. Developing cultural sensitivity to Latino patients entails recognizing and appreciating their diversity. In terms of health, on some measures Latinos are better off than other ethnic groups. Rue for earache. For literate patients, it may be helpful to write things down, even if this must be done in English rather than Spanish. Results: Teas were most commonly used for colic, upper respiratory tract symptoms, and abdominal pain. 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. There are also differences in drug use within the Hispanic population as shown in Figure 1. Publicaciones de SAMHSA disponibles en espaol (Additional SAMHSA Spanish-language publications). Conveying medical instructions to patients with limited English skills can be frustrating. Latinos are a multiracial, multicultural group." Some Mexican Americans have been in the US for many generations. For example . Plants are used on their own, or mixed together to form herbal remedies. Active Journals Find a Journal Proceedings Series. Lower rates of hypertension awareness, treatment, and control have been observed in Hispanics/Latinos compared with non-Hispanic whites. Cold water with lemon for high blood pressure. Oregano tea for coughs. 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. 1 This change resulted in a substantial increase in the prevalence of hypertension from ~32% to ~46% in the United States (US) adult population. Nevertheless, Hispanic Americans are very heterogeneous in the circumstances of their migration and in other characteristics. Underwriting for these materials was provided by a generous anonymous donor. The APA additionally reported that both language barriers and values created barriers to treatment for Hispanics experiencing mental health issues. Hayes-Bautista relayed that one important theme presented in the collaborative workshops is how . Interferon gammarelease screening tests are preferable to tuberculin skin testing in immigrants who have received the bacille Calmette-Gurin vaccine. Our Future. This is lower than the average of 43 percent for adults in the U.S. overall. 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. The extra time necessary for this technique is justified by the prospect of much better understanding and adherence.31. Adding to the language barrier is the pitfall of false fluency, when physicians mistake the meaning of a Spanish word because of unfamiliarity with cultural or linguistic subtleties.4 Another barrier is inability to afford health insurance; nearly one-third of Latinos (30.7 percent) lack coverage.5 Yet another barrier stems from cultural mistrust coupled with a predisposition to seek alternative care first, thus delaying conventional treatment. Hispanics' experience with discrimination or being treated unfairly varies greatly by age. Media Contact . 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. 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. Addiction is a chronic, yet treatable brain condition similar to other chronic illnesses like diabetes. Latinos' belief in alternative treatment is affected by many factors, including education, socioeconomic class, and time spent in the United States (acculturation). The agency is contracted with the leading insurance carriers and works diligently to secure contracts with additional funding sources on an on-going basis. Very often they have faced extremely hazardous conditions crossing the border-enduring hunger, dehydration, violence from vigilantes, rape, abuse, severe weather conditions and harsh treatment by border agents. High level of belly fat or metabolic syndrome. 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. Moreover, the family itself can play an enormously important role in supporting and empowering the patient within the medical setting. 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). The commentaries provide perspective and insight on what went right, what went wrong, and how things might have gone differently in these culturally challenging situations. Talk. Materials are available in English and Spanish. Vari Hall, Santa Clara University500 El Camino RealSanta Clara, CA 95053408-554-5319, Ethical Considerations for COVID-19 Vaccination, Hackworth Fellowships Project Showcase 2021, The Ethics of Going Back to School in a Pandemic, Systemic Racism, Police Brutality, and the Killing of George Floyd, COVID-19: Ethics, Health and Moving Forward, The Ethical Implications of Mass Shootings, Political Speech in the Age of Social Media, Point/Counterpoint: Democratic Legitimacy, Brett Kavanaugh and the Ethics of the Supreme Court Confirmation Process, https://depts.washington.edu/pfes/PDFs/LatinoCultureClue.pdf, Culturally Competent Care for Latino Patients. Themes common to Latino participants were: "We are put off to one side"; "If I can't work, I can't survive"; and "Without documents, you are no one." Information. In Santa Clara County the figure is 25.7 percent-over a quarter of the total population. Delayed immigration protocols and anti-immigration legislation may contribute to stress. Because of less access to health care, Latinos with diabetes are often diagnosed later and have a greater risk of complications.15,16 Despite these unfavorable health and socioeconomic statistics, overall mortality is lower than would be expectedan anomaly termed the Hispanic paradox.17 Latinos live an average of 2.5 years longer than non-Latino whites (to 80 years, seven months of age) and 7.7 years longer than non-Latino blacks.1 It is not known what protective factors exist, but immigrant hardiness, social integration, and diet may have a role.1 Raising awareness about the consequences of obesity is necessary in Latino communities, especially because being somewhat overweight (gordito) can be considered healthy. In either case, they are treated with the opposite hot or cold treatment. Asian or Hispanic ancestry. However, the most useful technique is teach back or show me: having patients repeat their care instructions until they do it correctly. 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. al., "Racial and Ethnic Disparities," Chart 5-2. Each person is unique and simultaneously formed by a variety of cultures and subcultures, not to mention personal choices and socioeconomic circumstances. The 2017 ACC/AHA hypertension guidelines lowered the blood pressure threshold for diagnosis of stage I hypertension to 130-139/80-89 mm Hg. needs and experience of less acculturated Latino clients who are mostly from Mexico and Central America, and represent a large segment of the Latino community in Southern California. Apart from these language and socioeconomic disparities and variation in the way health care is envisioned and sought out, differences in the way values are ordered and articulated can also strain the clinical health care encounter for Latino patients. In fact, compared to both white Americans and African-Americans, Latinos generally report feeling less listened to and understood by their doctors, as well as less able themselves to understand their doctors; and they are twice as likely to leave a doctor's office with unasked questions. 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. 17.4% were Hispanic, and 49.1% were White. The specific herbs mentioned in this study for use of treatment of diabetes included: nopal (cactus), aloe vera, nispero (loquat leaves), garlic, and diabetina. Adding to the language barrier is the pitfall of false fluency, when physicians mistake the meaning of a Spanish word because of unfamiliarity with cultural or linguistic subtleties. Cultural Barriers to Treatment and Compliance. From the upstairs hallway of our home, I watched my great-aunt prepare for the cleansing. For instance, Latinos highly value family. Poor communication with health care providers is often an issue. The U.S. Latino population is also quite young relative to the general U.S. population; in 2007, the median age for the former was 27.6, compared to 36.6 for the latter.2. www.behaviorfrontiers.com. America is rapidly changing as a cultural collision between Latino and white culture transforms lives on both sides of the border. Patient activation will help motivate the patient to become involved in his or her own care. The largest and fastest growing minority population in the United States today is commonly referred to as "Hispanic" or "Latino." 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. Significantly, some patients appear to experience greater improvement after meeting with folk practitioners than with Western doctors.14. Some cultural barriers may be overcome by using the teach back technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients. You then schedule a return visit, during which an interpreter will be available. According to a study done at UCLA, 15.7 percent of non-elderly Latinos in either fair or poor health, who are covered under MediCal or Healthy Families (both California low-income health insurance programs), report having no usual source of care but rather obtain their clinical health care on an ad-hoc basis, if at all.11, Some Latinos find their health care in non-clinical places, relying on folk medicine and traditional healers. Despite a lack of U.S. studies, a Norwegian study found that although immigrants from tuberculosis-endemic regions did bring more strains of tuberculosis with them, they did not significantly contribute to the spread of tuberculosis within the resident population.18, Non-Latino physicians may be perplexed by references to folk healing and illness in Latino patients. By 1852, over 25,000 Chinese immigrants had arrived, and by 1880, over . They are written by health care providers and others who work with the relevant Latino sub-community. 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. Alonso, M., Val, E., & Rapaport, M. M. An open-label study of SSRI treatment in depressed Hispanic and non-Hispanic women. Latino culture has several normative values that must be recognized in clinical settings. Objective Breast cancer is the leading cause of cancer death among Hispanic women. 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. Missing data was handled using this carry-forward method. Today, one in three farm workers are newcomers to the United States, with most of these coming from Mexico. Because people stand closer to each other in most Latino cultures, physical proximity is also perceived as being more personable. It took extra time in relationship-building (personalismo), a team approach, an interpreter, negotiation, and a bit of research to make it all happen. Medical practices and hospitals should strive to create an environment that is warm and welcoming to Latino patients. 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. . Her visits to your clinic have been challenging because of her limited English proficiency, late arrivals, and nonadherence to several medications. She has three grown children: two still live in Mexico, and the third lives in a distant U.S. city. Maria needs to eat fruit; she should also consume more fiber to counteract her high-carbohydrate diet. 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. Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). The point deserves emphasis: Health care providers must be cautious not to oversimplify the values, customs, and beliefs that characterize any ethnic group-especially one as heterogeneous as Latinos. Keeping these cautionary notes in mind, the cases and commentaries in this section seek to address numerous issues that arise in the course of providing clinical health care for Latino patients of various backgrounds. Find treatment facilities confidentially and anonymously, 24/7, National Helpline1-800-662-HELP (4357) 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. 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. Spanish language handouts are a better option. Modern Mexicans turn to old ways of childbirth. For those who have a serious mental health disorder, around 44 percent did not receive treatment. Unfortunately, few studies disaggregate Hispanic patients by race to understand its implications on treatment and clinical outcomes such as mortality. 3 percent report that they have trouble navigating the U.S. health care system. 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. Barriers to care have resulted in striking disparities in quality of health care for these patients. Become an expert on our coaching methods, internal systems, processes, and technology. 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 Among Hispanics ages 18 to 29, 65% say they have experienced discrimination or unfair treatment because of their race or ethnicity. Free and confidential support for people in distress, 24/7, Behavioral Health Treatment Services Locator Hence, the individual's good cannot be neatly separated from his or her community. Background Patients who are members of minority groups may be more likely than others to consult physicians of the same race or ethnic group, but little is known about the relation between. 16"Communicating with Your Latino Patient," University of Washington Medical Center, 2007; accessed at https://depts.washington.edu/pfes/PDFs/LatinoCultureClue.pdf. However, as gold rush fever swept the country, Chinese immigrants, too, were attracted to the notion of quick fortunes. For Latino/Hispanic adults suffering from any type of mental health disorder, roughly 67 percent did not receive treatment. A high-carbohydrate and high-calorie diet, a more sedentary lifestyle in the United States, and genetic factors may contribute. More than half of Hispanic young adults ages 18-25 with serious mental illness may not receive treatment. 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. Obesity and genetic factors increase risk. Cold linseed tea and hibiscus flower tea for diabetes. 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. 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. Visit SAMHSA on Twitter 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. Text: 435748 2 Although the new guidelines comprehensively address how to define, measure, and treat high blood pressure . Demographics and Addiction. These may include antioxidants, probiotics, or a combination of medications to target any of the contributing factors. The same is also applies to the substance abuse treatment. al., "Racial and Ethnic Disparities," Chart 4-1. Latinos have disproportionately higher rates of obesity and diabetes mellitus. Compared to White people, Hispanic/Latino people are less likely to receive treatment for depression, anxiety, and other behavioral problems. Some states have extremely large Latino populations; for instance, as of 2006, 36 percent of Californians (13.2 million people) identified themselves as Hispanic or Latino, as did 36 percent of Texans (8.6 million people). Respondents using these herbs reported never replacing their medical regimens with herbs. Garlic and onion are used extensively, as is aloe vera. "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. SAMHSA will be highlighting the important role each of us has in maintaining a healthy life and ensuring a productive future. As with any patient, Latinos should be treated as individuals first, while exploring possible cultural distinctions. Interferon gammarelease assays are preferred to tuberculin skin testing in immigrants with a history of BCG vaccination. Additionally, when a woman gets married, her husband's name may be appended to her father's name. 1Elizabeth M. Grieco and Rachel C. Cassidy, "Overview of Race and Hispanic Origin 2000," Census 2000 Brief, U.S. Census Bureau, March 2001. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. Allow extra visit time for patients with limited English proficiency, Hire bilingual staff and physicians, and encourage existing staff to learn Spanish, Make printed and Web-based cultural information available to staff, Offer flexible scheduling: patients may be seen in sign-in order rather than fixed appointments, Post bilingual or Spanish-language signage, Provide cultural sensitivity training for staff (e.g., monthly lunchtime discussions, in-service training, a bulletin board devoted to cultural issues, ethnic food potlucks), Provide culture-specific interventions in nursing care plans, Provide interpretation services for patients with limited English, proficiency (required under Title VI of the 1964 Civil Rights Act); whenever possible, try to avoid using patient's family or friends as interpreters, Provide Spanish-language medical handouts and patient forms, Recognize Latino holidays (e.g., Cinco de Mayo [May 5], Day of the Three Kings [January 6]). 15 supp. The value of familismo perhaps deserves to be emphasized for the important role it plays for many Latino patients. Herbs often have hot or cold properties; hot herbs are used to treat cold conditions, and vice versa. SAMHSA Blog. A consequence of these problems is a marked disparity in the quality of care that Latino patients receive. Latinx/Hispanic Communities and Mental Health Mental Health America Offers information about mental health issues in Latinx/Hispanic communities, including demographics, prevalence, treatment issues, and more. Instituting more culturally competent care is likely to improve treatment adherence and health outcomes. 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. These factors have not been studied in Hispanics/Latinos with chronic kidney disease (CKD). Combination therapy generally uses multiple treatment methods at once. 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. A wide array of herbs offered at La Botanica Orquida in northeast Georgia. Using the LEARN model, you listen to her story about her poor control of diabetes and frustration with her diet. 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. 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. hispanic methods of treatment. Although this review summarizes findings for U.S. Hispanics, it is important to note that the panethnic term "Hispanics" describes a large, heterogeneous group originating from multiple Spanish-speaking nations and that evidences substantial variability in socio-cultural characteristics, beliefs, behaviors, and attitudes toward health and health 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. Cross-cultural interviewing can be facilitated by following specific guidelines, and several mnemonics have been developed for use by physicians. She says that she does not feel better when taking the medicine, and says the diet you prescribed does not include tortillas or any of the foods she likes. Call or text 988 or chat 988lifeline.org. The toolkit includes tips and techniques to overcome challenges and increase effectiveness when working with Latino populations. Emotional distress often presents with headaches (dolor de cabeza) or other physical symptoms instead of depressed mood.9 Consequently, a high index of suspicion is needed to recognize adjustment reactions or depression. In one survey of Mexican American nurses, family support was identified as one of the most important areas to which health care providers should attend while caring for Latino patients. She agrees to start taking medications, but does not refill her prescriptions or lose weight. using as treatment, if they remained open-minded, and if doctors had an understanding of folk medicine.37 Another common barrier within healthcare delivery is that the alternative or traditional medicine within the Latino culture is deeply rooted in spirituality and religion.38 While in the United States, 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. 1-877-SAMHSA-7 (1-877-726-4727), SAMHSA.gov, Substance Abuse and Mental Health Services Administration, Buprenorphine Physician & Treatment Program Locator, Early Serious Mental Illness Treatment Locator, View All Helplines and Treatment Locators, Implementing Behavioral Health Crisis Care, Mental Health and Substance Use Disorders, Substance Abuse and Mental Health Prevention, Technology Transfer Centers (TTC) Program, State Targeted Response Technical Assistance (STR-TA), Clinical Support System for Serious Mental Illness (CSS-SMI), Suicide Prevention Resource Center (SPRC), African American Behavioral Health Center of Excellence, Asian American, Native Hawaiian, and Pacific Islander Behavioral Health Center of Excellence (AANHPI-CoE), Center of Excellence for Building Capacity in Nursing Facilities to Care for Residents with Behavioral Health Conditions, Center of Excellence for 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