african american culture
TRANSCRIPT
Running head: AFRICAN AMERICAN’S BELIEFS AND U.S. HEALTH CARE
African American’s Beliefs and U.S. Health Care
Andrea Boye, Christine Huttayasomboon, Arlene Ramirez, Mitra Saifyan, and Kimberly Tran
California State University, Los Angeles
African American’s Beliefs and U.S. Health Care
Over the years as various cultures immigrated into the United States it is apparent that
there are many different beliefs, patterns and habits that contribute to the delivery of health-care.
In turn it is imperative for caregivers to be aware and sensitive to these beliefs and diversities.
Although certain cultural groups have resided in the U.S. since the establishment of the country,
there continues to be differences in how they perceive health, illness and all of it’s relating
factors. One of such cultures that has accommodated to living in this country are the African-
Americans. We will be looking at how the African-American culture is vulnerable to certain
diseases, their beliefs about health, illness, birth and death, and their preferences and how habits
regarding food, folk remedies, and alternative therapies influence their care in the United States
Health Care System. More specifically, we will address how the implications of these cultural
beliefs affect culturally competent nursing care and what the appropriate nursing assessment
strategies and interventions are.
Description of Culture
Over 34,500,000 African-Americans live in the United States and are descendants of the
Africans brought to the United States from 1619 to 1860 as slaves (Purnell & Paulanka, 2005).
Slavery has a remaining impact on the African-American culture with many of their
characteristics today reflecting those that were forced upon them to survive. During slavery,
African-Americans were forced to live with other African Americans from different geographic
regions leading to the development of a common language by combining dialects. They were
separated from family members continuously, which destroyed the family unit and resulted in the
male role of provider and protector to be demolished. African-Americans have been the victims
of severe discrimination and from this experience, the African-Americans today have a passed on
view of the world around them. Characteristics of this culture include (a) a value for education
(which may require great sacrifice), (b) reliance on extended family for support, (c) use of
“Black dialect”, (d) exaggerated body movements, (e) an increase speech volume, (f) female-
dominated households (matriarchal) (Giger & Davidhizar, 1999, p.175), (h) a constant struggle
for socioeconomic status, (i) isolated social groups, and for a majority, (j) a strong religious faith.
Health
African Americans have a long history in the United States In the last century, the slavery
and discrimination made many African Americans mistrustful of mainstream institutions and
providers who are members of the dominate culture. Even though the painful discrimination
period has finished, the African Americans believe discrimination doesn’t vanish and brings
some shortcomings in health care. Good communication and respectful behavior can create the
necessary trust. Some African American families have been in the United States for many
generations; others are recent immigrants from Africa. African Americans are a “heterogeneous
group” (Giger & Davidhizar, 1999, p. 176). Many African American beliefs take root from old
African beliefs like direct relation between soul and body. Because of this belief, many African
Americans understand their illness as a combination of physical and psychological problems.
Even though the strong relationship between body function and mental status have been proved
in research studies, it is normal to be surprised by the explanation of causes of illnesses such as
relating an ulcer to the acts of past sins, financial loss, or emotional conflicts, (Giger &
Davidhizar, 1999, p. 176). NO description of health!
Illness
In the United States some African-Americans perceive illness as a natural occurrence
resulting from disharmony and conflict in some aspect of an individual’s life (Giger &
Davidhizar, 1999, p. 178). African-American culture originally stemmed from life centered on
the family unit, because of this illness was a commotion to the entire family. There are three
areas that attribute to illness: (a) environmental hazards, (b) divine punishment, and (c) impaired
social relationships (Giger & Davidhizar,1999, p.178). There are many different behaviors
exhibited by some African-Americans a few of which may be the belief in balance, that
everything has its opposite such as for every birth there is a death. Another is the inability to
separate illness from the physical, psychological and spiritual often wanting to be treated on all
levels (Giger & Davidhizar, 1999, p.178).
Death
For many, death is a time for mourning and commemoration of the deceased. However,
depending on the religious beliefs the family holds, there will be slight variations in how to
express grief and procedures with memorial services and funerals. The majority of African-
Americans are “non-Catholic individuals who combine both traditional Western Christian
practices and traditional African beliefs surrounding death” (Clements, et al., 2003, p. 21.).
According to Kagwa-Singer (1994, as cited in Clements, et al., 2003, p. 21), Christianity is
different in that there is an extremely short formalized period of mourning and public
acknowledgement of death. The memorial service and funeral may be one and the same and
usually occur within one week of death. During this time, only the religious ceremonies
acknowledge the death. Some believe in “voodoo death [and that it] …may come to an
individual via a supernatural force” (Purnell & Paulanka, 2005, p. 29). Voodoo has many names;
others may know it as “root work, hex, fix, conjuring, tricking, mojo, witchcraft, spell, or black
magic” (Purnell & Paulanka, 2005, p. 29). Also, many African-Americans do not know about
complete advance directives, many due to the fact that end-of-life decisions are usually made by
the family.
Birth
Older generations of African Americans believe health to be harmony with nature.
Many desires can be considered as desires of body to promote this harmony like eating clay by
pregnant women is considered (missing word.Evidence?) of unborn child’s need for some
supplement (Purnell & Paulanka, 2005, p.29). However, the providing of body needs based on
desires of person cannot be enough. High number of low birth weight, preterm birth and infant
mortality shows the deficiency of prenatal care among African Americans. According to the
National Center for Health Statistics (NCHS) 2005 report, infant mortality is two-and- half times
more than in white people. The rate of death due to low birth weight and prematurity for African
American infants was nearly four times more than the rate for white infants. Factors contributing
to poor health outcomes among African Americans include some cultural barriers and lack of
access to health care. Supporting programs can provide knowledge and financial support for
expectant mothers.
Traditional practice related to delivery of baby are eating a heavy meal to provide energy
for delivery, sniffing pepper and many other suggestions that are not popular and usual between
most African Americans in the United States. After delivery, the postpartum period is longer.
The care is more focused on mother than baby. Adequate rest and keeping mother warm can help
her to get back her strength in Black culture beliefs (Purnell & Paulanka, 2005, p.28). Many
African Americans follow these rules for postpartum period.
Dietary Preferences
As socioeconomic status (SES) is a determining factor in how people live their lives, it is
also the main contributing factor to the dietary preferences and patterns for African-Americans.
A typical African-American diet consists of foods that are “high in fat, cholesterol, and sodium
and low in fiber, fruits, and vegetables” (Purnell & Paulanka, 2005, p. 26). Foods of this type are
referred to as “soul food” and are typically found in Southern regions of the United States. Salt
pork (back fat), chitlins, chicken, beans, pork, and homemade foods such as bread, ham, grits,
and greens are some of the very common food items (Airhihenbuwa, et al., 1996). As a result,
the diet is low is necessary nutritional vitamins such as iron and calcium, and health problems
such as obesity, hypertension, and iron deficiency anemia become concerns (Kittler & Sucher,
2001). On the other hand, obesity is seen as a positive thing, and it is commonly believed that the
ideal body weight is “having enough meat on one’s bones to be able to afford weight loss during
times of sickness” (Kittler & Sucher, 2001, p. 26).
Food, as it is in many cultures, is used to celebrate special events, holidays and birthdays
as a symbol of health and wealth. There are special meanings behind food as well. For example,
the hosts often offer food to guests when they enter or leave the household; to reject the food is
to reject the giver of the food as well (Purnell & Pualanka, 2005). It is important to be sensitive
to the meaning of food as one is expected to accept the “gift” of food.
Folk and Alternative Health Practices
The practice of folk medicine varies among many culture groups. One of these cultures is
the African- American community who use folk medicine to treat an illness. In folk medicine
health and illness is perceived as natural and unnatural. According to (Giger & Davidhizar 1999),
“Natural events are those that are in harmony with nature and provide individuals who believe in
and practice folk medicine with a certain degree of predictability in the events of daily living.
Unnatural events, on the other hand, represent disharmony with nature, and so the events of day-
to-day living cannot be predicted” (Giger & Davidhizar, 1999, p.179). These events are practiced
in folk medicine through witchcraft, voodoo, and spiritualism. Folk practitioners assist in these
practices, which there are three types of practitioners. There is the “old lady” or “granny”, the
“spiritualist”, and the voodoo priest or priestesses. The “old lady” or “granny” is like a
consultant who uses a variety of home remedies to treat common illnesses. The “spiritualist”
performs rituals, uses herbal medicine and spiritual beliefs to cure certain illnesses. The voodoo
priest or priestesses inherit a special gift or has the right to practice it. (Giger & Davidhizar,
1999).
Witchcraft is widely practiced around the United States. It is a practice that can cure an
illness as well as cause the illness. Sympathetic magic is used in the practice of witchcraft that is,
“everything in the universe is connected” (Giger & Davidhizar, 1999, p.181). The body has a
connection with the forces of nature. There are two types of magic that are from sympathetic
magic, contagious and initiative. Contagious magic is the part of an action that is against the
whole. Initiative magic is one’s desire that is achieved by imitation (Giger & Davidhizar, 1999).
Folk medicine is used because of tradition based on past experiences of discrimination
and unfair treatment. African Americans were discriminated against by health care services,
which led to the use of folk medicine to compensate for this unjust service.
Conflicts with U.S. Healthcare
The opening of King/Drew hospital in Los Angeles, California was expected to be a
success, unfortunately it has been ranked one of the worst in the United States. In December
2004, supervisors had taken steps to try to improve the hospital but the board did not implement
any actions despite accusations of racism by the community. While the hospital was still open
some clients didn’t have very much trust for the healthcare providers since people were aware of
nurses neglecting patients and various other malpractices. Some African Americans have no
choice of the quality of care they get due to their socioeconomic status and discrimination that
some of them may face (Weber, Ornstein, & Landsberg, 2005).
Traditional African Americans turn to African healers, botanical remedies, and
superstition to serve as a solution to their health dilemmas. A number of African Americans
believe that an illness is a bad omen from God that serves as a punishment for any wrong doings.
This cultural group will turn to the care of physician and nurses’ only if it is absolutely crucial.
There are multiple conflicting beliefs of this particular group concerning perception of a proper
diet. African Americans tend to eat foods high in fat, cholesterol, and sodium. They also see
being overweight as a beneficial asset. Their theory is that if they were to ever encounter
sickness they would have weight to make up for the loss (Purnell & Paulanka, 2005). Some
people from this ethnic background also believe that babies should be given food along with
milk so that they don’t go to sleep on an empty stomach. This can be detrimental to the baby
because they could possibly choke the food due to the fact that they have yet to develop teeth.
Geophagia is a common practice held in the African culture, it is the action of the African
American pregnant women consuming clay. (Purnell & Paulanka, 2005). They believe that this is
an essential nutrient for the unborn fetus; such a practice can actually be harmful to the mother
and/or fetus. Older people tend to refer to the Farmer’s Almanac to help them to decide when
medical and dental procedures should be done (Giger & Davidhizar, 1999). This can be a
disadvantage to an individual if they need emergency care or to prevent certain problems from
getting worse. It is also common practice for African Americans to use laxatives (Kittler &
Sucher, 2001). Although this can serve as remedy for constipation it can damage the normal
bacterial flora within their intestines. It can also make people of this ethnicity dependent on
laxatives to point where bowel movements can only occur with taking the medication. This
minority group also believes that the causation of hypertension is stress and some also think that
worrying results in contracting diabetes (Kittler & Sucher, 2001). As traditional African
Americans become more aware that some of their practices provide little or no benefit to them or
even induce harm, this would allow health care in the U.S. to be an alternative option to this
ethnic group.
Nursing Interventions
When working with African-Americans, the health-care provider must not stereotype
African-Americans based on factors such a “Black dialect” or misunderstand an increased
volume for anger. Families or the client’s support system should be included in the care plan for
the client, especially if there is a strong female influence this women should be involved in the
decision-making. When it comes to pain many African-Americans will not want to
inconvenience the nurse.
The health care provider should consider the effect of spirituality on health. Many
cultures are adjusting their beliefs over time and through the generations. The diversity of beliefs
between people and cultures suggests that health care providers should be prepared with
knowledge about such beliefs. Encouraging patients to talk about his/her ideas about health and
health care can do this. With respectful behavior, the health care provider should be able to
create a trusting and professional relationship with the patient. It is important to acknowledge
and respect-meaning patients may have associated with their illness and make medical
suggestions in light of the patients’ beliefs. In any case, health care providers should provide
enough information to educate clients with general knowledge on how to improve their health.
According to Purnell and Paulanka (2005), the main belief regarding death is to keep the
body intact upon burial; therefore, if applicable, nurses will need to explain legal requirements of
an autopsy. A common response to hearing about the death of a loved one is sudden collapse,
paralysis, and the inability to see or speak. Nurses will need to recognize this severe emotional
shock as a cultural response to death and not a medical condition that will require emergency
medical intervention (Purnell & Paulanka, 2005). Also, it is pertinent to “accept varied
responses to bereavement” (Purnell & Paulanka, 2005, p. 30), as it is usual for those mourning to
not show emotions of grief until the funeral where catharsis will eventually be reached.
Ultimately, it is important for the health care provider to “…show respect for families’ cultural
heritage and encourage them to decide how to honor the deceased” (Clements, et al., 2003, p.
20).
There is a need for effective intervention programs to reduce the risks contributing to low
birth weight and poor pregnancy outcomes in the African-American population. High mortality
rates, low birth weight of infants, and preterm delivery are all associated to the traditional
practices of the culture. While remaining respectful and sensitive to the traditions, implementing
preventative measures, support programs, and education for pregnant women can greatly reduce
these risk factors. In particular, it is imperative to stress the importance of prenatal care.
Diets for African-Americans are frequently high in fat, cholesterol, and sodium, and low
in fiber, fruits, and vegetables. The nurse should recommend a diet with liver, greens, eggs,
fruits, and vegetables to compensate for the deficiency. Being overweight is considered a
positive thing in the African-American culture; however this is a barrier to health for that
individual. It will be necessary to negotiate with the client to determine an acceptable weight.
Also, parents are encouraged by elders to begin feeding solid foods to children at an early age.
Presenting parents with the necessary research and evidence that this is not healthy will help
them in the decision-making (Purnell & Paulanka, 2005).
African Americans view illnesses as natural or unnatural. The nurse must acknowledge
proper interventions according to its classification. A natural illness may implement some of the
healing remedies if it does not affect the human body. An unnatural illness may be difficult to
implement because it is, “believed to be the direct result of evil influences, are more difficult for
the nurse to combat” (Giger & Davidhizar, 1999, p. 183). These are ways of recognizing their
cultural beliefs by helping the client to recover.
According to Giger and Davidhizar (1999) there are two main attitudes of African-
Americans towards health-care. They either value flexibility or are present-time oriented. A
step that nurses need to initiate for those that care about flexibility is to explain the importance of
having treatment done at specific time. On the other hand there are individuals that care solely
on the present time with disregard to the future. In this case nurses must not take appointments
lightly or postpone educating them about illnesses. Giger and Davidhizar categorize health
practices in three areas: (a) efficacious, (b) neutral, or (c) dysfunctional. Efficacious practices
are considered beneficial under Western medicine even though there may be no scientific theory
to back it up. Neutral health practices are those that elicit neither benefit nor harm.
Dysfunctional health practices are those that induce pain. An example of dysfunctional practice
of African-Americans is those that are highly religious may consume boiled goats, milk and
cabbage juice to cure a stomach infection. It may be difficult to convince clients with this belief
that western treatment will lessen or eliminate their problems (Kittler & Sucher, 2001). As
referenced by Kittler and Sucher (2001), a fourth of Blacks lived below the poverty line.
According to the research, Blacks are the least (? Most?) underpaid of any cultural group in the
U.S. As a result, it is very difficult for this community to gain access to healthcare at all.
Although it is apparent that there are preferences and beliefs that are held or perceived by
the majority of the African-American population, it is crucial to keep in mind that all individuals
are unique and different in their own ways. Therefore, it will be necessary for nurses to keep and
open mind at all times and realize that not all individuals will adhere to the cultural beliefs is
associated with their culture. However, having a basic understanding of the beliefs will help in
the flexibility for providing individualized care.
References
Airhihenbuwa, C.O., Kumanyika, S., Agurs, T.D., Lowe, A., Saunders, D., & Morssink, C.B.
(1996). Cultural aspects of African American eating patterns. Ethnicity & Health, 1(3).
Clements, P.T., Vigil, G.J., Manno, M.S., Henry, G.C., Wilks, J., Das, S., Kellywood, R. &
Foster, W. (2003). Cultural perspectives of death, grief, and bereavement. Journal of
Psychosocial Nursing, 41(7), 20-21.
Giger, J. N., & Davidhizar, R. E. (1999) Transcultural nursing: Assessment & intervention. (3rd
ed.). St. Louis, MO.: Mosby.
Kittler, P. G., & Sucher, K. P. (2001). Food and culture (3rd ed.). Belmont, CA:
Wadsworth/Thomas Learning.
Purnell, L. D., & Paulanka, B. J. (2005). Guide to culturally competent health care. Philadelphia,
PA: F.A. Davis Company.
Weber, T., Orstein, C., & Landsberg, M. (2005, December 1). Deadly errors and politics betray a
hospital’s promise [Electronic version], Los Angeles Times.
Retrieved on November 3, 2006 from
http://www.latimes.com/news/local/kingdrew/la-me- kdday1dec05,0,5281026.story