Cultural Models For Health Assessment
Cultural competence requires an overall understanding of culture because health problems disrupt personal, family, and social life, intimate behavior, and self-image and place additional demands on family and friends. Medical treatment can produce further disruptions and reduce a patient's motivation and ability to comply. Providers can reduce these difficulties by understanding the impacts of maladies and treatments on patients' lives and managing these disruptions as part of the total care of patients. This requires an assessment of the relationship of patients to their cultural context. Appropriate treatment planning requires an understanding of the client's sociocultural environment. Social and cultural factors such as economic resources, unemployment, social roles, and community organization and those of acculturation, education, occupation, class, values, discrimination, and religion affect maladies and patients' treatment.
Culturally responsive care requires attention to many cultural effects on health. Medical anthropology, medicine, transcultural nursing, public health, and social work address culture through similar approaches that involve cultural systems models. While sharing core elements, these models also have variation reflecting context- and task-specific differences in the particular aspects of health on which they focus. For instance, nurses are concerned with source of consternation and anxiety. Hospital food replaces the traditional diet of rice and chicken with herbs that provide vital treatment to help in postpartum recovery. The traditional ritual care of the baby's placenta is a challenging situation for those who live in apartments and cannot follow the tradition of burying it beneath their house.
Family and kinship roles are important in relationship to the staff. The Hmong patriarchal kinship systems and patrilineal residence (newlyweds live with husband's family) give men central roles in decision making. Heads of lineages, rather than patients, may be the focal decision makers regarding health care, but they consult extensively with family members and relatives in reaching a decision and today often consult the wife's side of the family as well. Collective agreement about the course of treatment relieves any individual, including the head of the family, from blame in the event of a poor outcome.
Unlike the respect they traditionally received, Hmong elders in America are culturally and personally traumatized, reduced to menial jobs or dependence on government support. Changing gender roles and the increased independence of women produce further conflicts and stress. Their once tight-knit communities and generational structure have disintegrated, producing alienated youth with mental health problems. The clan systems that helped ensure that marriages remained successful are weak in the United States, contributing to escalating domestic conflicts in isolated nuclear families. Grandparents, once considered authorities in raising their grandchildren, today find their views ignored. Acculturation has produced role reversals where the elderly now depend on their grandchildren for their translation assistance with doctors.
factors that affect the physical assessment of patients whereas public health workers are concerned with behaviors that contribute to the spread of disease. Consequently, diverse models are necessary for organizing learning about and research into the myriad influences on health and addressing the multiple areas of culture. Aspects of the cultural systems models that are discussed in this chapter focus on nutrition, reproductive behaviors, family structures, and ideological culture. The principles of religious healing and traditional ethnomedical practices—the "witch-doctor's legacy"—are addressed as part of anthropological medicine. Anthropological medicine elicits the sociocultural dimensions of healing processes, those that address the personal, social, and cosmological dimensions of health concerns. Culture may not be able to cure disease, but it has many mechanisms for healing illness and providing care for all maladies. Leininger's (1991) concept of culture care is presented to illustrate the cultural dimensions of addressing basic human needs when confronting health problems.
A key issue in developing culturally responsive care and health services is an assessment of community health needs. These approaches incorporate communities into health care planning, development, delivery, and assessment. The basic processes of community health assessment are outlined, beginning with the involvement of community in determining priorities for health planning and programs. Community health assessment approaches are provided in the processes of ethnographic rapid assessment, response, and evaluation, which are tools for creating community-responsive health care programs and extending cultural systems models in context- and foci-specific assessments that guide inquiry into culture and health relationships.
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