Cultural Barriers to Treatment and Compliance - Dimensions of Culture As with any patient, Latinos should be treated as individuals first, while exploring possible cultural distinctions. 35% less heart disease and 49% less cancer; A lower death rate overall, but about a 50% higher death rate from diabetes; 24% more poorly controlled high blood pressure; 23% more obesity; 28% less colorectal screening. Remedies used for common pediatric illnesses and for the traditional folk illnesses: mal ojo(evil eye), empacho(blocked intestine), mollera caida(fallen fontanelle), and susto(fright). National Prevention Week 2020 is about Our Lives. 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. First among these, of course, is a language barrier. This is especially (though far from uniquely) true in the agricultural sector of the U.S. economy. One suggestion she readily agrees to is to include nopales (prickly pear cactus pads), a favorite from her childhood in Mexico. Mozote (Bidens pilosa) to refresh and clean the stomach. 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. Hispanics and Health Care in the United States | Pew Research Center Journals. 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. 3 percent report that they have trouble navigating the U.S. health care system. 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. Poor communication with health care providers is often an issue. Culturally Competent Care for Latino Patients Hispanic Pain Experience - NIMHD These broad generalizations are just that: broad generalizations. Prayer was reported as helping to reduce stress and anxiety. Folk Cures and Alternative Treatment Are Putting Hispanic Patients At Combination therapy generally uses multiple treatment methods at once. She says that since her husband died, she has lost interest in what might happen to her in the future. 3 Essentially, a curandero or curandera removes mental, emotional, physical and spiritual illnesses or imbalances. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. You then schedule a return visit, during which an interpreter will be available. In either case, they are treated with the opposite hot or cold treatment. Some trials examined overall CAM use, whereas others looked at. Racial/Ethnic and Sex Differences in Somatic Cancer Gene Mutations among Patients with Early-Onset Colorectal Cancer. Cultural Humility and Counseling Hispanic and Latino Populations - NAADAC Other healing specialties include yerberas (herbalists), hueseros (bone setters), parteras (midwives), and sobradores (similar to physical therapists).21, Symptoms are often interpreted differently based on cultural presuppositions. 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. Neurocysticercosis is the most common cause of seizures in Latino immigrants. Patient activation will help motivate the patient to become involved in his or her own care. Cysticercosis is caused by consumption of contaminated with pork tapeworm. Partner with other Coach Managers to build relationships, share learnings and provide consistency for all of our . 3Pan American Health Organization, "For U.S. Latinos, Shared Heritage Has an Impact on Health," June 9, 2004 (www.paho.org). For those who have a serious mental health disorder, around 44 percent did not receive treatment. 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." This content is owned by the AAFP. Case 1: Delinquency or a Mental Health Problem: The Case of Pablo Sanchez, Case 3: From Chronic to Critical: End-of-Life Decisions. Using the LEARN model, you listen to her story about her poor control of diabetes and frustration with her diet. Depression education fotonovela for engagement of Hispanic patients in Although most Latinos living in the U.S. do speak at least some English, 60 percent of Latino adults speak primarily Spanish at home.6 According to the U.S. Census, more than half of U.S. Latino residents age 5 and older speak English "very well," but a nevertheless significant number of Latino adults speak English "not well" or "not at all. In terms of health, on some measures Latinos are better off than other ethnic groups. Fluegelman, Andrew, ed. Asian or Hispanic ancestry. 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. Other health problems include stress, neurocysticercosis, and tuberculosis. Interferon gammarelease screening tests are preferable to tuberculin skin testing in immigrants who have received the bacille Calmette-Gurin vaccine. | Mar 1, 2011. 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. We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care. PDF Folk Medicine and Traditional Healing Basics - NATIONAL CENTER FOR Objective Little is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. 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. Generally speaking, Latino cultures include a more family-centered decision making model than the more individualistic or autonomy-based model embraced by modern mainstream biomedical culture in the United States. By the year 2050 that figure is expected to rise to 24 percent of the total U.S. population. High cholesterol or dyslipidemia (unhealthy blood fat levels) . A consequence of these problems is a marked disparity in the quality of care that Latino patients receive. In today's United States, these terms are often thought . Underwriting for these materials was provided by a generous anonymous donor. Addiction Demographics: Substance Use in the US | Recovery.org A mother might use cooling herbs to treat diaper rash, a hot condition. Guide to Statistics and Methods; Guidelines; Hair Disorders; Health Care Delivery Models; . There are also differences in drug use within the Hispanic population as shown in Figure 1. 5Larry D. Purnell and Betty J. Paulanka, "Mexican-Americans," chapter in Transcultural Health Care: A Culturally Competent Approach (Philadelphia: F.A. Addiction can affect a person's impulse control, ability to stop using a substance, using despite risks, and physical and mental changes. 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. The Difference Between Hispanic and Latino - Hispanic Network Magazine Behavior Frontiers Announces Data-Driven Treatment Outcomes al., "Racial and Ethnic Disparities," Chart 4-1. You recommend a compromise treatment plan for her diabetes and grief. 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. 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. For instance, Latinos highly value family. 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. 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. While not considering Hispanics as a distinct race, the U.S. Census (utilizing federally delineated categories) defines someone "Hispanic" or "Latino" as "a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. The extra time necessary for this technique is justified by the prospect of much better understanding and adherence.31. Again, it is imperative to stress that these values represent broad generalizations that may or may not apply to any individual patient or in any given situation. These terms are often used interchangeably, including by the U.S. Census Bureau, although "Hispanic" is more often utilized in governmental and market research and statistical record keeping, while "Latino" perhaps enjoys more popular usage today. This is lower than the average of 43 percent for adults in the U.S. overall. Studies show that Hispanics and Latinos seeking substance use disorders and mental health treatment confront many barriers to accessing culturally and linguistically competent care. Recent immigrants may face additional obstacles to care, including illegal immigration status (fears of deportation), illiteracy, and a radically different set of health beliefs. In this article I will make use of both terms, relying more heavily, however, on "Latino. 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. Plants are used on their own, or mixed together to form herbal remedies. 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). 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. 17.4% were Hispanic, and 49.1% were White. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Her husband died in an industrial accident four years ago, and she is still grieving. Substance Use and the Hispanic/Latino Population: What to Do? 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. Hispanics' experience with discrimination or being treated unfairly varies greatly by age. In a 2002 report from the Institute of Medicine, more than 175 studies were cited to document this disparity.6 In an attempt to address this problem, the National Standards for Culturally and Linguistically Appropriate Services (CLAS) were released in 2001 by the Office of Minority Health of the U.S. Department of Health and Human Services.7 Fourteen guidelines were published, which were organized around three main themes: culturally competent care, language access services, and organizational supports. 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. dissertation, University of Southern Cali-fornia, 1973. Innovative Diabetes Interventions in the U.S. Hispanic Population 11Jennifer Aguayo et. Hispanic people are the youngest population, with 33% below age 18, and 57% below age 34 (Figure 4). Linden tea and lemon grass tea for nerves (anxiety). Oregano tea for coughs. Working With Hispanic and Latino Families - Child Welfare These materials focus on the challenges that can confront Hispanics in American health care settings. 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. A few candles were lit in the dark, curtained bedroom. Conveying medical instructions to patients with limited English skills can be frustrating. Call or text 988 or chat 988lifeline.org. PDF Hispanic Culture and Healthcare in the United States Latinx/Hispanic Communities and Mental Health Each person is unique and simultaneously formed by a variety of cultures and subcultures, not to mention personal choices and socioeconomic circumstances. Moreover, 32.7 percent (nearly one-third) of all U.S. Latinos completely lacked health insurance that year, compared with 15.3 percent in the general population; and nearly half of Latinos reported being uninsured at some point during the previous year.9 Latinos are nearly two and a half times more likely than whites to report that they have no regular doctor.10 Even among many insured Latinos, coverage and care are far from adequate. Information. (Kaiser Foundation Health Plan, 2001): 4. Latinos are a multiracial, multicultural group." Some Mexican Americans have been in the US for many generations. Respeto implies attentive concern for the patient and respect of his or her personhood and age, especially if the patient is older. Among Hispanics ages 18 to 29, 65% say they have experienced discrimination or unfair treatment because of their race or ethnicity. The progress made in expanding health insurance coverage for Latinos is now at risk, because of the COVID-19 economic recession's disproportionate impact on Latino workers. Medical practices and hospitals should strive to create an environment that is warm and welcoming to Latino patients. Hispanics progress against racism but have long way to go - UNM Newsroom Copyright 2023 American Academy of Family Physicians. Have a question about government service? Karen Peterson-Iyer is a program specialist in health care ethics at the Markkula Center for Applied Ethics. Mental Health In The Latino/Hispanic Community Hypertension in Hispanics/Latinos: Epidemiology and Considerations for 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. 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. . Find treatment facilities confidentially and anonymously, 24/7, National Helpline1-800-662-HELP (4357) Garlic and onion are used extensively, as is aloe vera. 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. 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. Alonso, M., Val, E., & Rapaport, M. M. An open-label study of SSRI treatment in depressed Hispanic and non-Hispanic women. 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). The term "Latino" has become more commonly used in recent years to describe those whose primary ethnic heritage stems from Latin America. However, the most useful technique is teach back or show me: having patients repeat their care instructions until they do it correctly. This article provides an evidence-based review of the prevalence, presentation, and management of major depression in primary care in this heterogeneous ethnic group. 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. Addiction is a chronic, yet treatable brain condition similar to other chronic illnesses like diabetes. Chagas Disease Is a Consideration in Latino Patients, http://www.stanford.edu/group/ethnoger/hispaniclatino.html, http://www.rice.edu/projects/HispanicHealth, http://www.hogarhispano.homestead.com/HispanicHealth.html, http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=3, http://www.ohsu.edu/xd/education/library/research-assistance/patient-education-handouts.cfm/, https://www.aamc.org/download/54328/data/tacctresourceguide.pdf.pdf, http://depts.washington.edu/pfes/CultureClues.htm. Active Journals Find a Journal Proceedings Series. 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. 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 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Services, Evidence-Based Practices (EBP) Resource Center, Interagency Task Force on Trauma-Informed Care, Protection & Advocacy for Individuals with Mental Illness (PAIMI) Program, Asian American, Native Hawaiian, and Pacific Islander, Disaster Preparedness, Response, and Recovery, Qualitative and Quantitative Assessment Methods, Early Serious Mental Illness (ESMI) Treatment Locator, Faith-Based and Community Initiatives (FBCI), Historically Black Colleges and Universities Center of Excellence in Behavioral Health, Mental and Substance Use Disorders and Homelessness Resources, Medications, Counseling, and Related Conditions, Pharmacist Verification of Buprenorphine Providers, Become an Accredited and Certified Opioid Treatment Program (OTP), Buprenorphine Dispensing by Opioid Treatment Programs (OTPs), Become a SAMHSA-Approved Opioid Treatment Program (OTP) Accrediting Body, Submit an Opioid Treatment Exception Request, Notify SAMHSA of Opioid Treatment Program (OTP) Changes, About 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Prevent Your Child From Drinking, Why You Should Talk With Your Child About Alcohol and Other Drugs, Why Small Conversations Make a Big Impression, How To Tell If Your Child Is Drinking Alcohol, COVID-19 Information for SAMHSA Discretionary Grant Recipients, Training and Technical Assistance Related to COVID-19, Listening Session Comments on Substance Abuse Treatment Confidentiality Regulations, Advisory Committee for Womens Services (ACWS), Tribal Technical Advisory Committee (TTAC), Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC), Interdepartmental Substance Use Disorders Coordinating Committee (ISUDCC), Interdepartmental Substance Use Disorders Coordinating Committee Biographical Information, Interdepartmental Substance Use Disorders Coordinating Committee Roster, Asian Americans, Native Hawaiians, and Pacific Islanders, Quality Practice and Workforce Development, The Behavioral Health Barometer: United States, Volume 6, National Survey on Drug Use and Health: Hispanics, Latino or Spanish Origin or Descent Individuals, Double Jeopardy: COVID-19 and Behavioral Health Disparities for Black and Latino Communities in the U.S. (PDF | 426 KB), The Opioid Crisis and the Hispanic/Latino Population: An Urgent Issue, El alcohol y la depresin: El camino de Jorge hacia una vida mejor, Prevencin de la Sobredosis de Opioides Manual de Instruccin, Publicaciones de SAMHSA disponibles en espaol, quality practice and workforce development, Alcohol and the Hispanic Community from the National Institutes of Health National Institute on Alcohol Abuse and Alcoholism, Chartbook for Hispanic Health Care (Agency for Healthcare Research and Quality), Hispanic-Latino Mental Health (American Psychiatric Association), Latino Mental Health Facts (National Alliance on Mental Illness), Mental Health: A Guide for Latinos and Their Families (American Psychiatric Association) (22 minutes, 13 seconds), National Latino Behavioral Health Association (NLBHA), Behavioral 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