 1998). Overall, becoming aware of others' cultural health generalizations can be helpful in understanding different health practices.

Source: Purnell, L. D., and Paulanka, B. J. (1998). Transcultural Health Care: A Culturally Competent Approach. Philadelphia: F. A. Davis Company.

Sikh Perspectives on Health Care

The sanctity of life is an injunction, therefore:
- Assisted suicide and euthanasia are not encouraged.
- Therapeutic genetic engineering is accepted.
Organ transplants and blood transfusions are accepted. Furthermore, the Sikh youth are encouraged to become donors.
When possible, consult the patient and family before procedures requiring the removal of hair.
Advanced directives are individual choices.
Maintaining a terminal patient on artificial life support for a prolonged period in a vegetative state is not encouraged. Most Sikhs will probably specify a period of time during which they would prefer to be kept on life support.
When timely, have relatives and granthi (a spiritual leader) nearby to recite Shabad Kirtan (sacred music) at end-of-life.
When possible, avoid interrupting prayer or meditation when patient care can be delayed.
When feasible, allow the family and granthi to follow traditions to prepare the body for cremation.
The body should be cremated expediently, unless the family is waiting for other relatives to arrive.
There are no contraindication to autopsies.

Sources: Bhatia, J.M. (2004). "Sikh Perspectives on Healthcare." Multicultural Health Series, UMHS, PMCH, Cultural Competency Division.
Andrews, J.D. (2005). “Sikhs.” Cultural, Ethnic, and Religious Reference Manual for Health Care Providers. (3rd edition). JAMARDA Resources, Inc. Winston-Salem, NC.
Sikh Patient’s Protocols for Health Care Providers. http://www.sikhwomen.com/health/care/protocol.htm#Practices
(accessed 1/05)

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