1. Chapter 10: Role of Culture in Epidemiology

2. Introduction (1 of 2) The United States is now a melting pot of different cultures. Advanced practice nurses must be able to: – Identify cultural values, beliefs, practices – Proactively modify treatment methods accordingly These steps are necessary to affect more positive patient outcomes.

3. Introduction (2 of 2) Examples – Using a cross-cultural interview to take a history – Eliciting information about use of nontraditional therapies – Respecting cultural beliefs to establish better relationships with patient and family – Reducing biases toward a culture through understanding

4. Cultural Beliefs and Issues May Impact Health (1 of 8) Native Americans – Consider health a balance of mind, body, spirit, and nature – Nature is respected, everything is interconnected, silence is encouraged Amish – Rely on herbal medicines, prayer, Barouche doctors – Marriages to close relations may lead to genetic disorders

5. Cultural Beliefs and Issues May Impact Health (2 of 8) Same-sex couples – Increasing recognition, legal rights, adoption of children – Higher suicide rates in gay and lesbian community Indian Americans – Hindus believe in herbal medicines, Karma. – Marriage, festivals, traditional customs are important.

6. Cultural Beliefs and Issues May Impact Health (3 of 8) Hispanics – Some traditional women avoid viewing an eclipse during pregnancy. Chinese – A traditional belief is that health is balance between yin (negative force) and yang (positive force).

7. Cultural Beliefs and Issues May Impact Health (4 of 8) Vietnamese – Believe in traditional holistic treatments – “Coining,” “steaming,” and “cupping” are used. Expel bad spirits and cleanse the body Peruvians – Believe eggs have healing powers

8. Cultural Beliefs and Issues May Impact Health (5 of 8) Filipinos – Believe illness is associated with spiritual causes or wrongdoings – Hilot (traditional art of healing) uses massage, body manipulation, herbal medicines. Turks – Traditional healers recommend eating raw gallbladder and/or bile of carp for visual acuity.

9. Cultural Beliefs and Issues May Impact Health (6 of 8) Brazilians – Women use a 28-bead necklace to remember events associated with menstrual cycle. Fluorescent beads indicate fertility period. Hatians – Believe that illness is punishment from God – “Arrested pregnancy syndrome”: blood flow to uterus is diverted to menstrual blood, foiling pregnancy

10. Cultural Beliefs and Issues May Impact Health (7 of 8) Muslims – Believe that health is the greatest gift bestowed by Allah – Alcohol and pork are prohibited, Halal meat is preferred. – Incidence of beef tapeworm infection is higher. – Women do not like to be seen by male healthcare providers.

11. Cultural Beliefs and Issues May Impact Health (8 of 8) Italians, Asian Indians – May attribute cause of illness to evil eye and curses Female circumcision – Act of cruelty – Prohibited in United States – Encouraged in some African nations

12. Traditional Healthcare Systems (1 of 2) Some cultural methods have placebo effect. Others produce extraordinary outcome that cannot be explained with scientific knowledge. Herbal medicines can interact with allopathic medicines. You may wish to refer patients for traditional practices.

13. Traditional Healthcare Systems (2 of 2) Figure 10-3 Ayurvedic medicine is prepared from herbs, minerals, and oils. The preparations of these medicines are described in detail in the ancient textbooks of Ayurvedic medicine. Source: Picture courtesy of Dr. Suvarna Vemula. Ayurvedic medicine is prepared from herbs, minerals, and oils, following ancient textbooks.

14. Traditional Methods of Health Restoration Cultural health beliefs may contribute to the development of modern treatments. Examples: – Use of boiled milk with honey to treat colds in Ethiopia – Fenugreek to promote lactation in India – Frankincense as disinfectant and antibacterial agent in Iran

15. Food Culture That Affects Well-Being Food specific to a culture is based on availability of resources and values. – Hindus avoid eating meat because they worship nature and animals. Diet choices can have negative or positive effects on patient outcomes. – Negative example: niacin deficiency in prolonged corn diet – Positive example: green chilies can help protect stomach from gastritis