Demographics
The term “Hispanic” is used to mean a group of people that share similar cultural and national identities from the Caribbean, Mexico, Puerto Rico, and Central and South America. This ethnic group is made up of several subgroups following their cultural heritage such as Mexican Americans, Latin Americans, Spanish Americans, and Latin Americans. Hispanic Americans are the most rapidly growing ethnic minority. “Between 1990 and 2000, the population of the Latinos grew by 58 percent, more than four times as fast as the U.S. population in total,” (Marger, 2008, p. 222). This is because of a combination of factors such as a persistent high immigration rate and a relatively high birthrate. As of 2005, only 59.3 percent of all Hispanic-Americans were born in the United States. Hispanics are also a comparatively young population. The median age of the Hispanic-American population is 27, compared to 40 for non-Hispanic whites. Approximately one-third of Hispanics are under 18 years of age compared to one-fifth of non-Hispanic whites. On the other hand, approximately 5 percent of Hispanics are 65 or older compared to 15 percent of non-Hispanic whites (Marger, 2008, p. 222).
Hispanic Americans are the second poorest ethnic group, after the Native Americans. Almost a third of all Hispanic Americans had incomes of less than $26,000 annually in the year 2006. High poverty rates affect other aspects of Hispanics’ life such as health and crime. Hispanic Americans are less healthy than non-Hispanic whites. For instance, they receive irregular prenatal care and have higher incidences of death in childbirth. Individual Hispanic Americans are more than twice as likely to lack health insurance like the general population, with 34.1 percent of Hispanics lacking coverage, compared to only 15.8 percent of the general population.
Hispanic Americans, especially Mexican Americans, have higher rates of type 2 diabetes, hyperinsulinemia, and obesity than whites. Cardiovascular diseases and stroke are some of the major causes of mortality among Hispanics. These are the result of poor nutrition habits the Hispanics acquire when they migrate to the U.S. and become acculturated. Language also creates barriers in health and medical care (Friedman, Bowden & Jones, 2003) given that Spanish is the predominant language of the Hispanics. Hispanic Americans who speak English are more likely to visit their healthcare provider than those who mainly speak Spanish. Hispanic Americans also have the lowest level of formal education after Native Americans. Ochoa and Smith (2008) argue that “the educational condition of Hispanics has been characterized by below-grade-level enrollment, high attrition rates, high illiteracy rates, a low number of school years completed and under-representation in higher education” (p. 228).
Spiritual, Religious, and Cultural Practices
Many Hispanics place significant importance on religion. They believe in self-sacrifice, that is, giving rather than receiving, and they accept the fate of any nature. The majority of Hispanics are either Catholic or Pentecostal. Nevertheless, a small number of Hispanics are also Mormons, Jehovah’s Witnesses, Seventh Day Adventists, Presbyterian, or Baptist. Religion plays an important role in the health beliefs and practices of the majority of Hispanics. Many Hispanics relate health and illness to their soul or spirit. It is thus important for health care providers to be comfortable with communicating and being sensitive to Hispanics’ spiritual beliefs.
Although the Hispanic ethnic group is made up of several sub-groups, each with distinct characteristics, there are some common characteristics among the subgroups. To begin with, the majority of Hispanics view modern medicine as inadequate and suspicious therefore they commonly visit traditional healers. Health and illness are also associated with the power of God. Of importance is the fact that Hispanics view illness as punishment for sins or wrongdoing rather than as caused by pathogens. Health and illness are also viewed by Hispanics as holistic, affecting not only their physical being but also their psychological, spiritual, social, and metaphysical beings (Ebersole, Hess & Luggen, 2004).
The family is the central social institution of Hispanics. Hispanics’ families are usually large and extended, which offer close interpersonal ties to the Hispanics. The family plays an important role as far as physical and emotional support is concerned, especially when one of the members falls ill. Family members not only provide direct care to the ill member but also take part in the decision-making process. When Hispanic patients are hospitalized, most often than not they prefer having their family members present throughout the admission. Other than traditional healers, Hispanics believe in curanderismo, a practice in which some older women (referred to as curanderos) act as health practitioners or providers of health-related information. Curanderismo is closely tied with religious beliefs and practices.
The family (la familia) is one of the Hispanics’ unwritten rules. Others include respect (respecto) towards other people depending on age, gender, social status, economic status, and authority. Personalismo is also an unwritten rule and refers to the relationships people have with others and with the community. Hispanics also attach great importance to trust (confianza) and to spirit, mind, and body (espiritu) (Young & Koopsen, 2005).
Health Issues and Practices
Certain health care issues affect Hispanic clients more than non-Hispanics due to their unique social, economic, and environmental factors. To begin with, Hispanics suffer a stigma toward mental health in which this disorder is seen as a sign of weakness. “Hispanics have a high incidence rate of mental health problems, particularly depression, anxiety and substance abuse,” (Rogler, 1996, p. 94). The high incidence rate in these illnesses is attributed to the stress caused by immigration, acculturation, and biculturalism (Friedman et al., 2003). Second, Hispanics suffer from stressors associated with social problems such as the assimilation process and socioeconomic factors. Third, Hispanics experience environmental health problems due to air pollution and residential pollution resulting from poor living conditions. The rate of alcohol and drug abuse is also high among Hispanics. This is attributed to high poverty rates, low educational attainment levels, and a lack of good employment opportunities, especially among the youths. These are the major health problems that face Hispanic Americans and any health promotion and education program targeting the Hispanic community should consider these factors.
Cultural Competence Health Care concerning Hispanic Americans
A culturally competent health care provider dealing with Hispanic American clients should consider several factors. Hispanics attach significant importance to respect and therefore the healthcare provider should be respectful towards the client. Hispanics do not like offending others and often do not question a person even if an action does not satisfy them. The healthcare provider should keep this in mind and ensure that the client is satisfied with the service and understands what is required of him/her. The provider can achieve this by questioning the client frequently until he/she is sure that the client is satisfied. The family is an important institution for Hispanics. The healthcare provider should therefore involve all family members in all aspects of care, from diagnosis to treatment, medication, and therapy. All decisions should be made in the presence and with the input of family members (Perez & Raffy, 2008).
When dealing with older patients, the healthcare provider should address them in a traditionally accepted manner. This shows respect to the elderly. Hispanics also hold some non-verbal communication dear, including touch and a smile. These gestures are as important to Hispanics as verbal communication. It is also important to note that the time orientation of Hispanics in the present, that is, Hispanics are present-oriented. Therefore, Hispanics do not attach great importance to preventive healthcare. They also often show up for appointments later than originally planned and in some cases, they do not show up for appointments at all. The healthcare provider should therefore be patient with Hispanic clients and should follow up on them if they fail to show up for an appointment. Because Hispanics value their religious beliefs including their belief in traditional healing practices, healthcare providers dealing with Hispanic clients should respect these practices as they are likely to affect the health and recovery process of the patients (Perez & Raffy, 2008).
Cultural Assessment Framework
The cultural assessment framework used in this analysis is the framework by Huff and Kline (1999). This framework was created to be used for patient assessment and health promotion and preventive education programs for small groups or communities. The framework consists of five major areas. The first area is culture-specific demographic factors such as age, gender, social class and status, education and literacy, language and dialect, religious practices, occupation and income, residence patterns and living conditions, as well as acculturation and assimilation. When health practitioners and educators know about these demographic factors, they are better able to target healthcare programs toward specific ethnic and racial groups. For instance, even though the Hispanic group shares common features among the subgroups, the differences among the Hispanic subgroups should be taken into account when creating programs that target specific Hispanic subgroups (Perez & Raffy, 2008).
The second area is culture-specific epidemiological and environmental factors such as morbidity and mortality, disability rates, and environmental influences. Assessing environmental factors such as the nutrition habits of the area in which the patients live or the living and working conditions of the clients is important in understanding the major causes of mortality and morbidity among the client population. The third area is cultural characteristics of the client such as cultural/ethnic identity, cosmology, time orientation, perceptions of self and community, social norms, values and customs, and communication patterns. Understanding the cultural characteristics of clients enables healthcare practitioners to be culturally competent and sensitive to the racial and ethnic groups with which they work. Healthcare providers should also know the cultural, religious, and spiritual beliefs and practices as these affect how the clients view and access health care including conventional Western healthcare. This is the fourth area of the framework. The last area of the framework is Western health care organization and service delivery variables such as cultural competence and sensitivity, organizational policy and mission, facilities and program preparation, and evaluation of culturally competent services (Rankin, Stallings & London, 2005).
Reference List
Ebersole, P., Hess, P. A., & Luggen, A.S. (2004). Toward healthy aging: human needs and nursing response. St. Louis, MO: Mosby.
Friedman, M. M., Bowden, V. R., & Jones, E. G. (2003). Family Nursing: Research, theory, and practice (5th ed). Upper Saddle River, NJ: Prentice Hall.
Marger, M. N. (2008). Race and ethnic relations: American and global perspectives. Belmont, CA: Cengage Learning.
Ochoa, G., & Smith, C. (2008). Atlas of Hispanic-American history. New York: Infobase Publishing.
Perez, M., & Raffy, L. (2008). Cultural competence in health education and health promotion. San Francisco, CA: Jossey-Bass.
Rankin, S.H., Stallings, K.D., & London, F. (2005). Patient education in health and illness. New York: Lippincott Williams & Wilkins.
Rogler, L. H. (1996). Research on mental health services for Hispanics: Targets of convergence. Cultural Diversity and Mental Health, 2(3), 145-156.
Young, C., & Koopsen, C. (2005). Spirituality, health & healing. Sudbury, MA: Jones and Bartlett Publishers.