Cultural health beliefs and practices across Southeast Asian, Hispanic, and African-American families

Cultural Diversity in Health and Illness/Health Tradition Base on Cultural Heritage

Cultural beliefs and practices: Nursing challenges

Nurses are apt to use the term 'health' with patients as if it means the same thing to all people, from all backgrounds. However, that is not always the case: different cultures can conceptualize 'health' and 'healthy living' in ways that may be at odds with the nurse's professional concept of health. Cross-culturally, while all of the subjects whom I interviewed for my cultural diversity assignment placed a high articulated priority upon health, particularly the health of their children and family members, more probing questioning revealed distinct differences in the degree to which mental health was incorporated in their family's health status, the importance of preventative health actions through diet and exercise, and the general trust of the health profession's guidelines regarding diet and exercise.

My background

Growing up in a Southeast Asian household, I learned from an early age that food and preventative medicine were a very important part of living a healthy lifestyle. My parents ensured that their children ate plenty of vegetables and low-fat proteins, such as fish and chicken. Tea and other types of herbs were often used as medicine for mild ailments such as nasal congestion and an upset stomach, although serious ailments always lead to a trip to the doctor. Whenever my mother was in doubt about the health status of her children, she often consulted my grandmother. The wisdom of older individuals was an integral and respected part of my daily life, as is the case with many Southeast Asian families (Heritage assessment: Southeast Asian, 2010, Office of Minority Medicine). Although my mother and father never engaged in formal exercise, everyone in the family was expected to help with regular chores, and keep physically active.

Although I am more apt to consciously watch my diet and to engage in physical activity than my parents and grandparents, I learned many valuable lessons by example from my family, namely the importance of having fulfilling mental and physical work, and the need for a low- sugar, varied diet that is healthy and balanced.

Interview results

One difficulty experienced by all of the families I interviewed was the challenge of balancing the time and economic demands of everyday life with leading a healthy lifestyle. For example, while the Hispanic family I interviewed was careful about going for check-ups for their children, often fruits and vegetables were not a part of the family's daily diet. "They are expensive, and the children don't eat them," said the mother, noting that she did not want to buy food that was not consumed. This is difficult, because often children must be exposed to food before they will willingly eat it: when I pointed this out to her, it was evidently anxiety-provoking that children would not 'clean their plates,' and caused her to feel she had failed as a mother.

Psychologically, both she and the African-American family I interviewed were concerned that their children were above 'average' or normal weights and wished the children could be more active and participate in team sports. (Although they also confided they were worried about their children getting hurt, as they had never played sports regularly as children). However, although both sets of parents were aware of concerns about childhood type II diabetes, this had not translated into an overall reformation of the family diet. Unfortunately, Latino and African-Americans have a higher susceptibility to such illnesses than other populations (Lacet 2010).

While certain aspects of health, such as vaccinations and regular dental visits, were a priority, food was viewed as more of an economic concern. Both families said they hated to waste food, or to spend too much money on expensive fruits and vegetables. The psychological impact of being overweight and participating in sporting activities was seen as more of a frivolous social concern. Both sets of parents in the Hispanic-American and African-American families were overweight, which they did not see as a problem for them: they said that their parents also had 'meat on their bones.' I connected this with the attitudes of my own grandparents. While not overweight, they were inclined to see chubbiness in children as cute, particularly given the poverty and hunger in which they had grown up. This belief was echoed in the Southeast Asian family I interviewed.

Health protection and health restoration were less suspiciously viewed than I anticipated: in my preliminary research I read that African-Americans who had experienced racism in the medical system were often mistrustful of doctors and nurses (African-American parents more likely to report distrust of medical research, 2009, JAMA and Archives Journals). My personal interviews indicated that health protection and restoration was of great priority, and overall all of the parents trusted their family physicians. Health promotion through diet was less clearly understood in terms of how it was prioritized and there may have been a failure on the part of family physicians to communicate how to treat obesity in a 'medical' fashion that was meaningful and realistic in the context of the patient's lifestyles and belief patterns.

Nursing: Professional culture

My professional culture of nursing counsels me on the importance of communicating dietary and nutritional needs in a severe and unmistakable way. However, as a nurse I also realize the importance of communicating with a patient to make the advice meaningful: understanding how to make diet and exercise work with the patient's lifestyle is just as important as conveying the importance of maintaining a healthy weight.

Conclusion

Amongst individuals of all cultures, there is often a disconnect between perceptions of obesity in their child and 'reality' (Doolan 2009). But past, cultural memories of food insecurity, even if not directly experienced by the parents can impact how children's and adult's health is perceived, particularly if elders have an important role in the household rearing of children and health beliefs and practices, as in the case of African-Americans and Latinos, as well as Southeast Asian households like my own. Nurses must not assume that the patient 'knows' he or she is at risk for certain health complications before it is too late, and contextualize the presentation of medical information in light of the patient's cultural heritage.