The Hispanic culture has barriers to receiving adequate healthcare (Swanson, 2012). Language has been a huge barrier in respects to the practitioner's ability to speak Spanish that has created communication barriers. Long wait times, staff taking adequate time in a caring manner, and the physical environment, whether friendly and facilitates interactions, can develop perceptions of the lack of caring. Some Hispanics believe they receive poor quality of care because of financial limitations, race or ethnicity, or the accent in the way they communicate in English (Livingston, 2008).
The Hispanic culture is community oriented with a high value placed on family input (Swanson, 2012). The family encounters provide a huge amount of support for the Hispanic patient. Members who speak Spanish and English are heavily relied on for support in healthcare decision making. Gender roles are especially appreciated as women do caregiving, even in hospital, and men are the decision makers and bread winners for the family. The Hispanic culture also places high value on whether health providers take adequate time in a caring manner that places communication on a personal level.
The Hispanic population accounts for disproportionate shares of new cases of tuberculosis, diabetes, and sexually transmitted diseases, with diabetes a serious health challenge with increased prevalence, a greater number of factors, and greater incidence of complications (Paulk, 2010). Gaps in research include instruments used to measure cultural competence had no information regarding reliability and validity (Gozu, 2007), lack of consensus on how to measure the concept of cultural competence objectively (Barone, 2010), limited to physician perspective and lack of cultural remedies being considered, and the lack of understanding the different cultures from various areas that make up the Hispanic culture (Swanson, 2012). Other gaps include medicines and physicians from Mexico are better and cheaper, medicines are linked to spiritual beliefs, and cultural-based beliefs about the causes of illness (Swanson, 2012). Hispanics gain health information more through family, friends, churches, community groups, and media sources, such as television, than through healthcare providers (Livingston, 2008).
Three pertinent findings from the interview of a Hispanic subject include the view of Mexico as a better place to receive healthcare and medicine. The subject held the view of illness being caused by the way a person takes care of their self. And, there was the feeling of fear in situations of closeness from individuals the subject does not know, especially where men are concerned. The subject is primarily supported by the father, even though; the subject no longer lives at home.
As long as the family qualified for Medicaid services, United States healthcare was utilized. When the family no longer qualified for Medicaid services, the family utilized Mexico health services and purchased medicine from Mexico because of the cheaper costs. The subject comes from a family of seven, which makes it hard for the father to afford health insurance. It was also viewed that the father would pay higher costs utilizing insurance than by just going to Mexico for care needed for the family.
The primary source for health information was the subject's mother. Even though the subject had friends from various cultures, the subject leaned on the family for health information. The subject was taught through life that illnesses are caused from not taking care of oneself and from doing things that are known to cause illness, such as not wearing an adequate coat when going out in cold weather. The subject was taught that healthcare services are necessary only when getting sick and taking medicine does not get rid of the illness.
The subject stated that fear was felt in situations of closeness with people the subject did not know, especially men. The subject also voiced being silent in awkward situations, such as being questioned, but felt uncomfortable with crowds in silence. The subject was raised in a poor family for most of their life. The subject did not discuss the reasons for the fear, but did state that anger was not allowed to be voiced in the family home, the children were demanded to be quiet when feeling anger, and only feelings of sadness or happiness was allowed to be voiced. The subject also stated that judgmental insults were unacceptable behaviors, they were demanded to be courteous and don't argue.
The subject's views on health and illness are consistent to research in terms of community involvement, physical space, and practicing of cultural medicine (Barone, 2010). The subject primarily obtained health related information from the mother, which is consistent with obtaining health information from the subject's cultural community. Even though the subject did not explain why there were feelings of fear in situations of closeness, especially with men, it could easily be associated with the environment the patient enters, whether friendly or facilitates interactions, that causes the perceptions of the quality of care (Swanson, 2012). It could also be associated with the gender role models of the culture in respects that women are care givers, so they have a nurturing nature that is felt by the patient. Men are decision makers that can give a since of fear to the kind of decisions made in the course of care given.
The views on cultural medicine are consistent with research in respects that some feel that medicines and care are better and cheaper in Mexico than the United States (Swanson, 2012). The subject stated, "…it is cheaper in Mexico," but it could also be a comfort zone for the Hispanic culture to receive medical care in Mexico due to being in the presence of someone from their own culture, feeling they understand more about them in order to provide better care. This is also consistent with community involvement of the culture the subject comes from.
Language barrier was not consistent with research. The subject was born and raised in the United States. Even though Spanish was the language used in the family home, English was learned to be able to go to school and live in the society.
There were no unexpected findings or biases prior to the interview. The subject was born and raised in the United States and had adapted to the customs of the U.S. Even though the parents of the subject were immigrants to the U.S. from two different cultures, the subject learned mostly of U.S. customs because of being born and raised here. The subject did not really know the grandparents to learn of their cultures. The father was from El Salvador and told the subject he did not know his own family. The mother was born and raised in Mexico, but did not visit family in Mexico, so the subject did not get to know the generations of the family other than the parents.
Three effective interventions in caring for the Hispanic patient are culturally competent training of physicians and staff, learning effective communication, and organizational supports (Paulk, 2010). The Hispanic culture involves different cultures from Mexico, Cuba, El Salvador, Spain, as well as other countries that contain different beliefs and customs from each of the areas. Culturally competent training is essential to understanding the different areas that patients come from and the belief systems they live by in order to incorporate the needed care of the patient to the point they understand the care being given. Effective communication comes in the forms of staff from the individual's culture that understands how to communicate with the patient in an effective manner. The use of interpreters can also be utilized, but is better if the interpreter has knowledge of healthcare practices for effective communication. The use of family members who speak both languages can be used, but creates limitations in the communications. Organizational supports can consist of strong commitment to cultural competence, community involvement, recruitment of minority staff, training and professional development, and organizational assessments. A strong community involvement is necessary to understand and assess the needs of the community.
The communication style was not adequate in respects that there is always room for improvement and the more understanding of the culture that is present, the better someone knows of which questions to ask and how to ask them to understand the individual patient. Some patients do not want to fully answer some questions because of some questions being personal, not understanding the necessity of the healthcare provider knowing the answer, or not fully understanding the question being asked. The cultural competence of the provider asking the questions may be limited, which can create problems in communicating effectively. The way questions get asked can create barriers in communication when cultural competency is not adequate, even if the patient speaks the same language of the provider. Cultural competency and understanding the beliefs and customs of patients help to better communicate and ask questions in an appropriate manner to better understand the needs of the patient.
Barone, T. (2010). Culturally-sensitive care 1969-2000: The Indian-Chicano health center. Qualitative Health Research, 20(4), 453-464.
Gozu, A. e. (2007). Self-administered instruments to measure cultural competence of health professionals: A…