Health beliefs: a cultural division?

Uptake of preventive health programmes seems to be related to people's underlying motivations, attitudes and beliefs about health and illness. Current theories used to account for variance in behaviours by social group (such as the health belief model and locus of control model) explain only some of the variance in these motivations and attitudes, and have not been adequately tested on women from different ethnic minority groups. Health beliefs have important implications for nursing given the role of the nurse in health promotion and patient teaching. This paper identifies and compares the health beliefs of women of Asian origin and white indigenous women living in an inner-London borough, through in-depth semi-structured interviews, and considers the findings in relation to health promotion practices and the role of the nurse. The Asian women rated their health as worse than the white women; this requires further study. Comments and views gathered about the causes of various diseases indicated that it may be unrealistic to fit a person's health beliefs into a distinct model. Beliefs about disease appeared to be culturally sensitive; health education, therefore, must also be culturally sensitive.     

Culturally sensitive case study: A newborn with down syndrome

With the change in the demographic data in the United States, nurses are frequently involved in the care of patients who come from different cultures and hold different beliefs. These patients may have beliefs that differ from the beliefs of the nurse. To give culturally sensitive care, the nurse needs to listen carefully to the family, try to avoid being judgmental, and separate personal feelings and beliefs. Nurses grow within their practice as they learn about different cultures and religions and integrate that knowledge into their nursing care. This article is a case presentation about an acutely ill Hasidic Jewish newborn with Down syndrome. It will review the infant's medical problems, the family's religious and cultural beliefs, and how nursing care was modified to optimize the care. Copyright 2002, Elsevier Science (USA). All rights reserved.     

Experiences with advanced cancer among Latinas in a public health care system

ContextCultural dimensions related to illness are triggered at significant times in an illness trajectory, such as at illness onset or when death approaches. These factors influence views on how illness is understood and managed, which is likely more difficult for minority populations. Although Latinos experience barriers to high-quality health care, late-stage cancer diagnoses, and poor health outcomes, little is known about their experiences with advanced, life-threatening cancers.ObjectivesWe examined Latinas’ experiences with advanced, metastatic cancers to identify sociocultural beliefs that influenced their care.MethodsWe interviewed 24 Latinas taking part in a randomized controlled trial focused on improving quality-of-life outcomes for co-occurring cancer and depression and explored their beliefs about the cause, course, and cure of cancer. This study used a phenomenological analytical approach to explore women’s lived experiences of having advanced cancer.ResultsThemes revealed issues about experiencing advanced cancer that included the following: initial reactions to cancer, disbelief about the lack of pain, economic impact, beliefs about the cause, coping with cancer, beliefs about the cure, and confusion about cancer severity. Sociocultural factors influence misunderstanding and confusion about cancer care but also can be a source of strength.ConclusionProviders need to become culturally sensitive to the needs of underserved Latinas. Denial or ignorance of these issues can create other problems, such as gaps in patient-centered decision making from diagnosis through the end of life.     

Hispanic adults' beliefs about type 2 diabetes: clinical implications

PURPOSE: This integrative literature review focused on Hispanic adults' beliefs about type 2 diabetes. Type 2 diabetes is a progressive, chronic illness with the potential for debilitating complications that disproportionately affect Hispanic adults. By understanding Hispanic adults' beliefs about type 2 diabetes, health professionals will be able to offer more culturally competent health care. DATA SOURCES: Published research reports on Hispanic adults' beliefs about type 2 diabetes were obtained using multiple computerized databases and by searching reference lists of published reports. A total of 15 research reports comprised this review. CONCLUSION: While there was some variance among Hispanic subgroups, in general, Hispanic adults' understanding of the etiology of diabetes was an integration of biomedical causes such as heredity and traditional or folk beliefs such as susto, which is the concept of strong emotions. Hispanic adults believed that diabetes is a serious illness and that they could identify many of the symptoms of diabetes. They identified both biomedical and herbal treatments for diabetes. Negative attitudes toward insulin were common. Religious beliefs also factored into Hispanic adult's explanatory models of type 2 diabetes. IMPLICATIONS FOR PRACTICE: Hispanic adults have a fairly cohesive explanatory model of diabetes. Healthcare professionals can use this information as a starting point to discuss each individual patient's explanatory model of illness, clarify misconceptions, and develop an individualized plan of care.     

Beliefs of mothers in Asian countries and among Hmong in the United States about the causes,treatments, and outcomes of acute illnesses: an integrated review of the literature

An understanding of mothers' beliefs regarding the causes of illness, treatment, and outcome is an important component of culturally competent care. However, little is known about the beliefs of Asian parents related to acute illnesses. The purpose of our article is to synthesize what is known about the beliefs of mothers regarding the causes, treatment, and outcome of acute illnesses in Asian countries and Hmong in the United States. The literature review covers the period from 1990-2000. The electronic bibliographic databases explored included Pub Med, MEDLINE, HealthSTAR, CINAHL, and PsycINFO. Keywords used were beliefs, health beliefs, mothers or parents, cause of illness or etiology, treatment, diarrhea, acute respiratory infection, measles, Asia, and Hmong. A total of 15 articles were retrieved and examined. Using the matrix method, each article was evaluated according to five frames of reference: journal, purpose, sample, method, and findings. Content analysis was used to generate themes. Expressions of belief related to the causes of illnesses among mothers from Asian countries and Hmong who have emigrated from Laos to the United States of America were found to be quite similar. Beliefs about practices were primarily related to feeding and home care. The majority of mothers first provided treatment for their children using traditional practices. When the child did not recover, the mother sought medical advice.     

Chinese Perspectives on Culture and Mental Health

Central to providing culturally appropriate nursing care is sensitivity to and knowledge about the group being cared for. Although “mental health” and “mental illness” are artificial concepts among people who do not differentiate and treat mind, body, and spirit separately, and who may not differentiate illness from other problems of living, many individuals ethnically rooted in one or more Asian cultures enter Western mental health care systems. Quality nursing care requires understanding and respect for traditional values, beliefs, and practices that may differ significantly from those typical of Western European-based societies. Whether clients are traditional in orientation or highly acculturated to Western ways, nurses are responsible for providing culturally appropriate care. This article discusses mental health and nursing care from various perspectives of Asian and Asian-American clients, and in particular those of Chinese descent.     

Concepts related to Chinese patients' perceptions of health,illness and person: issues of conceptual clarity

Since most health professionals who care for Chinese patients are trained using Western medical educational systems, they are often unaware of the complex Chinese culture that influences their patients' responses to care. Discrepancies often exist between health professionals' and Chinese patients' perceptions of health and evaluations of the quality of care.In order to provide culturally sensitive care for this population, the complex Chinese traditional philosophies, such as the theory of yin and yang and the five phases, as well as the philosophies related to the concept of personhood including Confucianism, Taoism and Buddhism are examined first. This is because these theories and philosophies not only influence Chinese patients' values and beliefs, but also determine their perceptions of health, illness and nursing care. The discussion of implications for surgical cardiovascular nursing practice for this particular population are followed.     

Beliefs about AIDS, health, and illness in low-income white women

A sample of 42 low-income white women were interviewed to describe their beliefs about AIDS and its treatment and to determine whether these beliefs were related to the subjects' general framework of beliefs about illness and its treatment. Content analysis was used to classify data. The causes and treatment of AIDS were categorized as professional sector, popular sector, and traditional sector health care beliefs. Professional sector beliefs included the cause and major modes of transmission and prevention identified by the biomedical system and the public health service. Popular sector misconceptions included beliefs about casual transmission and immunizations. Traditional sector beliefs concerned causes such as contamination and impurities and remedies such as herbs and diet. The respondents' explanations for the causes and treatment of AIDS in these three areas were integrated into a lay explanatory model of illness involving germs, resistance, and the immune system.     

UNDERUTILIZATION OF MENTAL HEALTH SERVICES BY ASIANAMERICANS RESIDING IN THE UNITED STATES

Asian-Americans are the fastest-growing minority in the United States, and they are a culturally diverse group. Knowledge about this growing minority population is important for the purposes of planning appropriate mental health care. Asian-Americans living in the United States rarely use mental health services. The reasons for this, along with suggestions for developing more culturally sensitive mental health services, are presented. A model for cultural competence can provide a framework for psychiatric nurses and other mental health professionals (MHPs) to become more aware of Asian-American values and beliefs and provide more culturally sensitive care. Awareness tools are included to guide MHPs in determining whether culturally competent care is available locally to meet the needs of this underserved population.     

Mental illness and Egyptian families

ABSTRACT:  People from Egypt have cultural belief systems about mental illness and its causes that are at variance from Anglo-Saxon-derived understandings that predominate in Australian psychiatry. These differences in understanding can affect how mental health services are experienced and accepted by this cultural group. This paper is a review of the literature on Egyptians' beliefs about mental illness and how families in Egypt cope with a relative with mental illness. Because of limited literature on Egyptians' experience with mental illness in Australia, this paper will be used to shed some light on the way in which people experience mental illness and communicate this suffering in the Australian context, based on what has been known to occur in Egypt. The Zar cult and related practices focusing on belief in the evil eye, magic, and evil possession will be explored. Historical and contemporary mental health care systems in Egypt, and the influence of education and religion are discussed. In order to provide culturally sensitive care, nurses need to be aware of possible influences on belief systems about mental illness. This paper has the potential of helping nurses to gain a deeper understanding of cultures that differ from theirs and to provide care to clients and their families based on respect for the others' beliefs, values, and practices.     

Exploring the Use of Explanatory Models in Nursing Research and Practice

Purpose: To address the lack of information in nursing for delivering culturally appropriate care and provide a framework for nurses to incorporate diverse beliefs and health needs into research and practice. People interpret and react to health and illness events within a cultural system. However, the nursing literature contains little about how to elicit cultural beliefs.
Organizing Framework: Use of Kleinman's (1980) concept of explanatory models (EMs) is explored first, by describing the concept as it was developed by Kleinman, and second, by illustrating how it was used in three research studies conducted between 1990 and 1994.
Method: Individual in-depth interviews were conducted with community-based convenience samples. Data were analyzed using content analysis. Explanatory models were explored with healthy people, with people following illness, and with people having a condition with potential health risks, to illustrate their usefulness in nursing research and practice.
Conclusions: The findings provide a beginning understanding of the complex linkages between beliefs and actions and demonstrate the versatility and usefulness of EMs for nursing research and practice. Assessing models offers one means for researchers and clinicians to explore health beliefs and the linkages between beliefs and behaviors.     

A study of health beliefs and practices of the Yoruba

The issue of how immigrant populations combine traditional and Western health beliefs and practices has not been given due attention. Hence, this qualitative research study of Yoruba immigrants, an ethnic group from south-western Nigeria, living in the mid-Atlantic region of the United States, sheds some light on the question of how best to provide culturally appropriate health care to Yoruba immigrant groups with differences in health beliefs and practices. The study found that there are three types of Yoruba immigrant groups: (1) those who use only Western medicine (though mostly for pragmatic reason); (2) those who combine traditional Yoruba and Western beliefs; and (3) those who combine Western medicine and Christian beliefs.     

Values and beliefs about obesity and weight reduction among African American and Caucasian women.

Designing culturally relevant weight-reduction programs requires understanding of ethnic variations and illness beliefs. Preliminary data on the values and beliefs about obesity and weight reduction were obtained from women of different ethnic/racial backgrounds. Purposive sampling was used to recruit African American (AA) and Caucasian (C) women with a body mass index (BMI)>or= 30 from the general internal medicine clinics of a large tertiary care facility. Four focus groups (2 with AA women and 2 with C women) consisting of a total of 20 subjects were conducted in a 2-month period. AA women cited culture specific barriers to weight loss more so than did C women. AA women and C women also differed on how health care professionals could help them with weight loss. These findings have implications for nursing's role in the design of culturally relevant weight-loss programs.     

Beliefs about AIDS, health, and illness among low-income Latina women.

The purposes of this study were to describe (a) the health beliefs of Latina women about acquired immunodeficiency syndrome (AIDS); and (b) the relationship of these beliefs to the subjects' traditional beliefs about illness and its treatment. The sample consisted of 59 low-income Latina women attending nutrition programs in Los Angeles. A qualitative approach was used to gather the data in semi-structured focus group interviews. Content analysis was used to classify data according to causes of AIDS and prevention and treatment of AIDS. Causes of AIDS included all of the current biomedical and public health explanations of transmission, current popular beliefs and misconceptions about transmission, and long-standing traditional beliefs about the causes of illness. Prevention and treatment of AIDS reflected these same three perspectives. The women's beliefs consisted of accurate, inaccurate, and incomplete information about AIDS. Implications were drawn from the findings for AIDS education and prevention programs which are congruent with the participants' cultural beliefs, values, attitudes, and expectations.     

Native Americans: traditional healing

There are an estimated 4.1 million people who are classified as American Indian and Alaska Native alone or in combination with one or more other races. This racial group composes 1.5% of the total U.S. population. The leading causes of illness and death among American Indians are heart disease, cancer, unintentional injuries (accidents), diabetes, and stroke. American Indians also have a high prevalence of obesity, chronic renal failure, alcoholism, and are at increased risk for mental health issues and suicide. In an effort to build a trusted relationship with these patients and become an active participant in their care, the health care provider must demonstrate respect for the traditions of the American Indian.     

Health beliefs, practice, and priorities for health care of Arab Muslims in the United States.

The Arab Muslim population is one of the dramatically increasing minorities in the United States. In addition to other factors, religion and cultural background influence individuals' beliefs, behaviors, and attitudes toward health and illness. The author describes health beliefs and practices of the Arab Muslim population in the United States. That population is at an increased risk for several diseases and faces many barriers to accessing the American health care system. Some barriers, such as modesty, gender preference in healthcare providers, and illness causation misconceptions, arise out of their cultural beliefs and practices. Other barriers are related to the complexity of the health care system and the lack of culturally competent services within it. Nurses need to be aware of these religious and cultural factors to provide culturally competent health promotion services for this population. Nurses also need to integrate Islamic teachings into their interventions to provide appropriate care and to motivate healthy behaviors.     

Cultural attitudes and beliefs about pain.

Patients and health professionals bring their own cultural attitudes to the communication and interpretation of the patient's pain experience. In this interaction, it is the health professional's knowledge and attitudes that dominate the response to the patient's experience of pain. In Saudi Arabia, a multicultural foreign and local health care team is challenged to understand the cultural beliefs and attitudes toward pain of both patients and team members. To increase cultural understanding and knowledge, a collaborative inquiry project using a culturally diverse group was conducted to learn about cultural attitudes and beliefs on the causes, treatment, and experience of pain. This article presents the knowledge gained from the collaborative inquiry journey of action and reflection.     

Ethno-medical beliefs and practices of Mexican-Americans

Family nurse practitioners working with Mexican-Americans are acutely aware that some of their clients are skeptical of typical Western medical techniques. Examination of their health-care seeking behavior shows that they will seek professional medical care when their self-treatment and folk-healing practices have not been successful. FNPs working in a primary care setting need to have a working knowledge and understanding of these beliefs which are deeply rooted in tradition. Only then can the FNP and other health care practitioners render care that is culturally sensitive and acceptable to the client. This article examines some of the more common afflictions in the Mexican-American culture (and their causative factors) in an effort to broaden health care providers' perspective of cultural differences in health and illness.