Hispanic-Americans' health beliefs and cultural competence in healthcare

Hispanic-Americans

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Hispanic: Cultural health beliefs

Cultural group

"Currently, the nation's 53 million Hispanics comprise 17% of the total U.S. population" (Awakened giant, 2012, Pew Center). According to the Office of Management and Budget (OMB) a Hispanic or Latino person is someone "of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race" (Hispanic or Latino populations, 2012, CDC). Hispanics are the fastest-growing U.S. ethnic demographic. "The U.S. Hispanic population for July 1, 2050 is estimated to reach 132.8 million, constituting approximately 30% of the U.S. population by that date" (Hispanic or Latino populations, 2012, CDC). Hispanics are also one of the youngest demographics so the population is likely to expand at a particularly rapid pace in the near future. Given this statistic, it is critical that the needs of the population are addressed in terms of the unique health concerns presented by Hispanics to the healthcare system. 30. 7% of all Hispanics did not have health insurance in 2010 (Hispanic or Latino populations, 2012, CDC).

Diabetes is particularly prevalent amongst Hispanics, along with conditions associated with diabetes and obesity such as heart disease. Mexican-Americans, by far the largest Hispanic population group in the U.S. (63%), have higher rates of diabetes and diabetes-related complications (Awakened giant, 2012, Pew Center). "Mexican-Americans are almost twice as likely as non-Hispanic whites to be diagnosed with diabetes by a physician. They have higher rates of end-stage renal disease, caused by diabetes, and they are 50% more likely to die from diabetes as non-Hispanic whites" (Diabetes and Hispanic-Americans, 2012, Office of Minority Health). "Over 70% of Hispanics are Roman Catholic. General religious values include a fundamental belief that life is predetermined by God's will and a responsibility to the community" (Young 2001: 17)

Health needs: Discussion

The low rate of health insurance and the high rate of chronic health conditions like diabetes are alarming. Expanding health insurance coverage, although important, is not enough. Hispanic-Americans are often victims of poverty, and the environmental conditions of poverty can give rise to a greater likelihood of having a lack of access to fresh fruits and vegetables and places to exercise. "In the Seattle area, a region with an average obesity rate of about 20%, only about 4% of shoppers who filled their carts at Whole Foods Market stores were obese, compared with nearly 40% of shoppers at lower-priced Albertsons stores" (Bouie 2010).

Yet even this is not enough: people must also want to change their health behaviors and be sufficiently alarmed that something is indeed amiss. What was also striking about the Seattle study of Whole Foods was that even when nutritious foods were available and lower-priced supermarkets, shoppers simply did not have the money to buy them, because it was viewed as more cost-effective to buy processed foods, and also easier for people who were hard-pressed in terms of leisure time, as they struggled to 'make ends meet.' "It's not that healthier ingredients are absent or too expensive -- even lower-priced supermarkets have plenty of fresh produce available -- it's that preparing those meals requires more time and energy than is available to most lower-income people" (Bouie 2010).

But as well as economics, cultural preferences can also dictate food choices. Combined with a tendency to associate overeating, and even higher weights in children with prosperity and health, a cultural shift is needed as well as greater access. Caregivers must be sensitive to the perspective of clients, and along the lines of the Transcultural Model of nursing, seek to understand health beliefs from the client's perspective and propose methods of change that are commensurate with that perspective -- for example, stressing the need to be healthy for one's family. According to the model, "Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care. 1. Cultural preservation or maintenance. 2 Cultural care accommodation or negotiation. 2. Cultural care repatterning or restructuring" (Transcultural nursing, 2012, Nursing Theories). In the case of obesity prevention, a combination of strategies two and three may be required. Suggestions to improve meals and incorporate exercise must be done with the family's budget and taste in mind, but culturally congruent care does not mean validating all food and lifestyle choices as health-promoting. Cultural restructuring regarding diet and other beliefs (such as a fatalistic attitude to healthcare) may be required to replace them with more empowering belief structures. However, interventions must still be based in health data: although a larger body size may be normalized within a community for children and adults that does not automatically make it 'healthy,' particularly in the face of a genetic susceptibility to diabetes.

Discuss the management of health and illness needs

Partially because of the lack of health insurance within the Hispanic community, and also partially because of cultural practices, there is often a strong emphasis on self-care and home-based remedies. Using the emergency room vs. relying upon preventative care becomes the fall-back strategy, causing additional expense to the healthcare system and reducing access to much-needed supportive lifestyle-related care from providers who know the patient's culture and health history.

Description and analysis

The dominant healthcare practices of Hispanics are shaped by the stressors of poverty in many instances, and dietary and cultural behaviors are shaped by an adherence to traditional community norms such as a respect for elders and the centrality of food. An overreliance upon unhealthy, high-sugar, high-carbohydrate foods and a lack of a proactive response to dietary modifications are the primary tensions between the community and suggested health practices. A normalized and realistic weight and dietary prescription must be achieved for all patients. The Transcultural Model of Nursing which suggests a negotiation between the norms of the client rather than a radical break and imposition (or conversely, accepting all differences as culturally unalterable) is a feasible model of changing negative lifestyle habits. However, it does not address the problem of under-insurance in the community and encouraging an initial visit to a physician in the first place.