Essentials of Cultural Competence in Pharmacy Practice: Chapter 4 Notes

Chapter Author: Dr. Amy Drummond

Hispanic/Latino Patients

Learning Objectives1. Articulate the variability across patients

who are identified as Hispanic/Latino.2. Recognize the role that extended family

may play in the procurement of health care.

3. Specify the health care disparities that may affect Hispanic/Latino patients.

4. More accurately assess spirituality, illness and limited English proficiency in patients.

Hispanic/Latino2006 U.S. Census Bureau estimates of the

Hispanic/Latino populationThe largest numbers reside in California,

Texas, and Florida.

How Is Hispanic/Latino Defined?“A person of Cuban, Mexican, Puerto Rican,

South or Central American, or other Spanish culture or origin regardless of race.”

Based upon 2000 U.S. Census data, approximately two-thirds of the Hispanic/Latino culture living in the United States have identified their race as Mexican.

ImmigrationPrimarily for political and economic reasons. Early 20th century: immigration due to political

instability and opportunities for economic advancement.

Depression Era: many immigrants sent back to their native countries.

World War II: Mexican immigrants again welcomed into the United States to assist with farm and factory labor.

Since that time, immigration from Mexico has been met with various political views.

Communication StylesTraditionally, Spanish was the primary language, but

largely dependent upon the individual’s country of origin.

A third generation Hispanic/Latino living within the United States may speak only English.

In regions of Hispanic/Latino inhabitation that have strong French and Native American influences, French and Native American dialects may be the primary language.

Such influences have led to some being described as co-lingual.

High ContextGreetings-a special focus on the abrazo, an embrace

used to greet those that an individual is close to. Emotional--great emphasis on body language and

touch

Communication Styles (cont’d)During interaction with healthcare

providers, people of the Hispanic/Latino culture often do not take on active roles in communication.

Therefore, pharmacists must be cautious that effective communication and understanding of the rationale for treatment occur.

Silence should not be viewed as a patient’s acceptance of treatment.

PersonalismoInteracting in a caring manner

extending beyond the individual to their family and other aspects of their life.

The application of personalismo to interactions in pharmacy practice may improve patient compliance.

Interpretation of TimeLoose frame of reference. It is not uncommon for individuals to

schedule meeting times and then not arrive punctually.

When arranging meeting times, pharmacists should ascertain if they are following the American clock or the Latin clock.

Family Roles/OrganizationsThe Hispanic/Latino culture subscribes to a strong

extended family system (familismo).Males typically work outside the home to provide

financial support for the family. An important concept for many Hispanic/Latino

males is machismo—placing honor above all other things to preserve the male’s sense of being.

The traditional role of females has been that of wife, mother, and homemaker.

A larger portion of the United States work force will be made up of Hispanic/Latino women in the future.

Hispanic/Latino culture subscribes to a strong extended family system.

Mexican American grandparents play a vital role in contributing to the family unit.

Great respect toward elders.

Lesbian, Gay and Bisexual RelationshipsMinority sexual orientations are

generally not viewed favorably among the Hispanic/Latino population.

Strong sense of familismo. Values of procreation, carrying on the

family name, and machismo may lead individuals to avoid disclosing their sexual orientation.

Workforce IssuesHispanic/Latinos born in the United States

contribute to virtually any occupation in the professional or service industry.

Foreign born Hispanic/Latinos make up a large portion of the construction, agricultural, and service industries.

Within the work force, Mexicans may choose not to associate with the Hispanic/Latino culture in the hopes that they will achieve greater financial gain.

Relevant Disease States Leading causes of death in 2002 among Hispanic/Latino

individuals. Conditions with exceptionally high rates among

Hispanic/Latinos compared to other cultural groups. Among the Hispanic/Latino population, conditions of

which Puerto Ricans have the highest prevalence. The prevalence of diabetes and obesity are similar

between Puerto Ricans and Mexicans. Hispanic/Latinos tend to have a higher incidence of

tuberculosis.

High Risk BehaviorsThe Hispanic/Latino culture has a significantly higher

incidence of human immunodeficiency virus (HIV) compared to other groups within the United States.

Prevalence of tobacco use in Hispanic/Latino males and females.

The prevalence of smoking is lower among the Hispanic/Latino population than the non Hispanic/Latino white population.

Data on alcohol consumption within the Hispanic/Latino population.

The rates of substance abuse do not differ significantly between Hispanic/Latinos and non-Hispanic/Latinos.

Hispanic/Latinos were more likely to report using illicit substances when compared to non Hispanic/Latinos.

Health Seeking Behaviors Hispanic/Latino men tend to seek care when they are unable to

carry out their occupational responsibilities. Hispanic/Latino women tend to seek health care for the

family and often place their family’s needs before their own.

Lack of insurance coverage may limit seeking health care. When significant healthcare decisions need to be made, many

family members may be involved with the ultimate decision being made by the elder male family member. This may present challenges to the pharmacist when trying to maintain privacy standards.

Nutrition It is difficult to generalize nutritional intake based

upon availability of local foods. Typical components of the traditional Hispanic/Latino

diet are high in intake of plantains, beans, rice, and poultry and low with regard to most fruits and vegetables.

Food is an important part of the traditional culture.

Pregnancy/Childbearing/Childrearing Familismo has contributed to the development of large

families among many Hispanic/Latinos. Engaging in the maternal role may be a core value for many women.

Catholicism--A high percentage of Hispanic/Latinos are Catholic.

The maternal role may be changing from the traditional homemaker with child rearing responsibilities as more Hispanic/Latina women enter the work force.

Practices associated with newborn care.

Pregnancy/Childbearing/Childrearing Infants born to Hispanic/Latino women tend to have low

mortality rates. Less than 80% of Hispanic/Latina women begin to receive

prenatal care during the first trimester. Common belief that life is determined by fate. Consequently, it

is difficult to proactively influence a pregnant woman to make lifestyle changes.

Within the Hispanic/Latino culture, it is expected that health care providers demonstrate great respect toward women, and especially pregnant women.

Some women prefer to have only females involved in their care.

After giving birth, some women may wish to bury the placenta. During the postpartum period, the mother may observe La

Cuarentena, a time period of nearly six weeks in which the mother limits physical activity and focuses on caring for herself and her newborn and the father becomes engaged in his paternal role.

Spirituality Spirituality is deeply rooted within the Hispanic/Latino

culture. The primary religion among the Hispanic/Latino culture is Roman Catholic.

Various depictions of the Virgin of Guadalupe. Spirituality among a group of Hispanic/Latina women. The meaning of life follows the core values associated

with family discussed earlier.

Hot/ColdA belief that health is in a state of balance when

equilibrium exists between “hot” and “cold”. Hot diseases are treated with cold remedies and

nutritional intake, and cold diseases are treated with hot remedies or nutritional intake.

The “hot” and “cold” is not referring to the temperature of the patient, remedy, or nutritional source.

Traditional Healersyerberos focus upon herbal therapy.parteras practice as midwives.sobadores practice involves massage

therapy.curanderos practice curanderisomo and are

able to treat a multitude of symptoms.

AntibioticsAntibiotics can be easily obtained without a

prescription or other medical intervention. A study found that more Hispanic/Latino parents felt

that antibiotics were a required treatment for their offspring as compared to non-Hispanic/Latino whites.

A study in New York City conducted in 2004 indicates that in a Hispanic/Latino area surveyed, antibiotics were available without a prescription in all of the grocery stores.

Even in the United States there are opportunities for patients to obtain antibiotics without seeking medical care.

Pain Management Less than optimal. Beliefs about pain The culture may also rely upon prayer and alternative therapies

to obtain pain relief. Cancer patients may not follow the health care provider’s

recommended pain therapy regimen.

Role of Healthcare PractitionersTraditional healers are expected to be qualified

and interact with close, personable behavior toward their patient.

The healer is following their “calling,” which indicates a deep sense of spirituality.

Health care providers are well respected within the Hispanic/Latino culture.

Hispanic/Latinos seek physicians from their own culture.

Reflection Questions1. How might the concept of personalismo

affect the patient counseling you provide?2. As a pharmacist, how will you work with

Hispanic/Latino patients to mitigate known health disparities?

3. How will you use the information contained in this chapter to inform your practice?