Looking Beyond “Affordable” Health Care: Cultural Understanding and Sensitivity—Necessities in Addressing the Health Care Disparities of the U.S. Hispanic Population

Abstract

Health disparities are pervasive in the United States; but among Hispanics, access to health care is encumbered by poverty, lack of insurance, legal status, and racial or minority status. Research has identified certain aspects of Hispanic culture, values, and traditions contributing to the nature of the Hispanic patient-doctor relationship and the quality of the health care service. Current educational efforts by nonprofit organizations, government, health professionals, and pharmaceutical manufacturers fail to address the needs for accessible and appropriately culture-sensitive information when approaching the diverse Hispanic community. Understanding Hispanics' consumptive practices and expectations surrounding medications is critical to the success of many treatment regimens. Recommendations are presented to address this health care issue.

Heart Failure in Hispanic Americans: Improving Cultural Awareness

“…41 Using simple terminology and visual aids can assist providers in communicating. 32 When communicating with patients, providers should not appear rushed. A personalized conversation can cultivate a relationship of trust with Hispanic patients.…”

“…Hispanic patients are likely to state that health-care providers do not involve them in decision-making or spend enough time explaining or answering their healthcare concerns. 32 Early studies of Hispanic HF patients indicated that Hispanics were less likely than Caucasian and African Americans to receive an assessment of left ventricular ejection fraction, 33 be discharged on an angiotensin-converting enzyme inhibitor, 33 or receive complete discharge instructions at the time of hospital discharge. 34 Although the overall delivery of health care to Hispanic HF patients at hospitals has improved, 35 an examination of Medicare Hospital Cultural competency education for providers Monitor for quality outcomes and evaluate provider adherence to evidence-based practices with Hispanic patients Enhance comanagement of patient care between cardiologists and primary-care providers when patient referred from a community health center Increase Hispanic participation in National Institutes of Health-funded heart failure research trials Improve access to health insurance Use of interpreter services Use of culturally appropriate and easy to read educational material Understanding of Hispanic cultural communication behaviors B Slow-paced conversation B Avoid direct eye contact B Open and friendly nonverbal communication Present orientation time frame and using short-term treatment goals Understanding of the Hispanic respeto value system and how power distribution is imbalanced toward the provider Include family members, especially female family members, in treatment discussions, with consent of the patient Familiarity, understanding, and inclusion of Hispanic alternative therapies and the use of curanderos as appropriate Quality measures has indicated that Hispanic patients with HF are less likely to receive smoking cessation counseling and discharge instruction, especially at poorer performing hospitals.…”

“…39 Poverty and employment in low-income occupations that do not offer insurance prevent many Hispanics from obtaining employer-based insurance or purchasing individual health insurance policies. 32 Regardless of insurance status, many Hispanics report difficulty in paying for health care. 27 Lack of insurance results in Hispanic patients receiving fewer referrals to specialists, reduces access to preventive care, and results in later detection of life-threatening conditions and inadequate management of chronic diseases, all which worsen health-care disparities.…”

“…42 Interventions and education material should use culturally appropriate references to have success. 32 Respeto is a Hispanic cultural value in which respect and deferential behavior is demonstrated to those in authority. 32 This distribution of power favoring the provider in the patient-provider relationship may impair communication.…”

“…32 Respeto is a Hispanic cultural value in which respect and deferential behavior is demonstrated to those in authority. 32 This distribution of power favoring the provider in the patient-provider relationship may impair communication. Due to the respeto value, a patient may tell the provider that they will adhere to prescribed treatments when they have no intention of following the provider's instructions, or the patient may not ask questions as they may perceive this as a sign of disrespect.…”