Cultural awareness in healthcare is the ability to perceive our own cultural beliefs, values, and customs, and to understand how they shape our decisions and behavior. All cultures have developed systems of beliefs to explain the cause of illness, how illness can be cured or treated, and who should be involved in the health care process. In other words, every culture has beliefs about health, disease, treatment, and health care providers.  Working with a language services provider that specializes in healthcare translations can help you in your communication efforts and aid you in understanding how you can affect better health outcomes.  This is our third in a series of blogs written on culture and beliefs affecting healthcare.

Culture influences healthcare at all levels, including communications and interactions with doctors and nurses, health disparities, health care outcomes, and even the illness experience itself. People in some cultures believe illness is the will of a higher power, and may be more reluctant to receive health care.

Cultural Awareness in healthcare with Hispanics

Among the first concepts that health care providers must take into consideration is that there is sub-cultural variation in the Hispanic population.  Hispanics from several nations share a strong heritage that includes religion and family, but each subgroup of the Hispanic population may have its own cultural customs and beliefs. Subgroups may have a unique use of language, family roles, religion and spirituality, definition of illness, and the use of healing and treatment practices. The Hispanic population in the United States is incredibly diverse having origins in Mexico, Central and South America and the Caribbean. Each of these sub-areas has its own linguistic and dialectic variations as well as differences in beliefs, lifestyles, and customs.

• Some from Hispanic cultures and other cultures may even believe in folk illnesses, such as the “Evil Eye” or Mal de Ojo that can heat the blood of the recipient to cause vomiting and diarrhea. While most Hispanics use primary care physicians and other cosmopolitan sources of health care, some still prefer home remedies as suggested by a folk healer or curandero.

• Many older Hispanic individuals do not appreciate over-familiarity early in a relationship; they may respond with silence and non-compliance. Older adults from many cultures may not make direct eye contact with those they do not know well.

• The language barrier can also contribute to high levels of caregiver stress.

  For more cultural insights into the Hispanic population, the CDC has a publication to increase cultural awareness in healthcare with this specific population.

  Cultural Awareness in healthcare with Asians

  Among Asian cultures, maintaining harmony is an important value; therefore, there is a strong emphasis on avoiding conflict and direct confrontation. Due to respect for authority, disagreement with the recommendations of health care professionals is avoided. However, lack of disagreement does not indicate that the patient and family agree with or will follow treatment recommendations. Among Chinese patients, because the behavior of the individual reflects on the family, mental illness or any behavior that indicates lack of self-control may produce shame and guilt. As a result, Chinese patients may be reluctant to discuss symptoms of mental illness or depression.

  In the Vietnamese culture, mystical beliefs explain physical and mental illness. Health is viewed as the result of a harmonious balance between the poles of hot and cold that govern bodily functions. Vietnamese don’t readily accept Western mental health counseling and interventions, particularly when self-disclosure is expected. However, it is possible to accept assistance if trust has been gained.

  Non-verbal cultural differences, such as head of household responsibilities or rules about making eye contact, are also a factor. For example, the oldest male of an Asian-Pacific Islander family is often the decision-maker and spokesperson, so doctors would talk to the eldest male about health care decisions instead of the patient.

  When traditions or beliefs that are important to the patient are not recognized, it can be a barrier to patient/provider relationship. It is the little things that can be frustrating for the patient. Then the patient feels neglected or disregarded.  Providers should perform cultural assessments and learn about the top 3 or 4 cultures they work with in order to offer culturally competent care.

  A recent NPR podcast “Invisibilia” addresses this with the Cambodian community in Orange County and the collective trauma they have with genocide.  It’s a fascinating listen!

• Cultural Awareness in Healthcare and next steps on what you can do

  Culture plays a huge role in medical interactions. It influences how an individual might view an illness or treatment, for example, and affects how a physician should address an older patient. Culture may also affect the decision-making process. Cultural beliefs can affect how a patient will seek care and from whom, how he or she will manage self-care, how he will make health choices, and how she might respond to a specific therapy.

Groups can have different perspectives on what is a legitimate and effective way of providing care and addressing health conditions.  Lowering one’s blood pressure to a certain level for example, might be central to good health in different cultures.  The mechanisms for doing so though – the use of a drug versus acupuncture – can vary greatly (Fogoros, 2019). Culture is a complex concept. We have to check our own biases and step back and look at ourselves through a stranger’s eyes and be open to doing things differently.  The checklist to the left can be very helpful.  To read more and download the cultural awareness checklist, visit Dr. Alexander Green’s blog.

To read more about the intersection of culture and medicine, visit our other blog.  Karmic consequences in healthcare?  Read more about it.

Creating healthcare communications for other cultures?  Work with a language service provider that specializes in healthcare translations and can advise on a cultural perspective. Give us a call to talk about your next project and need for healthcare translations.