The United States has a significant share of Hispanic populations, and it is expected that the number of Hispanic or Latino people will grow further in the future. Although a certain degree of cultural assimilation among Hispanic people is evident, there are a lot of sociocultural beliefs, practices, and issues that affect their health. Therefore, medical professionals should apply culturally congruent health promotion and treatment strategies in order to improve the health status of this population. The present paper will provide an overview of health and health promotion beliefs, health needs and concerns, and evidence-based health promotion strategies specific to Hispanic people.
Background
A significant share of the U.S. population is comprised of Hispanic people. According to Velasco-Mondragon, Jimenez, Palladino-Davis, Davis, and Escamilla-Cejudo (2016), Hispanics are the largest minority group in the United States, with a population of 55.4 million people (17.4% of the U.S. population). The group is expected to grow further in future decades, reaching 119 million (28.6%) by 2060 (Velasco-Mondragon et al., 2016).
Hispanic people come from various countries and thus have a rich cultural background. However, as a result on numerous factors, including cultural, political, lifestyle, and socioeconomic, Hispanics face health disparities and are at an increased risk for conditions such as diabetes, obesity, cardiovascular disease, hypertension, and stroke (Velasco-Mondragon et al., 2016). In order to develop and implement effective health promotion strategies, it is critical for providers to understand health beliefs and needs of the population, as well as to apply culturally congruent interventions.
Health and Health Promotion Beliefs
Health and health promotion beliefs of Hispanic people are greatly influenced by traditional Latino medicine. Juckett (2013) states that Hispanic people often interpret symptoms differently based on their cultural presuppositions: “A child’s failure to thrive may be attributed to mal de ojo (‘evil eye’), a hex conveyed by an envious glance” (p. 50). Hispanic people who adhere to traditional medical practices also believe that there are different ‘hot’ and ‘cold’ illnesses.
For instance, cancer, colic, indigestion, headache, and pneumonia are considered to be ‘cold’ conditions, whereas diabetes, gastroesophageal reflux disease, hypertension, and sore throat are among the ‘hot’ conditions (Juckett, 2013). Maintaining the hot-cold balance, thus avoiding both types of illnesses, is usually perceived to be the key to health promotion and disease prevention.
The classification of diseases affects their treatment in folk medicine. Herbal therapy containing ‘hot’ herbs is used to treat ‘cold’ conditions, and vice versa (Juckett, 2013). Herbal teas and supplements are at the foundation of traditional Hispanic medicine. They are widely available in Hispanic neighborhoods and are administered to children and adults alike. Even though traditional medicine treatments are often not supported by clinical evidence, they are usually harmless and can be accommodated into proper evidence-based treatment approaches.
Another important factor impacting the health of the Hispanic population is the sociocultural environment. Income, employment, and education levels have a significant effect on Hispanic people’s health (Velasco-Mondragon et al., 2016). Because many Hispanic people are undocumented immigrants, they often lack health insurance and have trouble accessing proper clinical care, which affects their health literacy and status.
Finally, work and living conditions also have a critical impact on the population. Chronic stress is connected to lifestyle risk factors, including substance use, poor diet, and low physical activity level, which place Hispanic people at risk for diabetes, obesity, and cardiovascular disease (Velasco-Mondragon et al., 2016). It is evident that successful health promotion initiatives have to take into account Hispanic people’s health beliefs and their sociocultural environment.
Health Needs and Concerns
Based on the analysis of health and health promotion beliefs, there are four essential health needs and concerns of the Hispanic population. First of all, socioeconomic factors affect their access to care, and thus it is critical to ensure that Hispanic people can obtain high-quality care in clinical practice settings. Secondly, increased reliance on traditional medicine could prevent Hispanics from seeking timely care (Juckett, 2013). Thirdly, poor health literacy is a pressing concern, as it affects people’s lifestyles and attitudes towards disease prevention. There is thus a need for health promotion efforts that bridge traditional medicine and evidence-based clinical care through patient education and timely care provision.
Lastly, language and cultural barriers often affect Hispanic people’s communication with health providers, which could hinder interventions (Jongen, McCalman, & Bainbridge, 2017). Moreover, the Hispanic population is largely diverse and includes people from various backgrounds, such as Puerto Rican, Mexican, Cuban, Guatemalan, and others (Velasco-Mondragon et al., 2016). Culturally congruent care could help health professionals to establish effective communication with Hispanic people, thus enhancing health literacy, health status, and care-seeking behaviors.
Evidence-Based Health Promotion Strategies
Jean Watson’s Theory of Human Caring
Jean Watson’s theory is often used in culturally congruent health promotion efforts, as it enables providers to care for people from all cultural backgrounds. The theory is founded on a set of carative factors that aim to promote love-heart-centered-caring and compassion (Pajnkihar, Štiglic, & Vrbnjak, 2017). These factors include humanism, hope, sensibility, helping relationships, the expression of emotions, problem-solving, teaching, the environment, needs, and spirituality (Pajnkihar et al., 2017).
Thus, care by Jean Watson’s is based on the concepts of humanism, hope, and sensibility, takes into account the patient’s environment, needs, and spirituality, and uses helping relationships, teaching, problem-solving, and the expression of emotions as means of care delivery. These principles could assist providers in addressing the health needs of Hispanic populations, as they help to foster communication and design culturally competent interventions. There are four main evidence-based interventions for health promotion among Hispanic people that conform to Watson’s theory: community-based programs, patient activation, language adaptation, and cultural competency.
Community-Based Interventions
Community-based programs are the primary type of interventions used to target the health needs of cultural and ethnic minorities. Community-based health programs engage the entire community, thus allowing people to receive health care and information in their cultural environment. Evidence suggests that community-based health programs improve health literacy and health-seeking behaviors, as well as access to care (Cruz, Hernandez-Lane, Cohello, & Bautista, 2013; Wang, Chen, Lai, Chen, & Chen, 2014). Therefore, such programs offer a culturally congruent and effective alternative to interventions used for the general population.
Patient Activation
Patient activation is a significant concept in cultural-specific care, as it encourages patient participation in health promotion. As noted by Juckett (2013), Hispanic people often underestimate the impact of their behaviors and habits on health due to superstitions and spiritual beliefs. Patient activation interventions seek to empower patients and engage them in the care process, thus having a positive effect on health literacy and self-care behaviors (Hibbard & Greene, 2013). In Hispanic patients, patient activation interventions can also help to improve responsiveness to patient education, thus improving adherence to recommendations about lifestyle and treatment.
Language Adaptation
Language adaptation interventions seek to address language barriers between patients and care providers. For instance, full language adaptation refers to cases when providers speak the same language and use the same terminology as their patients (Jongen et al., 2017). Given the popularity of traditional medicine among the Hispanic people and the fact that it uses different terminology for many diseases, full language adaptation could help to improve understanding and trust, thus contributing to patient-provider relationships.
Full language adaptation interventions were proven to enhance a variety of outcomes, including treatment adherence, service utilization, lifestyle, health knowledge, and health status (Jongen et al., 2017). Thus, implementing such initiatives in clinical practice would help to address the specific needs of the Hispanic population.
Cultural Competency
Interventions for raising cultural competency are also recommended to improve the health of Hispanics. According to Juckett (2013), culturally competent care proved to be effective in encouraging treatment adherence and achieving positive health outcomes in Latino populations. Culturally competent care is a multidisciplinary initiative, which involves knowledge of cultures, training, workplace diversity, cross-cultural leadership and communication, patient advocacy, and evidence-based practice (Douglas et al., 2014). Also, culturally competent care is not specific to a certain ethnic minority and can thus be used to improve health outcomes of other patient groups.
Conclusion
Overall, Hispanic people have unique beliefs about health and disease prevention that affect their attitudes toward health care and care-seeking behaviors. This population is also affected by many sociocultural factors, which raise people’s vulnerability to certain conditions. Using Watson’s theory to provide care to Hispanic patients would assist in improving communication and patient outcomes. Specific interventions recommended for culturally congruent care for Hispanic patients include community-based programs, patient activation, language adaptation, and culturally competent care.
References
Cruz, Y., Hernandez-Lane, M. E., Cohello, J. I., & Bautista, C. T. (2013). The effectiveness of a community health program in improving diabetes knowledge in the Hispanic population: Salud y bienestar (health and wellness). Journal of Community Health, 38(6), 1124-1131.
Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J.,… Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109-121.
Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences, fewer data on costs. Health Affairs, 32(2), 207-214.
Jongen, C. S., McCalman, J., & Bainbridge, R. G. (2017). The implementation and evaluation of health promotion services and programs to improve cultural competency: A systematic scoping review. Frontiers in Public Health, 5(1), 24-37.
Juckett, G. (2013). Caring for Latino patients. American Family Physician, 87(1), 48-54.
Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis)harmony with patient satisfaction. PeerJ, 5(1), 2940-2955.
Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G., Davis, D., & Escamilla-Cejudo, J. A. (2016). Hispanic health in the USA: A scoping review of the literature. Public Health Reviews, 37(1), 31-57.
Wang, J., Chen, C. Y., Lai, L. J., Chen, M. L., & Chen, M. Y. (2014). The effectiveness of a community-based health promotion program for rural elders: A quasi-experimental design. Applied Nursing Research, 27(3), 181-185.