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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 Culture

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Running head: AFRICAN AMERICANS BELIEFS AND U.S. HEALTH CARE

African Americans Beliefs and U.S. Health Care Andrea Boye, Christine Huttayasomboon, Arlene Ramirez, Mitra Saifyan, and Kimberly Tran California State University, Los Angeles

African Americans 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 its relating factors. One of such cultures that has accommodated to living in this country are the AfricanAmericans. 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) femaledominated 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 doesnt 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 individuals 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 AfricanAmericans 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 childs 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 ones 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 dayto-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 ones 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 didnt 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 dont 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 Farmers 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 clients 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 AfricanAmericans 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 hospitals promise [Electronic version], Los Angeles Times. Retrieved on November 3, 2006 from http://www.latimes.com/news/local/kingdrew/la-mekdday1dec05,0,5281026.story