Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). A wide array of herbs offered at La Botanica Orquida in northeast Georgia. There is ample evidence that Latinos, especially those of Mexican and Central American origin, face significant obstacles to obtaining health care, especially language barriers.4 Many hospitals and offices lack trained interpreters and rely on ad hoc interpretation by bilingual staff or even the children of patients. They are written by health care providers and others who work with the relevant Latino sub-community. They are also far more likely than whites to feel that they are treated unfairly by providers or by the medical system.8, These gaps and dissatisfactions become even more troubling in the context of significant disparities in access to health insurance and to the health care system in general. Developing cultural sensitivity to Latino patients entails recognizing and appreciating their diversity. Census Bureau News, "U.S. Hispanic Population Surpasses 45 Million," Press Release, Thursday, May 1, 2008; U.S. Census Bureau, "Hispanic Americans By the Numbers," accessed at www.infoplease.com/spot/hhmcensus1.html; and U.S. Census Bureau, "State and County QuickFacts: Santa Clara County, California," 2006, accessed at http://quickfacts.census.gov. placed on religious beliefs in the maintenance of health and the treatment of illness. They Hear You is SAMHSA's underage drinking prevention campaign that helps parents and caregivers start talking to their children early about the dangers of alcohol. America is rapidly changing as a cultural collision between Latino and white culture transforms lives on both sides of the border. Chartbook for Hispanic Health Care (Agency for Healthcare Research and Quality) This Hispanic Health Care chartbook is part of a family of documents and tools that support the 2014 National Healthcare Quality and Disparities Report (QDR). Herbal therapies play a major role in Latino folk medicine, so knowing the Spanish names of common herbs can be helpful (eTable A). Margaret E. "Group Methods and . Qualitative data analysis of the 75 symptom and treatment statements was completed, and data were grouped according to symptom and complexity of treatments. The Hispanic culture differs from that of America despite the ever-growing integration of both populations. For those who have a serious mental health disorder, around 44 percent did not receive treatment. Active Journals Find a Journal Proceedings Series. You recommend a compromise treatment plan for her diabetes and grief. This consortium study defined distinct somatic cancer gene mutation patterns by race/ethnicity and sex among patients with early-onset colorectal cancer (CRC), yielding novel biological clues into early-onset CRC disparities. al., "Racial and Ethnic Disparities in U.S. Health Care: A Chartbook" (The Commonwealth Fund, March 2008), Charts 6-25 and 6-26; and Joseph R. Betancourt, Alexander R. Green, and J. Emilio Carrillo, "The Challenges of Cross-Cultural Healthcare-Diversity, Ethics, and the Medical Encounter," Bioethics Forum 16 (3). National Network to Eliminate Disparities in Behavioral Health, SAMHSA National Survey on Drug Use and Health (NSDUH), AHRQ National Healthcare Quality and Disparities Reports, OMH National Standards on Culturally and Linguistically Appropriate Services in Health and Health Care (National CLAS Standards), 988 Suicide & Crisis Lifeline This traditional food is high in fiber and pectin and lowers lipid levels by binding bile acids; when eaten with other foods, it reduces the glycemic index of the meal by 50 percent. Obesity and genetic factors increase risk. Get to know your fellow coach managers and direct reports. More than half of Hispanic young adults ages 18-25 with serious mental illness may not receive treatment. savoie's real cajun dressing mix; PURPOSE Though patient variables are likely to play an important role in the undertreatment of depression, little is known of patients' perceptions of standard depression treatments. Similarly, a patient's silence when presented with a difficult treatment plan, rather than conveying agreement, may in fact indicate that patient's desire to maintain a polite relationship with the health care provider and avoid difficult or conflictual situations. 16"Communicating with Your Latino Patient," University of Washington Medical Center, 2007; accessed at https://depts.washington.edu/pfes/PDFs/LatinoCultureClue.pdf. Maria needs to eat fruit; she should also consume more fiber to counteract her high-carbohydrate diet. To provide an updated understanding of folk and traditional medicine (FTM) among Hispanic parents in the United States, we surveyed 200 caregivers identifying their child as Hispanic in a pediatric primary care clinic about their cultural health beliefs and practices. al., "Culture, Illness, and Care," 252. Courtney Parker, CC BY. Spanish language handouts are a better option. Mexican Americans are much less likely to be treated for hypertension than non-Latino whites (35 versus 49 percent).11 Targeted public health campaigns are needed for hypertension, diabetes prevention, and weight control. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Medical practices and hospitals should strive to create an environment that is warm and welcoming to Latino patients. A child's failure to thrive may be attributed to mal de ojo (evil eye), a hex conveyed by an envious glance. She has lost 10 lb (4.5 kg), and for the first time has acceptable blood pressure and fasting glucose levels. Web-based resources are available to assist physicians in understanding Latino health beliefs (Table 4). Her visits to your clinic have been challenging because of her limited English proficiency, late arrivals, and nonadherence to several medications. 17.4% were Hispanic, and 49.1% were White. For example . 3 percent report that they have trouble navigating the U.S. health care system. Natural laxatives such as oil with orange juice (or just oil in some cases). Hispanic and Latino are often used interchangeably though they actually mean two different things. Guide to Statistics and Methods; Guidelines; Hair Disorders; Health Care Delivery Models; . Barriers to care have resulted in striking disparities in quality of health care for these patients. Importantly, many Latinos themselves prefer the latter term, since it avoids reference to the more recent European colonial powers (from "Hispania," or the Iberian Peninsula) that laid claim to Latin America in the fifteenth and sixteenth centuries. Maria is a 54-year-old Mexican immigrant with type 2 diabetes mellitus, hypertension, and obesity. The term "Latino" has become more commonly used in recent years to describe those whose primary ethnic heritage stems from Latin America. Moreover, the family itself can play an enormously important role in supporting and empowering the patient within the medical setting. Specifically, to Latin America, to people from the Caribbean, South America, and Central America. High cholesterol or dyslipidemia (unhealthy blood fat levels) . 17Delese Wear, "Insurgent Multiculturalism: Rethinking How and Why We Teach Culture in Medical Education," Academic Medicine 78/6 (June 2003): 549-554. Author disclosure: No relevant financial affiliations to disclose. Approximately 43 percent of Mexican Americans older than 20 years are obese, compared with 33 percent of non-Latino whites. Karen Peterson-Iyer is a program specialist in health care ethics at the Markkula Center for Applied Ethics. Copyright 2013 by the American Academy of Family Physicians. They also must beware of the tendency toward "othering"; that is, the penchant to understand non-dominant groups as inferior, exotic, or deviant.17 Some efforts at cultural competence may incline toward these unhelpful postures. | Mar 1, 2011. Alonso, M., Val, E., & Rapaport, M. M. An open-label study of SSRI treatment in depressed Hispanic and non-Hispanic women. As with any circumscribed ethnic group, there is, of course, enormous cultural heterogeneity among Latino patients-to the point where it seems almost ludicrous to try to identify broad cultural tendencies across such diversity. Mozote (Bidens pilosa) to refresh and clean the stomach. Addiction is a chronic, yet treatable brain condition similar to other chronic illnesses like diabetes. 12Arthur Kleinman, Leon Eisenberg, and Byron Good, "Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research," Annals of Internal Medicine 88: 251-258 (1978). Her face lights up when you share this. Our Health. Visit the SAMHSA YouTube channel, Visit SAMHSA on LinkedIn Respeto implies attentive concern for the patient and respect of his or her personhood and age, especially if the patient is older. Treatment referral and information, 24/7, Visit the SAMHSA Facebook page Approximately 11.8 percent of Latinos older than 20 years and 13.3 percent of Mexican Americans have diabetes. A large selection of herbal teas are available from botanicas or yerberas in most Latino neighborhoods. This is because of barriers to accessing care and stigma surrounding behavioral health problems (Hostetter & Klein, 2018). SAMHSA will be highlighting the important role each of us has in maintaining a healthy life and ensuring a productive future. Similarly, in a national epidemiological survey of Latino households in the U.S., of those who reported awareness of a problem with at least one symptoms (overweight, binge eating, or weight control), only one fifth to one third of Latinos in this sample reported ever receiving treatment for an eating disorder (Alegria et al., 2007). Hispanic refers to people who speak Spanish and/or are descended from Spanish-speaking populations, while Latino refers to people who are from or descended from people from Latin America. Table 3 lists some common Latino folk illnesses, their symptoms, and treatment.19 Therapies for these conditions may seem odd, but most are harmless, with a few exceptions. Mexico's rate of C-sections is 30 percent above the rate recommended by the World Health Organization. In either case, they are treated with the opposite hot or cold treatment. In the LEARN model, which is illustrated in the Case Study below,28,29 the physician should first sympathetically listen to the patient's perception of the problem, explain his or her perception of the problem to the patient, acknowledge and discuss any differences and similarities between the two views, recommend a treatment plan, and negotiate agreement.30 Use of the LEARN technique identifies and helps resolve any cultural differences that may arise. 4 Another. Older patients should be addressed as seor or seora rather than by their first names. 3 Essentially, a curandero or curandera removes mental, emotional, physical and spiritual illnesses or imbalances. This reliance does not necessarily replace modern biomedicine; rather, herbal remedies and other non-allopathic treatments often are utilized in conjunction with Western medical care. Latinos have disproportionately higher rates of obesity and diabetes mellitus (Table 1).914 Approximately 43 percent of Mexican Americans older than 20 years are obese, compared with 33 percent of the non-Latino white population.12 Diabetes and hypertension are closely linked with obesity; 11.8 percent of Latinos older than 20 years have type 2 diabetes (13.3 percent of Mexican Americans), making it the foremost health issue in this population.14 A higher-calorie diet, a more sedentary lifestyle, and genetic factors contribute to this problem. 14 Kleinman et. Hayes-Bautista relayed that one important theme presented in the collaborative workshops is how . The initial arrival of Chinese immigrants to the United States began as a slow trickle in the 1820s, with barely 650 living in the U.S. by the end of 1849. Notably, studies that disaggregate Hispanics by their ancestral origin may provide greater insight into the sources of ethnic disparities. Still, being aware of these larger values may help health care providers to understand a particular patient's behaviors and actions in the context of larger cultural inclinations. Some trials examined overall CAM use, whereas others looked at. Garlic and onion are used extensively, as is aloe vera. Latino refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.1 Latinos comprised nearly 16 percent of the U.S. population in 2009, making them the largest minority group.1 By 2050, it is projected that they will comprise up to 30 percent of the U.S. population.2 The three largest subgroups include Mexican Americans (about 65 percent), mostly settled in the Southwest, Puerto Ricans (9.1 percent) in the urban Northeast, and Cuban Americans (3.5 percent) in Florida.3 However, these demographics are rapidly shifting as Latino populations are increasingly integrated into suburban and rural communities throughout America. Hispanic people are the youngest population, with 33% below age 18, and 57% below age 34 (Figure 4). Recent immigrants may face additional obstacles to care, including illegal immigration status (fears of deportation), illiteracy, and a radically different set of health beliefs. While this has been a challenge across patient populations, it has been especially pronounced among the U.S. Latino population, which shows a rate of non-adherence almost 40% higher than the rate seen in the U.S. Caucasian population. 4Center for Disease Control and Prevention, "Leading Causes of Death," accessed at www.cdc.gov/men/lcod/index.htm; and Richard Allen Williams, "Cultural Diversity, Health Care Disparities, and Cultural Competency in American Medicine," Journal of the American Academy of Orthopedic Surgeons, Vol. Her husband died in an industrial accident four years ago, and she is still grieving. The Concurrent Integration of Treatment Modali-ties in Social Work Practice." D.S.W. During Maria's next visit, you arrange for a telephone interpreter, which enables you to take a brief social history. It took extra time in relationship-building (personalismo), a team approach, an interpreter, negotiation, and a bit of research to make it all happen. Manybut not allfolk and herbal treatments can be safely accommodated with conventional therapy. In this article I will make use of both terms, relying more heavily, however, on "Latino. Although the program ended in 1964, the immigration trend has continued to the present day, and many of these immigrants work as migrant laborers in the U.S. agricultural system. For instance, a doctor could perceive as evasive a patient who declines to make direct eye contact, when in fact,that patient may be demonstrating respect for the doctor's position and authority. Thus, when working with diverse populations in the United States . Patients should be actively involved in their care rather than passively acquiescing to instructions. National Prevention Week is a SAMHSA-supported annual health observance dedicated to increasing public awareness of, and action around, substance use and mental health issues. One way of describing the distinction is that modern Western doctors are primarily trained to diagnose and treat diseases (in a purely biomedical sense), while traditional healers approach the patient as one suffering from an illness-that is, a culturally located experience of sickness.12 Among some Latino subcultures, folk illnesses such as empacho (a digestive ailment), mal de ojo (the "evil eye"), mollera caida (fallen fontanelle), susto (fright illness), and nervios (vulnerability to stressful experiences) are commonly described; and traditional healers range from curanderos (Mexican healers) and sobadores (traditional masseuses and bone setters) to yerberos (herbalists) and espiritistas (spiritual healers).13 Reliance on folk medicine certainly is not to be found in every, or even most, Latino communities; but it does exist as part of the health care landscape and is found among many patients from Mexico, as well as from various other regions within Latin America. Interferon gammarelease assays are preferred to tuberculin skin testing in immigrants with a history of BCG vaccination. Herbs often have hot or cold properties; hot herbs are used to treat cold conditions, and vice versa. Master the basics of the Virta Treatment and understand the full patient experience. Hispanics' experience with discrimination or being treated unfairly varies greatly by age. Cross-cultural interviewing can be facilitated by following specific guidelines, and several mnemonics have been developed for use by physicians. 1 (Sept. 2007). First-generation immigrants are likely to seek out curanderos, whereas their children may scoff at the idea. dissertation, University of Southern Cali-fornia, 1973. Such patient activation or motivation for change is more challenging in foreign-born Latinos, but may be achieved through active dialogue and discussion.32 Hopeful involvement in the care plan should replace fatalism or resignation. Latino/Hispanic families can provide much support to a child with the disorder and protect him or her from the development of conduct problems (Bauermeister et al., 2005). Racial/Ethnic and Sex Differences in Somatic Cancer Gene Mutations among Patients with Early-Onset Colorectal Cancer. Information. She might also stop giving her infant vitamins, because they are a hot therapy.24 It is often possible to safely accommodate conventional and alternative treatments (in reasonable doses) if potential conflicts or interactions are identified in advance. In an NIMHD-funded study, Hirsh and a graduate student, Nicole Hollingshead, are testing whether a computer-simulated intervention can change doctors' attitudes and lead to better treatment for African Americans. Low levels of hypertension awareness are a major problem in the Latino community. In fact, the number of Latino physicians dramatically lags behind Latino population growth; and, according to cross-cultural health care expert Larry Purnell, Latinos are the most underrepresented major minority group in the entire U.S. health care workforce.5 This discrepancy contributes to many different linguistic and cultural hurdles for Latino patients, as well as for their health care providers. This article provides an evidence-based review of the prevalence, presentation, and management of major depression in primary care in this heterogeneous ethnic group. Underwriting for these materials was provided by a generous anonymous donor. These include simpata (kindness), personalismo (friendliness), and respeto (respect).25 Simpata emphasizes politeness and conflict avoidance. Unfortunately, few studies disaggregate Hispanic patients by race to understand its implications on treatment and clinical outcomes such as mortality. Latino healing traditions include curanderismo in Mexico and much of Latin America, Santeria in Brazil and Cuba, and espiritismo in Puerto Rico.19 Curanderos, traditional healers, distinguish between hot and cold illnesses (Table 220 ) and occasionally between natural and unnatural (sorcery-related) diseases.19,20 Patients may seek out the care of brujos or brujas (wizards or witches) for the latter conditions. These may include antioxidants, probiotics, or a combination of medications to target any of the contributing factors. A 2020 review study found that those in the Hispanic community may face several barriers that affect access to treatment, including: higher rates of unemployment less likelihood of having. Objective Little is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. , may be one strategy to increase treatment . A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. The 2017 ACC/AHA hypertension guidelines lowered the blood pressure threshold for diagnosis of stage I hypertension to 130-139/80-89 mm Hg. You use teach back to ensure that Maria understands your directions, and you provide her with Spanish-language handouts about the benefits of controlling her diabetes and hypertension. Culturally competent care necessitates cross-cultural training, which is increasingly included in medical education, but with the realization that cultural competency is a lifelong learning process rather than an end in itself.8. Latinos are a multiracial, multicultural group." Some Mexican Americans have been in the US for many generations. Hispanics generally use multiple methods to treat themselves which involve prayer, folk medicine, prescription medications left over from friends as well as new medications prescribed by physicians. Visit SAMHSA on Instagram Asian or Hispanic ancestry. Home remedies, along with "lay healers" are also an integral part of the healthcare regimen for families in this culture. 58, Journal of . Objective Breast cancer is the leading cause of cancer death among Hispanic women. The LEARN technique can facilitate cross-cultural interviews. A little more than 45 percent of all births in Mexico are Cesarean sections, which makes it one of the world's leaders in the practice. In today's United States, these terms are often thought . Many Latino immigrants experience tremendous stress once they are in the United States. 6Kaiser Permanente National Diversity Council, "A Provider's Handbook on Culturally Competent Care: Latino Population," 2nd ed. 9Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica Smith, "Income, Poverty, and Health Insurance Coverage in the United States: 2006," Current Population Reports, U.S. Census Bureau, August 2007; and Mead et. Azarcon and greta (lead salts) and azogue (mercury) compounds, which are sometimes given for teething or empacho, are contraindicated.22 Some injuries have occurred with curandero treatment of caida de la mollera (fallen fontanel). Methods Hispanic . Interferon gammarelease screening tests are preferable to tuberculin skin testing in immigrants who have received the bacille Calmette-Gurin vaccine. You call the dietitian to alert him to this patient's cultural concerns. Hispanic Heritage Month, September 15 - October 15, is an important opportunity to raise awareness about these trends and more importantly, identify culturally and linguistically appropriate prevention and treatment strategies to reduce mental and substance use disorders in the Hispanic/Latino population. The American Psychological Association (APA) found that only one percent of psychologists identified themselves as Hispanic even though Hispanics represent 20 percent of the U.S. population as a whole. She asks about your family, and hesitantly, through the interpreter, you share a bit about your own children. Abdominal pain may be attributed to empacho, or food stuck in the intestine. al., "Racial and Ethnic Disparities," Chart 5-2. Religion can be a protective factor for mental health in Latinx/Hispanic communities (faith, prayer) but can also contribute to the stigma against mental illness and treatment (demons, lack of faith, sinful behavior), so targeting religious institutions to help encourage good mental health and treatment-seeking is important. Still, at the risk of oversimplifying, several trends emerge: -simpatia-politeness and the avoidance of hostile confrontation -personalismo-the value of warm personal interaction -respeto-the importance of showing respect to authority figures, usually including health care providers -familismo-collective loyalty to extended family and commitment to family obligation; -fatalismo-the belief that individuals cannot do much to alter fate15. 5Larry D. Purnell and Betty J. Paulanka, "Mexican-Americans," chapter in Transcultural Health Care: A Culturally Competent Approach (Philadelphia: F.A. 10Mead et. Contact USA.gov. The final commentary, drawing on the others, seeks to join the issues from an explicitly bioethical perspective. High level of belly fat or metabolic syndrome. Visit behavioral health equity resources for select SAMHSA in-language resources and quality practice and workforce development for select SAMHSA OBHE webinars and blog posts. Thematic analysis was used to identify common patterns and form recommendations for future research and programs. Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. 15Glenn Flores, "Culture and the Patient-Physician Relationship: Achieving Cultural Competency in Health Care," Journal of Pediatrics 136 (January 2000): 14-23; see also Maria R. Warda, "Mexican Americans' Perceptions of Culturally Competent Care," Western Journal of Nursing Research 22/2 (2000): 203-224. Animal-based medicines are also used, including snake oil, which is obtained from the fat of snake skins, and bufo toad medicine, which contains a powerful psychedelic. ", In 2007, the total U.S. Hispanic or Latino population surpassed 45 million, or 15 percent of the total U.S. population. Methods: Data from the National Mental Health Services Survey conducted in 2014 (N=13,015 facilities) and 2019 (N=12,345 facilities) were used to measure changes in the proportions of facilities that offered treatment in Spanish overall and by year, state, and proportion of Hispanic residents. 2U.S. www.behaviorfrontiers.com. Under-recognition of depression in adult Hispanic Americans may be related to language . US Hispanics, currently the largest minority group in the country, face disparities in the recognition and treatment of major depression. Cold linseed tea and hibiscus flower tea for diabetes. An intention-to-treat approach using a last-observation-carried-forward method was used to analyze outcome data whereby the last available measurement for all participants was then used for all time points through the 12-month final follow-up. Delgado Melvin Activities and Hispanic Groups Issues and Suggestions Social from FIL. This resulted in a rich compilation of remedies that Hispanics use in home treatments, with the emergence of a pattern comparable to the nursing process. hispanic methods of treatmentfeminine form of lent in french. Bilingual posters and medical literature are an important starting point. The ethnic terms Latino or Hispanic refer to a diverse population of Latin American descent that includes many nationalities and races. Lack of third party reimbursement for professional interpreter services exacerbates this problem. Media Contact . The material in this section is part of a larger project by the Markkula Center for Applied Ethics on culturally competent care; that is, health care that is sensitive to the differing values and needs of cultural subgroups within our pluralistic society. Copyright 2023 American Academy of Family Physicians. Switch to Chrome, Edge, Firefox or Safari. In addition, diet and exercise do not have a prominent place in the daily activities of the Hispanic family. These instructions can be studied by the patient or translated when time permits. Lower rates of hypertension awareness, treatment, and control have been observed in Hispanics/Latinos compared with non-Hispanic whites. Our Future. Yet the call for cultural competence can-at its best-urge practitioners to adopt instead a stance of cultural "humility": one which encourages an open mind, and a recognition that each one of us sees the world through our own very distinctive cultural lenses. "7 In the context of a hospital or medical clinic, where medical terminology can be complicated and communication often takes place quickly and amidst elevated emotions, this language barrier can be especially problematic. This content is owned by the AAFP. Text: 435748 Cysticercosis is caused by consumption of contaminated with pork tapeworm. Neurocysticercosis, a leading cause of seizures in Mexico, and pulmonary tuberculosis are more common in Latino immigrants.10 Interferon gammarelease assay blood testing for tuberculosis is now preferred over tuberculin skin testing in immigrants with a history of bacille Calmette-Gurin vaccination because of a high rate of false-positive results with skin testing (although skin testing is still recommended for children younger than five years).13 Publicized fears of contagion from illegal immigration may be overblown.
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