Social Determinants of Health in African-Americans
Culture is a system of beliefs, ideas, values, rules, and customs, and behaviors that are shared by a particular group of people or a society. Culture is used to interpret experiences and direct patterns of behavior. In this article, I will discuss the impact that culture has on African American people’s healthcare.
Social Determinants of Health in African-Americans
Sociocultural factors, race, and ethnicity have a significant impact on the delivery of quality health care. The socio-cultural background has an influence on a patient’s perspectives, values, beliefs, and behaviors regarding health and wellbeing.
This leads to differences in how patients recognize symptoms, when they seek medical care, how well they understand health management strategies, what they expect of health care (including preferences regarding medical procedures), and how well they are compliant with prescribed measures and medication.
If health professionals do not recognize and understand sociocultural differences between their patients and themselves, the result may be lower-quality care for the patients.
Racism and Mental Health the African American Experience
Studies have indicated that there are differences in health care provided to patients of different racial and ethnic backgrounds. Here are some sample findings:
- 23 percent of African Americans surveyed after a medical visit said they either had trouble understanding their doctor, felt their doctor did not listen or felt they could not ask some medical questions during the visit. This is in contrast to 16 percent for whites.
- African Americans are less likely than Caucasians to be referred for cardiac catheterization for coronary artery disease.
- African Americans (and also patients of Hispanic and Asian origins) are less likely than white patients to receive pain medication for bone fractures.
- An African-American is four times as likely as a European American to develop serious kidney disease that would need dialysis. African American patients on dialysis are less likely to be evaluated for kidney transplantation.
- White Americans are more likely to go for mental health treatment, than Americans from minority groups.
Cultural Competence Health Care African Americans
Many things lead to these differences, such as ineffective interactions with healthcare providers, language barriers, and unintentional bias.
Let us now examine how some of these cultural factors may be dealt with.
African Americans, and any other group, can receive better healthcare if health professionals used a patient-based approach in caring for patients.
Such an approach includes compassion, empathy, and learning and responding to the beliefs, needs, values, and expressed preferences of individual patients.
After that, the patient and health professional can negotiate strategies for the best possible health outcome. There are four main parts to the patient-based approach.
Evaluate the Main Cultural Issues
This involves determining issues such as whether or not the patient prefers to make health decisions by himself or herself, or prefers to consult others back at home.
African-American Healthcare Disparities
Another cultural issue is communication styles. For example, while some cultures view direct eye contact as defiance, some regard it as a sign of respect or honesty.
Still, under communication, some patients may be hesitant to express views that may seem to conflict with those expressed by the healthcare provider. The healthcare provider should employ strategies to draw out the patient’s views.
This can be done by asking open-ended questions. Also, the health professional should not assume that silence means agreement.
Trust Factors and African Americans in the Health Care System
Trust is another key cultural issue. African Americans may be mistrusting because of a history of discrimination and mistreatment. Such mistrust may manifest in questions on whether a particular course of action, such as a test, is necessary, or through the narration of a past bad experience.
- The healthcare professional should assure the patient and endeavor to build trust, This may be done through open discussion, seeking the patient’s views and preferences, and by providing reassurance regarding the specific concerns raised.
- Traditions, customs, and religious beliefs may influence what the patient will be willing or unwilling to do as part of their medical care. The health professional should find out what traditions and beliefs the patient has, and how they might affect the care that the patient receives.
In general, the healthcare provider should be aware of the patient’s culture and make effort to discuss with the patient with this culture in mind.
Explore What the Illness Means to the Patient
Patients often have certain beliefs about the cause of their symptoms, concerns about their illness, and what kind of treatment they should get. This is called the patient’s explanatory model.
The health professional may tactfully find out what the patient believes. This may be done by means such as focusing on what others believe, or by presenting hypothetical situations for the client to respond to.
The health professional may ask questions such as “What do you think may have caused this problem?” or “Why do you think this problem started when it did?” or “What kind of treatment do you think you should receive?” or “What worries you about this sickness?”
This last question gives the health professional the chance to reassure the patient by addressing his or her specific concerns.
Determining Social Context
Three aspects of social context are particularly important for cross-cultural healthcare. They are as follows.
- Change in environment. This can refer to migrating from one place to another, be it across countries or even just across streets, or it can refer to a change at work such as a new job or a demotion. Adapting to a new place can cause psychological and psychosomatic problems.
- Language and literacy. Language skills affect how well patients understand what the healthcare professional says. This includes diagnosis, treatment plans, use of medication, follow-up plans, and any special instructions. If the patient does not understand the health professional, he or she is likely to feel dissatisfied with the care received.
This is especially so if the patient is not very literate, or if he or she is more comfortable with a language other than English. Having a competent interpreter during discussions may help reduce the impact of this problem.
- Life Control and support. Culture, personal character traits, and economic factors will influence whether or not, or at what point, an individual will seek medical care. Social support also influences how the patient feels while unwell. A lonely patient will probably show more symptoms than one with a supportive social network. Being aware of these situations allows the healthcare provider to develop a plan that is workable for the patient.
Conclusion
Having established the patient’s perspectives, the healthcare provider should share information in a way that values the patient’s system of beliefs.
Any differences in opinion that are relevant should be discussed in a non-judgmental way. The patient and health professional should discuss with the aim of arriving at what the patient is willing to do to deal with their health condition. With this in mind, a plan that is acceptable to both parties can be developed.
One way of confirming whether the patient and the healthcare provider share an understanding of what has been agreed is to ask the patient to tell the healthcare provider what he or she is going to do.
This retelling may reveal any misunderstandings, which can be addressed.
Phyllis Robinson MSN, RN is a Registered Nurse of 27 years. Phyllis is passionate about the prevention and healing of heart disease using traditional and alternative methods. She has experience in emergency room, telemetry, infusion, and critical care. Phyllis currently practices in an intensive care unit.
