English language proficiency & health literacy | Social factors | Economic factors
Cultural beliefs & attitudes | Elder abuse
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CULTURAL BELIEFS AND ATTITUDES
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Within the next ten years, the US population will grow significantly older and more diverse. The minority older population will triple by 2030, when one quarter of the elderly population will belong to a minority racial or ethnic group (US Census Bureau,
January 2000). Different racial and ethnic groups have diverse beliefs and attitudes about health and medicines, which may affect adherence to therapy.A failure to appreciate these differences may contribute to misunderstanding or miscommunication about health care.
No one list can define the values that older adults may place on medications, or their beliefs about how health and healing take place. Each person must be considered individually. Listening and asking nonjudgmental questions begins the process of understanding people's diverse beliefs and practices about health and healing and how to integrate them into interventions to improve medication adherence.
"Culture" refers to integrated patterns of human behavior that include the language, thoughts, actions, customs, beliefs and institutions of racial, ethnic, social, or religious groups (California Endowment, 2003).
Every culture has beliefs about health, disease, treatment, and health care providers. People from the many immigrant cultures, as well as American Indians, bring their beliefs, and the practices that accompany them, into the health care system. This often proves challenging to health care professionals who have been trained in the philosophy, concepts, and practices of Western medicine (California Endowment, 2003).
People within any cultural group are not homogeneous, even though they may hold many beliefs, practices, and institutions in common. Messages and materials must respect the variations within cultural groups. Some of the major areas of difference within groups include educational level, English language proficiency, financial resources, adherence to folk customs and beliefs, sexual orientation, geographic location, health status, and preferred language.
Respect
In cultures where elders receive great respect, such as in the American Indian community, caring requires kindness and respect without any appearance of scolding (Salimbene, 2005), even if non-adherence may endanger the elder's life. Trust-building comes with storytelling, listening, respecting silence, and honoring the desires of the American Indian elder (University of Washington, 2005). Because of the experience of many
African American elders who grew up with segregated health care and social service systems in which they faced continual discrimination, it is extremely important to show respect to them in order to put them at ease and establish rapport. This includes at the least, using respectful forms of address (e.g., Mr., Mrs.) unless they give the permission to do otherwise (University of Washington, 2005).
Mistrust of the Health Care System
Based on personal history and experience, many African Americans may view receiving health care as a degrading, demeaning, or humiliating experience. Some may even fear or resent health clinics because of the long waits, medical jargon, feelings of racism or segregation, loss of identity, and a feeling of powerlessness and alienation in the system (Spector, 2000).
The African American experience in America has left many African Americans mistrustful of mainstream institutions and providers who are members of the dominant culture. The 40-year Tuskegee
