Hispanic, Tri-cities

The Hispanic Culture

By: Kippy Becker, Joanne Nguyen, Brian Steen, Alana Wilson  and Megan   Zanol

Cultural Attitudes/Beliefs

Gender Roles: The Hispanic cultural attitude of machismo reinforces female passivity and male dominance and virility, and can reduce safer sex practices and negatively influence treatment utilization. One study found high numbers of married Hispanic men with multiple sex partners. Some research indicates that condom use is sanctioned only to a limited degree, such as for extramarital sex, but not for sex with a regular partner.

Women who maintain traditional gender roles, called marianismo, have more difficulty refusing sex or negotiating condom use, since it is the man’s role to make these decisions. A woman who suggests condoms may be perceived as promiscuous or of accusing her partner of homosexuality.  Marianismo can affect adherence among Hispanic females, who may turn to their significant others for medical advice, regardless of their knowledge.

The new breastfeeding mother… Many new Hispanic mothers believe that because their milk has not come in yet, they are unable to breastfeed their babies.  This idea has been carried on through many generations.  It is very difficult to teach a new Hispanic mother about the importance of colostrum if she believes this.  When encouraging breastfeeding immediately after delivery, you may encounter “no leche, no leche”.  After telling you she has “no milk”, be ready for her to ask you for bottles for her baby.  Ironically, when the mother and baby arrive home from the hospital and the mother’s milk does come in, the breastfeeding success rate is very high. Reference: http://hab.hrsa.gov/publications/hrsa499.htm, http://www.fotosearch.com/clip-art/breast-feeding.html

Quinceañera

When a Hispanic girl turns 15, her family celebrates her 15th birthday by giving her a Quinceañera.  This includes a party and a ceremony, which is usually religious.  There is a special dance that is meant to be her first dance and is usually a waltz.  The parents make a toast after the girl’s first dance and the party guests join the dance floor.  A doll is given to the birthday girl representing her last doll as she becomes a young lady.  This doll is dressed just like her.  At the beginning and throughout the ceremony, the girl wears flat shoes.  During the reception, the father or godparents exchange the flat shoes for heels after her 1st dance and she is crowned.  This event is very important and can be as expensive as a wedding.

Watch a Video of a Quinceañera here:

References: A Special thanks to Jasmin Ola for the information, images courtesy of http://anothermaria.com and http://www.everywheremag.com, http://www.youtube.com/watch?v=v6_lO_HBS18

Sense of Self

Hispanic is a term that is used to describe people who were born or who can trace the backgrounds of their families to one of the Spanish-speaking Latin American nations or to Spain.

Hispanics actually come from diverse backgrounds: African, Native Indian, and European. It is important to realize that “Hispanic” does not denote a race; it is a racially mixed population encompassing people with different skin colors, immigration histories and socioeconomic statuses – all of whom can trace their lineage to Spanish-speaking Latin American countries or Spain.

Because the term Hispanic is so broad, it is often not preferred. Many people who we would consider Hispanic, would desire being associated with their country of origin along with the word American. Some examples are Cuban American, Mexican American, and Latin American.

Reference: http://www.bellaonline.com/articles/art31981.asp, http://hcselabs.wiki.hoover.k12.al.us/file/view/other3.jpg/41566463/other3.jpg

Hispanic Language

Spanish is the common language uniting Hispanic people, though there are some Hispanics whose native language is French or Portuguese. Spanish is considered a Romance language, with similarities to other Latin-derived languages such as French and Italian. While most Hispanic individuals speak Spanish, there are a variety of Spanish dialects and linguistic characteristics that distinguish speakers from various Hispanic groups. Differences in daily expressions, vocabulary, and accents can be found in the Spanish spoken by different individuals of Hispanic descent.

Many Hispanic children who are raised in the United States are bilingual, able to speak both Spanish and English. Most Hispanic children speak Spanish at home and learn English at school. Hispanic children, however, also have very different degrees of Spanish and English language proficiency, depending on levels of acculturation and family and community environments.

Communication and Social Interaction

Personalismo – This refers to the tendency of Hispanics to place utmost value on individuals as opposed to institutions. They tend to trust and cooperate with individuals they know personally, and many dislike impersonal and formal structures. Hispanic customers may identify a health worker by name rather than by job title or institution. In a professional situation, many expect formality in address (Mrs. X), but also personalismo (how are your kids doing in school?). The quality of a social interaction is often seen as more important than length.

Respeto – The special consideration and respect that should be shown to elders and authority figures within the community. When speaking Spanish, elders should be addressed as usted, not tu.

Simpatía

This describes many Hispanics’ preference for smooth social relations based on politeness and respect, as well as avoidance of confrontation and criticism. Overt disagreement is not considered appropriate behavior. Some expect offers of gifts or food to follow a pattern of offer, refusal, insistence, and final acceptance, so receivers do not appear greedy or givers insincere.

Many Hispanics are characterized by warm, friendly, and affectionate relationships. Personal space is close and frequently shared with family members or close friends. Some Hispanics may get agitated or emotional when nervous or frightened. They may communicate intense emotion and appear quite animated in conversations – a behavior that is sometimes misperceived by non-Hispanics as being “out of control”. Latinos’ voice pitch and inflections are sometimes misinterpreted as confrontational. Many are very loud and outspoken in expressing pain.

Many Hispanics, particularly if they were not raised in the US, may avoid direct eye contact with authority figures or in awkward situations.  Many will nod affirmatively but not necessarily mean agreement. Silence may mean failure to understand and embarrassment about asking or disagreeing.  Many may understand English better than they can speak it, especially under stress.

Modesty and privacy are important. Stigmatized health issues should be discussed through an interpreter and not family members. When a family member is used as interpreter, if the issue is personal, try to use a family member of the same gender. Sexuality issues are hard to discuss. Often the word for sex (sexo) is not even used – tener relaciones (to have relations) is used instead.

Reference: http://www.health.ri.gov/chic/minority/lat_cul.php

Hispanic Dress/Appearance

Spain:  In general the Spanish have a very modern outlook on clothing. They are keen on designer clothes but quality is more important than a designer name. Spanish made clothes tend to be high quality and reasonably priced. Teenage girls tend to wear trousers more than skirts. Denim is definitely “in”.   Teenage boys are keen on designer wear and appearance is important to them. Mature Spaniards dress conservatively and with style. Older men in particular tend to wear high quality clothing.

Mexico: Modern Mexican clothing does not differ very much from the clothes we use everyday. Thanks to the globalization, young Mexican people living in big cities trend to wear clothes like loud-colored cotton t-shirts, sneakers and jeans.

As for Mexican clothing used on celebrations, we can find a different costume for almost every special day of the year. National festivities are celebrated with typical clothes and accessories (including the famous Mexican Sombrero). Some special days like the Day of the Death are closely related to religion, and that can be seen on the costumes too. During the Carnival, the Mexican clothing of choice is the “Charro” suit (the picture to the left is an example of a Charro), popularized by the famous musical ensembles known as the Mariachis.

Reference: http://www.facts-about-mexico.com/mexican-clothing.html, http://www.buzzle.com/img/articleImages/4144-43.jpg

Diet and Food Practices

  • The typical diet is high in fiber, relying heavily on beans and grains (rice) rather than on meats for protein.
  • Leafy green vegetables not a usual part of the diet.
  • Relatively little intake of dairy products. Milk is consumed in coffee.
  • Generally eat a lot of tropical fruits, fruit juices, and starchy root vegetables (e.g., potatoes, cassava, plaintains). Sofrito (blend of spices) is used to season stews.
  • Puerto Ricans do not typically eat tortillas. More than 100 varieties of herbal teas are used to treat illness and promote health. For colds, flu and viruses, many use a mixture of honey, lemon and rum as an expectorant and antitussive. Egg yolk, sugar, and milk, malta, or fruit juices may be used as nutritional support for illness.
  • Moles: Pronounced Mo-lay, the name of this dish comes from the Aztec word for “mixture.” Mole Poblano de Guajolote, is a mixture of dried chiles, nuts, seeds, vegetables, spices and chocolate.
  • Tortillas: This flat bread is made of wheat flour or masa and forms the base of tons of tasty Mexican dishes like enchiladas, burritos and fajitas.
  • Ceviche: A Mexican dish of raw fish marinated in lime juice, often in a chopped salad.

http://i.ehow.com/images/a04/bm/oo/traditional-hispanic-food-800X800.jpg, http://www.ranchogordo.com/assets/images/cooking/ceviche2.jpg

Eating Habits

In Hispanic countries, a light meal is served for breakfast. Lunch, referred as el almuerzo, usually is the main meal of the day for Spanish-speakers. In some countries, it is customary for adult family members and children to come home from work or school for about two hours to be together for this meal. La siesta, which is a rest period taken after lunch, is known to be a common practice among adult Hispanics. In the early evening, la merienda, a light snack of coffee and rolls or sandwiches, is served. This meal is often very informal and may be just for children. In the evening, often as late as 9:00 p.m., la cena, a small supper, concludes the day’s meals.

Once settled in the United States, most Hispanics adopt the three-meal system. Midday and evening meals are important family or social events. Especially when guests are present, the meal may be followed by the sobremesa, a time to linger and talk over coffee or perhaps an after-dinner drink. Usually when food or additional servings are offered to Hispanics, they tend to accept only after it is offered a second or third time.

Reference: http://ohioline.osu.edu/hyg-fact/5000/5237.html

Time Consciousness

When invited to a Mexican’s home, there are proper dinning etiquettes to follow. In most places, it is known to arrive about 30 minutes late. If you were to arrive early or on time, then it would be considered inappropriate. If the gathering is small, typically the host would introduce you; however at larger parties you can introduce yourself.

Work Habits

The Hispanic culture’s work day doesn’t vary from ours. Depending on the business and their employer, most people will work six days a week. Some may take less days off in order to make extra money. Hispanic women don’t work outside the home as often as U.S women because they tend to stay at home and care for the family while the men support the family.

Most business appointments should be made at least 2 weeks in advance and reconfirmed one week before the intended meeting. It’s interesting to note that Mexican business associates can be up to 30 minutes late; however, you must be on time and not irritated if they run behind schedule.

References: http://www.kwintessential.co.uk/resources/global-etiquette/mexico-country-profile.html, http://www.ansci.umn.edu/dairy/dinews/10-1-hispanic.htm, http://www.fotosearch.com/illustration/late-meeting.html

Relationships/Social Organization

Traditional gender roles in the Hispanic community are well defined.  As previously defined, Machismo or marianismo are often terms used to describe the traditional and idealized Hispanic cultural expectations of an appropriate male and female behavior. Dominant, virile, and independent are some terms used to describe machismo. On the other hand, marianismo is described to be submissive, chaste, and dependent. “Familismo” is one of the strong cultural values in the Hispanic community. Family relationships and a strong value placed on childbearing are emphasized on family relationships. There is a strong emphasis on family obligation, the value of children and community and the importance of past and future generations.

The cultural emphasis on machismo for men is demonstrated through their role as a provider and sacrificing for the family or a negative one that emphasizes dominance and control. To clarify, the Hispanic fathers can be seen as nurturing in the sense that he places traditional emphasis on familial obligations. Due to the cultural emphasis on their economic role in the family, Hispanic men are often also seen as cold and domineering. The main role emphasized for females in Hispanic tradition is that of mother instead of wife; as a result, the women tend to define themselves through their family and children instead of independently or as a part of a couple. First and foremost, they would place themselves as a mother first and the couple relationship at a lower priority.

Finally, the stereotypical conservative gender roles as described can often lean to increased domestic violence in the Hispanic community. A strong commitment to the family and to the marriage itself along with the woman’s role as sacrificing and obedience can lend to the tolerance of domestic violence. Controlling behaviors are sometimes encouraged due to the fact that men are typically seen as the dominant decision makers in the family. Furthermore, sine the Hispanic women are often economically dependent on men, it makes it even more difficult to leave a relationship. On the other hand, Hispanic men who accept the positive side of machismo would be more likely to be less violent. The positive side of machismo emphasizes men to protect their families, including their wives.

Reference: http://www.acf.hhs.gov/healthymarriage/pdf/Gender_Norms.pdf

Mental Process/Learning

Mexican American elementary and middle school students identified a cool temperature and formal design as some of the important environmental learning elements. Adolescents of this culture are more conforming with a higher degree of structure. According to a study by Dunn and Dunn (1992), Mexican American children didn’t prefer learning alone compared to Caucasian students. It was also noted that children of this culture required significantly more sociological variety. Finally, research has indicated that Mexican American are more “field dependent” than nonminority students. Components of field dependent include individuals that are more group oriented, cooperative, and less competitive.

Reference: http://www.ericdigests.org/1996-4/hispanic.htm, http://school.discoveryeducation.com/clipart/clip/pushover.html

Hispanics in the United States…

Past, Present, Projected

Hispanic Population in the United States: 1970-2050 (population in millions)

Geographic Distribution of Hispanic Population:

1980 vs. 2006



Population Trends in the Hispanic Population

As of July 1, 2006: 44.3 million Hispanics, 14.8% of total population of 299 million

Between 2000 and 2006: Hispanics accounted for one-half of the nation’s growth and Hispanic growth rate (24.3%) was more than three times the growth rate of the total population (6.1%)

% Hispanics and Their Contribution to Annual Components of Change

Change in Population: 2000 to 2006

Socioeconomic Characteristics

(Median Age by Sex)

Marital Status by Sex: 2006

(Percentage population 15 years and older)

Reference: http://www.census.gov/population/www/socdemo/hispanic/hispanic_pop_presentation.html

The Health Care Environment for Hispanics

Perceived discrimination

Experiences of discrimination with people who identify themselves as Hispanic is what lead to the rise of the Chicano movement.  In one study, nearly all participants claimed to have experiences in discrimination while shopping or with the police.  People who are in this group have an awareness of low group status and a struggle for justice.  More convincing to this perceived discrimination comes from immigration reform.  Many Hispanics view the lack of amnesty to be fueled from racism, eugenics, and prejudice towards people of this culture.  Evidence of racism can be seen back in 2006 during the immigration debate when radio host Brian James made this comment:

“What we’ll do is randomly pick one night every week where we will kill whoever crosses the border. Step over there and you die. You get to decide whether it’s your lucky night or not. I think that would be more fun.”

In health care, Hispanics who were born in the United States and are citizens, were more likely to report discrimination when compared to other Hispanics born outside the United States.  According to the journal of Cancer Epidemiology, Biomarkers and Prevention, they concluded that minorities who reported discrimination are less likely to be screened for breast or colon cancers.  Women who reported being discriminated against were one-third less likely to have undergone a colorectal cancer screening, while for men it was as much a 70% less likely to have colorectal cancer screening (Coronado, G., Thompson, B., & Chen, L. 2009).  This is a simple procedure that is not being performed enough in the Hispanic community due to the challenges faced in discrimination.

Reference Article: Coronado, G., Thompson, B., & Chen, L. (2009). Sociodemographic correlates of cancer screening services among Hispanics and non-Hispanic whites in a rural setting. American Journal of Health Behavior, 33(2), 181-191. Retrieved from CINAHL with Full Text database.

Health Care Disparities

The Hispanic culture tends to be more relationship oriented.  This is why when it comes to health care, Hispanics prefer a more one on one relationship with their providers.   Unfortunately, the US health care system tends to work more like a business.  Physicians in this country focus their energy more in the field of treating disease or injury and not getting to know their clients.   This leads to health disparities for the Hispanic community due to lack of communication with the physician.  “about one-third of Hispanics receive most of their health care in a clinic or in an emergency department (ED).  Frequently, in clinics/EDs patients do not receive health care services from the same physician or health care provider at each visit” (Adams, C., Horn, K., & Bader, J. 2007). This leads to a lack of communication and trusting relationship between providers and patient.

Hispanics also have a different perception of age related changes.  Many Hispanics do not view growing old to be a significant issue, and in fact some embrace the benefit of respect some receive with age.  When it comes to the development of menopause, Hispanic women tend to not view the physical changes as being something to be concerned with.  Following a multicultural study, Bromberger et al.(2001) noted that due to psychosocial factors Whites have higher odds for distress than and Hispanic women.

Reference Articles:

Adams, C., Horn, K., & Bader, J. (2007). Hispanics’ experiences in the health system prior to hospice admission. Journal of Cultural Diversity, 14(4), 155-163. Retrieved from CINAHL with Full Text database.

Bromberger, J. T., Meyer, P. M., Kravitz, H. M., Sommer, B., Cordal, A., Powell, L., et al.  (2001). Psychologic distress and natural menopause: A multiethnic community study. American Journal of Public Health, 91, 1435-1442.

High risks for Hispanics

Occupations which require physical labor such as construction, farming and manufacturing, tend to have much higher rates of on the job accidents or fatalities.  These professions have largely been taken over by Hispanic immigrants.  The current population of the US construction work force includes 46.5% people of Hispanic origin.  Many of these Hispanic migrant workers lack the proper training and education.  They also have challenges in both language and cultural barriers which contribute to increased instances of work related injuries.  One study showed that 68.6% of falls from roofs in the construction industry were Hispanic.  Of workers who were struck by an object or equipment, 65% were Hispanic.  More startling, the same study also revealed that 10 out of every 12 construction workers who died as a result of being caught or crushed in excavation were Hispanic (Acosta-Leon, A., Grote, B., Salem, S., & Daraiseh, N. 2006).

Although Hispanic people have a much higher risk for injury, many are reluctant to seek treatment due to immigration status or lack of medical insurance.  This can be noted by looking at laws such as California’s Proposition 187, which require all physicians to report all undocumented immigrants to immigration authorities.  Immigrants living in Los Angeles, Houston, and El Paso were asked if they were reluctant to seek medical services due to immigration status.  39% surveyed expressed fear about being deported ( Lee, S., & Choi, S. 2009).  Therefore, their documentation status prevented them from receiving medical and dental care, along with prescription drugs such as antibiotics.

Not only do Hispanics have difficulty seeing a physician, they also have trouble paying for one.  One study concluded that of low income non-citizens, 58% did not have a form of medical insurance.  This statistic did not include the number of Hispanics that are under insured. Meanwhile, 30% of low-income citizens are uninsured, nearly half the rate of non-citizens (Cristancho, S., Garces, D., Peters, K., & Mueller, B. 2008).  Hispanic people then tend to avoid seeking medical treatment, which only makes illness or injury worse.  Any delay in treatment could result in infection or a progression of disease that can reach the point of untreatable, or far more expensive to treat then if they had early access to health care.

Reference Articles:

Acosta-Leon, A., Grote, B., Salem, S., & Daraiseh, N. (2006). Risk factors associated with adverse health and safety outcomes in the US Hispanic workforce. Theoretical Issues in Ergonomics Science, 7(3), 299-310. Retrieved from CINAHL with Full Text database.

Cristancho, S., Garces, D., Peters, K., & Mueller, B. (2008). Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use. Qualitative Health Research, 18(5), 633-646. Retrieved from CINAHL with Full Text database.

Lee, S., & Choi, S. (2009). Disparities in access to health care among non-citizens in the United States. Health Sociology Review, 18(3), 307-320. Retrieved from CINAHL with Full Text database.

Cultural Taboos

Attitudes About Sex: Frank discussion of sexuality is taboo in many Hispanic cultures. Individuals who suggest using condoms, engaging in premarital sex, or same sex sexual contact, may not be supported by their partners, families, or communities because of cultural and religious beliefs.

Did You Know… Some Hispanics believe that if you look at their baby or child and you don’t touch them, you could be giving the child the “evil eye” and they will become very sick or even die from it?  Always ask before you touch, you wouldn’t want to scare a parent!

The handshake! “We’re a touching people.  If you’re more than a handshake distance from your customer or patient, you’re too far.  Touching, how you make eye contact, the subtle things all count.”

What are the top 5 things a nurse or health care provider would need to know about someone that identifies with this culture?

Death and funeral

As a nurse or health care provider it is important to know that Hispanics do not fear death.  Death is actually embraced and celebrated in this culture. Most Hispanics are Catholic and tend to follow the traditions of Catholicism, which treat funerals as part of the dying process. They don’t necessarily wait until after death has occurred. Once a loved one has passed, most of the time a family member will stay with the body in order to keep them company and to ensure that they will receive proper treatment. In the Hispanic culture, a wake is a very social event. During a wake, the family sits with the body until the burial to offer prayers and to keep them company.  The Hispanic culture has strong family ties and believes that not even death can take the love a family has for each other.   Reference: http://www.bellaonline.com/articles/art40851.asp

Gender Roles

The father or oldest male holds the greatest power in most families and may make health decisions for others in the family.  At least publicly, women are expected to manifest respect and even submission to their husbands. Privately, some women will hold a greater degree of power, however, in too many marriages, the threat of physical violence is real and under-reported.   Reference: http://bearspace.baylor.edu/Charles_Kemp/www/hispanic_health.htm

Family Relationships

Perhaps the most import thing to consider in the Hispanic culture is with close relationships that families have.  “Traditionally, Hispanics include many people in their extended families, not only parents and siblings, but grandparents, aunts, uncles, cousins and compadres, close friends and godparents (padrinos) of the family’s children” (HRSA).  It is highly likely that the family will try and play a role in supportive care.  Therefore, a healthcare provider should anticipate communication with several family members and friends.  This may go against hospital protocols such as only allowing two visitors at a time.  As a result the healthcare worker should devise a plan that anticipates large groups of people, and be prepared to speak to groups about patient status if the patient permits the information being released.

Respect

Respeto or respect plays a major role in the Hispanic community.  “Respeto dictates appropriate deferential behavior towards others based on age, sex, social position, economic status, and authority.  Older adults expect respect from those younger, men from women, adults from children, teachers from students, employers from employees, and so on” (HRSA).  Therefore, if you are a younger provider, it is important to be as formal as possible to older Hispanic patients.   This should be viewed as a means of simply being polite and not as a means of being distant.

Health Care Provider – Body Language

Like many cultures, Hispanics have a strong desire to have a close relationship with their care providers.  With the Hispanic culture, this goes beyond verbal exchange.  Many non-Hispanic have a tendency to place themselves at the clients feet, which can be viewed as being distant, uninterested, and detached.  This is why it is important for a provider to place themselves closer to the patient, lean forward, and give a casual pat on the shoulder for comfort and support.  For patients that do not speak English, using non-verbal gestures are highly important in showing interest and desire to care for the patient.

Other useful sites to visit for more information, and where we gathered other information from:

http://www.health.ri.gov/chic/minority/lat_cul.php

http://www.facts-about-mexico.com/mexican-clothing.html

http://ohioline.osu.edu/hyg-fact/5000/5237.html

http://www.bellaonline.com/articles/art31981.asp

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


%d bloggers like this: