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S. U. S. Cultural Sensitivity. by Lee Pachter reviewed by William G. Bithoney. Goals. To understand the role of cultural beliefs and practices an individual’s approach to health-related issues. To develop an approach to asking patients about non-biomedical therapies and practices.
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S U S Cultural Sensitivity by Lee Pachter reviewed by William G. Bithoney
Goals • To understand the role of cultural beliefs and practices an individual’s approach to health-related issues. • To develop an approach to asking patients about non-biomedical therapies and practices. • To develop an approach to incorporating patient-held beliefs and therapies into health education and treatment plans.
Different Approaches to Health and Illness • An individual’s approach is based on: • Personal psychology/philosophy • Past experiences • Health education • Culture
Explanatory Model(Kleinman) • Beliefs regarding 1) Etiology 2) Time and mode of onset of symptoms 3) Pathophysiology 4) Course of sickness and type of sick role 5) Treatment
Health Beliefs History(Pachter, adapted from Kleinman) • What would you call this problem? • Why do you think your child has developed it? • What do you think caused it? • Why do you think it started when it did? • What do you think is happening inside the body? • What are the symptoms that make you know your child is sick?
Health Beliefs History (cont) • What are you most worried about? • What problems does this sickness cause for your child? • How do you treat it? • What will happen if this problem is not treated? • What do you expect from the treatment?
Differing Explanatory Models • Biomedicine: • Disease (malfunctioning of biological and/or psychological processes ) • Patients: • Illness (the biological and psychosocial experience of perceived malfunction, including their affective and social meanings; e.g.—the sick role)
Health Beliefs History: Examples • If a friend of yours asked you ‘What is asthma?’, how would you answer them? • Can you tell me what goes on inside the body when your son has an asthma attack? • Why do you think your daughter has asthma? • What makes his asthma get bad? What makes him get better when he’s sick?
Folk/Home/Alternative Remedies • “Some of my patients have told me that there are ways of treating asthma that doctors don’t know about, but are effective. Usually people in the community, especially older people like grandparents know of them. Some of them might be effective. Have you heard of any of these?”
“Have you ever tried these remedies?” • “Have you ever tried it for your child’s asthma?” • “Are you using it now?”
Strategies for Combining Patient Beliefs and Practices Into the Clinical Care Plan. • Combine the biomedical model with the patient model • ex. (pt belief that mucus causes asthma) • “You’re right, during an asthma attack your lungs do produce a lot of mucus. But also, your breathing tubes swell up and go into spasm…”
Strategies (cont) • Add non-harmful folk treatments to the biomedical care plan • ex: use of 7 jarabes • “If you want to continue using 7 jarabes, that’s OK—if used as directed it will cause no harm. But right after you give the 7 jarabes give a machine treatment with albuterol—don’t wait—they might work better together…”
Culture and Clinical Care:Awareness-Assessment-Negotiation • Become aware of the commonly held ethno-medical beliefs of the group in your community • Assess the likelihood a particular patient may act on these beliefs during a particular illness episode • Negotiate between the biomedical and ethno-medical belief systems
