A paradigm for culturally based care in ethnic minority populations

Abstract

Health care practitioners are encouraged to “know the cultures” of the multicultural client population they are serving in the United States. The premise behind this injunction is that the use of culturally sensitive techniques that are tailored to the cultural background of the client would result in effective therapy and produce positive outcomes. However, as reflected in the plethora of terms used to describe the application of this knowledge, it is not made explicit why culture would make a difference in therapy nor how it makes a difference, ultimately, in the outcome. The intent of this paper is to highlight one of the fundamental sources of variation in cultural beliefs that affect individual mental health. We propose a model that penetrates to the core of why culture makes a difference in how problems are perceived and appropriate responses defined. Humans have three basic needs: safety and security, integrity, and a sense of belonging. Yet each culture uniquely frames each of these needs and prescribes the sanctioned means to achieve them. In our struggle to define culturally competent or culturally based care, this fundamental aspect is often overlooked. Instead, the Western worldview, structure, and definitions are used as the template to assess dysfunction, diagnose a disorder, and prescribe appropriate care. The theoretical underpinnings of indigenous concepts of self and symbolic interactionism are integrated to clarify these cultural misconceptions and to construct a new paradigm for providing effective and acceptable mental health care.

A Critical Review of Theory in Breast Cancer Screening Promotion across Cultures

“…The fatalism controversy illustrates that "taken in isolation and out of context, [a] belief or behavior may be misinterpreted or even disregarded as unnecessary or maladaptive" (57). A dilemma is thus posed by the chasm between the need for clarity and the broad and multiple realities of cultural context.…”

Negotiating Cross-Cultural Issues at the End of Life

“…9 For this reason, the clinical encounter often requires a negotiation between the worldviews or cultures of the clinician and the patient and family to reach mutually acceptable goals. 2,10,11 In the end, addressing and respecting cultural differences will likely increase trust, leading to better clinical outcomes and more satisfactory care for patients and their families. 12 Using 2 case studies as examples of cross-cultural encounters-an African American couple in the southern United States and a Chinese American family in Hawaii and California-we examine 6 specific issues for end-of-life care (TABLE 1).…”

“…53 Patients who have emigrated from countries where truth telling is not common often bring that perspective to medical encounters in this country. 10,40,51 Even in the United States, as recently as the early 1970s physicians commonly withheld the diagnosis of cancer. 54 Not until 1979 did the first article note the practice trend of disclosing a cancer diagnosis, 55 and while open discussion of diagnosis has become the norm in this country, discussing prognosis remains difficult.…”

Comparison of symptoms in African-American, Asian-American, Mexican-American and Non-Hispanic White patients with major depressive disorder

“…Other investigators also have noted relatively high levels of emotional distress in these populations in comparison with Non-Hispanic Whites (Escobar et al, 1983; Farooq et al, 1995; Harding et al, 1980; Kalibatseva and Leong, 2011; Lepine, 2001; Sue et al, 1991). Cultural traits, such as, conceptualization of mental health and expectations of the treatment process, language barriers, accessibility to the services, stigma against mental illness and religious beliefs, may contribute to the minimization of symptoms and under-utilization of mental health services until the problems become more severe (Becerra, 1982; Chung, 1994; Kagawa-Singer, 1994; Sue et al, 1991). Clinicians and policy makers should be sensitive to such issues in the planning and implementation of mental health services for such groups.…”