Individual cultural assessment and application

Background
The individual is a 26 year-old female living in Bethesda, Maryland. For the purposes of retaining anonymity and privacy, only the person’s initials (MA) will be used to describe her responses to interview questions related to cultural affiliations, values, kinship, religion, and all other elements relevant to the comprehensive cultural assessment. The Andrews & Boyle (2012) cultural assessment framework is used to guide interview questions and analyze responses. Furthermore, MA’s responses will be compared with results of an interview with someone from MA’s family’s country of origin, which is Mexico. MA was the first in her generation to be born in the United States; both her parents were born in Oaxaca, Mexico. Comparing the results of MA’s interview with the results of an interview with her aunt who still lives in Oaxaca enhances the ability of a healthcare worker to provide culturally competent care.
Cultural Affiliations
MA identifies as Mexican American, and uses terms like “Hispanic” and “Latina” to describe herself. She was born in Baltimore, but her parents moved to Bethesda when MA was eight years old. Both of her parents were born in Oaxaca, Mexico and both speak English fluently. MA claims that both her parents are “proud” of their heritage, and like her, they identify as Mexican American. However, living in an area with a “negligible” Mexican community has impacted their connections with their heritage and culture. Interestingly, their level of enculturation may serve as a protective variable, as “enculturation was associated with increasing life satisfaction,” (Ojeda, Edwards, Hardin, et al, 2013, p. 63). MA claims that she and her parents will visit family members in Oaxaca and Puebla at most once per year but that they are close with their relatives in Mexico.
The cultural affiliations of a Mexican American are bound to be different from the cultural affiliations of a Mexican individual who still resides in Mexico. Comparing MA’s responses with those of her aunt in Oaxaca do reveal that the dual identity issues are not present in the aunt as they are with MA. MA “goes between” her different identities and adapts herself to the situation—something she claims she learned since she was a baby and has no identity conflicts. For example, in Mexico, MA is in “full Mexico mode” as she puts it, speaking only in Spanish. At the same time, she has one foot in each culture, whereas her aunt has both feet planted firmly in the root cultures of Oaxaca and Puebla, where she was from originally. The results of the interviews show that possessing a double identity as an immigrant or daughter of immigrants can lead to a unique cultural affiliation, which is distinct from the cultural affiliations of those who only identify with their one culture and nationality. At the same time, an analysis of MA’s aunt’s responses do show that being from Oaxaca is itself a unique cultural affiliation because of the diversity of Mexico’s own cultural landscape. In other words, a Mexican person from Oaxaca is perceived of differently than if she were from, say, Sinaloa—and also has a self-perception different from persons from other states in the country.
Values Orientation
When asked about health values, beliefs, and attitudes, MA chuckles because her father is a doctor who has “strong attitudes” about health, and who inculcated into his family a sense of respect for the medical profession in general. MA claims that she is much more interested in holistic and complementary medicine than her father, who is disparaging about anything that is not solidly grounded in the scientific literature. MA jokes about her father’s attitudes, and when pressed about her own, ultimately admits that she trusts the medical model even though it cannot “fix everything,” as she puts it.
Because both her parents have advanced degrees in their respective fields, MA’s attitudes towards educational attainment are goal-driven. MA is currently pursuing a degree in public policy and political science. Both her parents received their Bachelor’s degrees in the United States, after which they received work permits and eventually full United States citizenship. Their educational attainment was something they never took for granted, passing on their belief in education not just as a pathway to career achievement but as a means to fulfilling higher needs such as knowledge, independence, and self-fulfillment. MA claims that she is strongly oriented towards using her power and privilege to help others, which is why she became interested in public policy.
In terms of relating with people from other cultures, MA almost seems surprised by the question. She claims that while Bethesda might not have the “strongest Mexican community in the country,” that she nevertheless feels comfortable as a minority. MA’s perception of the demographics of Bethesda are reflected in United States Census (2016) data showing the area with less than 7% Latino/Hispanic. She says that she understands the implications of “passing as white,” and that most people do not realize that she is Mexican or Latina until they become close friends, hear her last name, or direct pose the question. MA is used to interacting with people from different backgrounds because she went to a school that had kids from “all over,” as she puts it.
Communication
At home, the family weaves between English and Spanish, using whatever language best describes the situation and their feelings. MA also acknowledges that they speak the language that makes their guests most comfortable, as when they have visiting relatives who do not speak English as well as they do. MA describes their family library as consisting of books in both languages, her mother having been a professor of literature for ten years followed by work at the Library of Congress. MA’s father is a surgeon who had worked for years at the main Johns Hopkins medical center and who was recently transferred to Suburban Hospital in Bethesda to lead the surgical team there. Given MA’s health-seeking behaviors and those of her parents, it is clear that there are “substantial differences between English-speaking versus Spanish-speaking Hispanics” in terms of acquiring health-related screenings—disparities that are only “partially explained by SES and access to care,” (Liss & Baker, 2014, p. 228).
In terms of non-verbal communications, MA jokingly refers to her heritage as a strong factor in their “massive hugging” and other signs of emotional expressiveness. MA claims that no one in their family, regardless of their gender or age, has a problem with emotionality and freely admits their feelings even if sometimes leads to miscommunications when interacting with people from more reserved cultures. Being around white people most of the time means that MA and her parents have adapted somewhat to what she calls “mainstream” cultural norms of communication. MA also points out that gender may play more of a role in determining communication styles in her family, with her father being much more reserved than her mother. On this note, MA’s responses provide an ideal counterpoint to the interview with the relative in Mexico who states almost the opposite in that men and women in Oaxaca are emotionally expressive verbally and nonverbally.
Health-Related Beliefs and Practices
MA’s health-related beliefs reflect her father’s position as a head surgeon at a Johns Hopkins institution. When asked specifically about body image, MA admits to having some struggles in the past. She was “borderline bulimic” in high school, and felt competitive with the other females in her class who were obsessed about their weight. MA claims that her cousins in Mexico are heavier than she is but more comfortable with their appearance than she is, and her statements were substantiated through the interviews with the aunt in Oaxaca. Another major difference in health-related beliefs and practices between MA and her relatives in Mexico is that the latter tend to be more superstitious, something that her aunt admits to freely but laughs because she knows her brother does not approve of their herbal remedies and uses of traditional healers in the community. MA also laughs, and is “on the fence” about the traditional healing practices. She states that she understands the role of traditional healing in the community, but does not necessarily believe that their methods work to achieve specific health-related goals.
Nutrition
Food is important to MA and her family, as it is for her relatives in Mexico. However, her father worked long hours and was only present for family dinners two or three times per week. Now that he is the head of the surgery department at Suburban Hospital, he has a more dependable schedule and spends more time at home. MA no longer lives with her parents but goes over to their house every Sunday for a big family dinner in the evening. Alternatively, their family hosts gatherings to watch football on Sundays. At those events, lots of food is served. Generally the food is of high quality, as MA’s mother is a good cook who is interested in healthy eating and who almost never eats fast food. MA inherited her values about food and nutrition from both her parents, and also claims that her friends are very healthy eaters who scorn junk food. Many of MA’s friends are constantly on a fad diet like being gluten free, something that MA used to try but has recently “made peace” with food by focusing on preparing healthy meals for herself at home based on a mainly plant-based diet.
On this point, there are several notable differences between MA versus her aunt regarding food choices and eating habits. MA’s aunt in Mexico prepares traditional meals at home for her family every day. Although the meals are homemade, they are rich and contain a lot of animal fats. The aunt’s responses substantiate the research in biocultural perspectives on nutrition practices in Mexico (Leatherman, Hoke & Goodman, 2016). Leatherman, Hoke & Goodman (2016) found that delocalization and urbanization have dramatically changed the Mexican diet and food preparation practices. MA’s aunt also eats out a few times per week without any consideration for health and nutrition, and admits to being a little overweight. When asked, MA says that her aunt is not obese but that her father does pressure his sister to lose weight for health purposes.
SES Considerations
MA and her parents are from a high SES status and are conscious of the advantages that their status confers. MA claims that her parents continually inculcated strong values in her and her siblings when they were growing up, refusing to spoil their children or making them feel like they deserved success simply because they were from a privileged background. Being relatively wealthy meant that the family focused on career attainment rather than worrying about putting food on the table, something that some of MA’s relatives in Mexico need to do because they are more of a working class socioeconomic status. MA’s aunt is a nurse who earns enough that she never worries about money, and she does have relatives who she gives money to regularly because they are less comfortable than she is.
Educational Background
MA is working on her Master’s Degree. Her mother has a Master’s degree, and her father is a doctor. Therefore, educational attainment is a family value. The value placed upon education stems from MA’s grandparents in Mexico, who were also highly educated. MA strongly affirms the connection between educational attainment and health literacy, and states that her familiarity with the hospital environment from her father has also tremendously improved her health literacy too.
Religion and Spirituality
MA states that her family is not at all religious, and that their celebration of Mexican cultural festivals is more about cultural pride than religiosity or superstition. These attitudes among MA as a Mexican American differ considerably from the religious practices and spiritual beliefs of MA’s aunt in Oaxaca. MA’s aunt is deeply spiritual, both in terms of participation in regular religious rituals but also in terms of personal spiritual beliefs. MA’s aunt is Catholic, but MA clarifies that some of her relatives in Mexico follow some folk religious traditions that combine indigenous with Catholic practices. For example, the family in Mexico participates in the lively Day of the Dead celebrations in Oaxaca. MA has attended the festivities on occasion in the past.
Kinship and Social Networks
MA is one of three children. Her older brother lives in New York, and her younger sister is attending university at Brown. MA lives alone. Although MA does have one cousin in Mexico who lives on her own too, MA’s aunt lives with her husband and two of her adult children as well as her mother in law. Gender plays a far bigger role in the aunt’s role in the family, versus MA’s own role and that of her mother. Interestingly, results from both the interview with MA and her aunt show that indeed, kinship patterns impact rates of obesity, with both high SES and high emotional connectivity being linked to lower rates of obesity and other health-related outcomes (Lindberg, Ek, Nyman, et al, 2015). In other words, high SES and strong kinship and social ties can be framed as protective variables in multiple cultural contexts.
Biocultural Variation
Similar to the United States, rates of diabetes are relatively high in Mexico, as are rates of obesity. Therefore, the concurrences between MA’s family in Bethesda versus the health status of her aunt in Mexico make sense in light of research on diabetes prevalence and obesity rates in Mexico and the United States (Potter, Ulijaszek, 2013). Because MA’s father is a doctor and her mother is health-conscious, they have been long aware of risk factors, eat well, and practice other health-seeking behaviors in their lifestyle choices. MA claims that several of her relatives in Oaxaca and Puebla are overweight, but most are aware of the connection between lifestyle and health outcomes. MA’s aunt is a nurse who is aware of the risk factors toward diabetes and obesity.
Developmental Considerations
Developmental considerations include issues related to critical life events, perception of elders and aging, and family evolution. As Telzer, Tsai, Gonzales, et al (2015) point out, “family obligation is an important aspect of family relationships among families from Mexican backgrounds and can have significant implications for adolescents’ well-being,” (p. 75). These results parallel the interview responses from MA and her aunt, who both fluidly discussed their own rites of passage, attending critical events in the family’s development in both Mexico and in the United States such as MA’s sister’s wedding, and the implications for family cohesion.





References

Andrews, M. M., & Boyle, J. S. (2012). Transcultural concepts in nursing care. 6th Edition. Appendix A
Leatherman, T.L., Hoke, M.K. & Goodman, A.H. (2016). Local nutrition in global contexts. In New Directions in Biocultural Anthropology. John Wiley.
Lindberg, L., Ek, A., Nyman, J., et al (2015). Low grandparental social support combined with low parental socioeconomic status is closely associated with obesity in preschool-aged children: a pilot study. Pediatric Obesity 11(4): 313-316.
Liss, D.T. & Baker, D.W. (2014). Understanding Current Racial/Ethnic Disparities in Colorectal Cancer Screening in the United States: The Contribution of Socioeconomic Status and Access to Care. American Journal of Preventative Medicine 46(3): 228-236.
Ojeda, L., Edwards, L.M. Hardin, E.E. et al (2013). The role of behavioral and cognitive cultural orientation on Mexican American college students’ life satisfaction. Journal of Hispanic Higher Education 13(1): 63-74.
Potter, C.M. & Ulijaszek, S.J. (2013). Predicting adult obesity from measures in earlier life. Journal of Epidemiology and Community Health 67(12): 1032-1037.
Telzer, E.H., Tsai, K.M., Gonzales, N., et al (2015). Mexican American adolescents’ family obligation values and behaviors: Links to internalizing symptoms across time and context. Developmental Psychology, 51(1), 75-86.
United States Census (2016). Quick Facts: Bethesda. Retrieved online: https://www.census.gov/quickfacts/fact/table/bethesdacdpmaryland/PST045216