Respecting differences among ethnic groups.
Rita Webb is senior policy advisor for health disparities in the Social Work Practice, Human Rights and International Affairs Division of the National Association of Social Workers in Washington, DC.
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The numbers of older members of minority U.S. populations (such as blacks, Hispanics, American Indians, and Asian and Pacific Islanders) will likely triple by 2030.1 By that time, about one fourth of the older adult population will belong to a minority racial or ethnic group. This shift presents challenges for social workers and nurses, who must be able to deliver culturally appropriate interventions that respond to the needs of diverse care recipients and family caregivers.
Research on health disparities shows that racial and ethnic minority groups encounter major barriers to receiving health care and other services. Barriers that may prevent care recipients and family caregivers from receiving adequate health care include language and other communication difficulties, poverty, and lack of adequate health insurance, housing, and transportation. Providers' lack of knowledge and understanding about the culture of the people they are serving, including their traditions, history, values, and family systems, can also hamper the optimal delivery of care.2
Cultural experiences define how care recipients and caregivers receive information and how they make choices. Other ways that cultural differences may affect health care include:
* how symptoms are expressed. For example, traditional Chinese culture places a value on the caregiver shielding the patient from having to discuss with providers the full severity of an illness, in contrast to Western medicine.3
* what type of treatment is preferred. For example, American Indian older adults, often referred to as "elders," traditionally play an important role as health care advisors and healers and may suggest using folk medicine approaches.
* who provides care. Asians, blacks, and Hispanics may prefer to care for a relative at home instead of placing a family member in a nursing home.
How long someone has been in the United States and how strongly the person identifies with her or his cultural background may also influence choices. These factors might differ for the care recipient and the caregiver. The social worker or nurse might want to know the following information:
* Has the care recipient or caregiver been in the United States since childhood, or did she or he recently arrive?
* In what region of the United States does the care recipient live? Is it an area where the person's native culture remains strong, such as in American Indian tribal nations, among Asians in the San Francisco Bay area, or among Cubans in the Miami area?
* How extensive is the care recipient's or caregiver's education?
* What are their levels of health literacy?
* Is the family an important social system? What other social support systems, such as religious institutions, are important?
* What is the care recipient's social status according to her or his culture? This often affects roles and expectations. For example, an American Indian elder may play an instrumental role in the family as well as in the community support system.
By learning the core cultural values of the major ethnic groups represented in their practice, nurses and social workers can provide better care. Each family caregiving case provides a professional with an opportunity to correct, validate, or expand her or his knowledge base and comfort level with people of different cultures.