The United States is a country where multiple cultures coexist and interact while retaining their cultural identities. However, in some cases, cultural differences can lead to worse outcomes in health care. Chinese Americans are a significant ethnic group with unique health beliefs, which can impact their interactions with the health care system. The Chinese culture has a strong emphasis on traditional medicine, which can impact a person’s perception of clinical, evidence-based medicine.
Chinese traditional medicine places a significant amount of trust in herbal medicines. Thus, a stronger belief in such medicines, combined with a lower belief in the benefits of Western medications, can lead to issues with medication preparation, administration, and adherence to the regimen. Moreover, cultural health and health care beliefs can assign different values to different conditions, potentially viewing some as less critical or needing treatment than do Western medical views.
The study by Eh, et al. (2016) found that belief in the superiority of traditional Chinese medicine was indirectly associated with reduced adherence to type II diabetes self-management and medication. The same study notes that this impact is less likely in more educated patients, suggesting that patient education can help improve adherence. Thus, programs aimed at educating patients, and instructing and empowering health care providers to instruct patients not only in the administration of medication but its effects and the reasoning behind its prescription can be beneficial.
The herbal preparations used in traditional Chinese medicine have been found to be contaminated with potentially harmful compounds. Specifically, instances of contamination with heavy metals, such as lead or arsenic, which are known to cause serious poisoning, were reported (National Center for Complementary and Integrative Medicine [NCCIM], 2019). Similarly, undeclared components or incorrect herbs, which can cause asthma, severe allergic reactions, or organ damage, have been found in some traditional Chinese herbal medicines (NCCIM, 2019). Thus, using herbal remedies alongside or instead of Western medicine can cause significant adverse reactions.
The same health and healthcare beliefs can lead to issues with medicine preparation and administration. Specifically, increased medication complexity and precision are required to prepare and administer medicines, especially with multimorbid or older patients (Schenk, 2019). Such patients who are less familiar with Western medications and more used to traditional herbal ones can find it difficult to prepare and administer their medications.
This issue can be further exacerbated by the language barrier, particularly for drugs with difficulty to read or pronounce names (Schenk, 2019). In these situations, patients can have difficulty identifying their different medications. Thus, there is a risk of the patient taking an incorrect drug, or an incorrect dose of the correct one. Both of these situations can be dangerous or limit the effectiveness of treatment.
Another issue with medication administration by patients relates to the timing of taking medication. In traditional Chinese medicine, certain times of the day are associated with different organs and systems in the body; therefore, medicines targeting these organs should be taken during these specific time frames. Conversely, patients may distrust medications that should be taken at times that conflict with this traditional schedule, potentially leading to reduced adherence to the prescribed regimen or refusal to take the medicine.
Cultural factors, particularly health and healthcare beliefs have a significant impact on various aspects of one’s interaction with the healthcare system and medication. For Chinese American patients, this can mean a general distrust of, or unfamiliarity with, Western medication and medical practices. Furthermore, a reliance on traditional Chinese medicines can lead to significant adverse reactions from undeclared components in them. Therefore, like with any other group, cultural awareness and competency are critical skills for a practitioner to ensure the best standard of care.
References
Eh, K., McGill, M., Wong, J., & Krass, I. (2016). Cultural issues and other factors that affect self-management of Type 2 Diabetes Mellitus (T2D) by Chinese immigrants in Australia. Diabetes Research and Clinical Practice, 119, 97-105. Web.
National Center for Complementary and Integrative Health (2019). Traditional Chinese medicine: What you need to know. Web.
Schenk, A., Eckardt‐Felmberg, R., Steinhagen‐Thiessen, E., & Stegemann, S. (2019). Patient behavior in medication management — Findings from a patient usability study that may impact clinical outcomes. British Journal of Clinical Pharmacology. Web.