People of African American Heritage. The Amish.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

African Americans
Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

African American

Second largest “minority” group in the United States.
Negro, black, Black American, person of color, and colored: Depends on the individual.
African American does not necessarily mean you have black skin—it is a term to denote that the person has pride in both the African and American heritage

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

African American

Much diversity among this group in terms of the variant cultural characteristics.
Half live in the Southern United States with large numbers living in large cities in the North.
Most came to the United States involuntarily with the slave trade from Africa.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Education and Occupation

Great inequities in educational opportunities in the past, and this still continues in some areas of the United States with inferior schools and lack of economic and human resources.
High drop-out rates from school due to pregnancy, socioeconomics, and family responsibilities.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Education and Occupation Continued

Less well represented in managerial and professional occupations.
High employment in “blue collar” positions and factories increase risks for cancer and poorer health status—steel and tire industries and other hazardous occupations.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications

Black English dialect where the “th” is pronounced like “de” = dese for these.
Gullah, a Creole language spoken by African Americans who come from the Georgia Coast and South Carolina. A dialect originating from Africa and is really a combination of two other languages.
Spoken in other places in the world.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Highly verbal and expressive with family and trusted friends.
Do not air your dirty laundry.
Dynamic loud speech pattern may be perceived as aggression or anger.
Touch easily among family and trusted friends.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Expressive nonverbal communications.
Comfortable with close physical distance between conversants.
Direct eye contact can be seen as aggression, especially by elders and lower socioeconomic persons—can be a way of protection, especially in times past.
Culture of “being in becoming” and relaxed with time and have a linear sense of time and are polychronic.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

More formal with names in the beginning.
Use appropriate titles.
Family name is highly respected.
People respected by community may be called aunt, uncle, cousin, mother, etc.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family

Traditionally matriarchal out of necessity during times of slavery. Now more egalitarian but great variation.
Single parenting creates more matriarchal families.
Gender roles are easily inter-changeable.
Cooperative teamwork is valued and the “norm”.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Continued

Value self-reliance and education.
Families try to protect their children from street violence, but society prevails during teen years and attempts may be seen as futile.
Employment at an early age is encouraged to develop self-survival and self-reliance skills—also help with chores.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Continued

Many see the future as having limited opportunities if from the lower educational and socioeconomic levels.
Value the Afrocentric Framework—although some do not know them by name.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Afrocentric Framework
Nguzo Sabo

Umojo—unity
Kujichagula—self-determination
Ujimaa—cooperative economics
Ujima—collective work and responsibility
Kuumba—creativity
Nia—purpose
Imani—faith

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Continued

Elders, especially grandmothers, are respected.
Not uncommon for grandparents to assist with and/or raise grandchildren.
Extended family is important and cousins and nephews, etc. are considered nuclear family—so are “non-blood relatives”.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Continued

Minimal to no stigma for single parenting.
High HIV and AIDS occurrence due to IV drug use and sexual activity.
Lesbians and gays accepted but not talked about for fear of increased stigma and rejection.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

Different assessment techniques required to detect cyanosis, pallor, rashes, and jaundice.
Overgrowth of connective tissue leading to keloids.
Long bones are longer, bone density is greater than that of Asians, Hispanics, and European-Americans.
Greater incidence of birthmarks.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology Continued

Leading cause of death among males is homicide.
Violence in inner city neighborhoods.
High morbidity and mortality due to hypertension —renin-angiotensin syndrome.
Cirrhosis and diabetes rates are also high.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology Continued

Sickle cell anemia
Glucose-6-phosphate-dehydrogenase deficiency
Lactose deficiency
Prostate cancer due to enzyme level detection
Colon tumors are deeper within the colon

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology Continued

Less responsive to beta-blockers
More responsive to monotherapy
Less responsive to mydriatic dilation
High frequency for psychosis and low frequency for depression
Higher doses of neuroleptics
Higher incidence of side effects for psychotropics and tricyclics

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition

Symbol for health and wealth
Accept food; otherwise you reject the person
Food considered important for controlling high blood and low blood
Soul food is high in fat and sodium with fatback used frequently

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued

Children introduced to solid food early
Milk, vegetables, and meat are strength foods
Diet frequently low in Vitamins A and C and iron
High-carbohydrate diet leads to obesity
Overweight is seen as positive

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Practices

Oral contraceptives is the most common method of birth control
Mother and grandmother are the primary advisors for pregnancy and childbearing practices
Consume your craving during pregnancy or the baby will be marked

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Practices Continued

Geophagia, eating non food substances, can lead to iron and potassium deficiency
A few believe that a pregnant woman should not have her picture taken because it will capture the baby’s soul
Do not take pictures while pregnant because it can cause a stillbirth

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Practices Continued

After delivery avoid cold air and get plenty of rest
Umbilicus may be wrapped or have a coin placed on it to prevent protruding outward—for some it is a means of protection from evil. Practice is rare but still occurs among some.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

Death does not end the connection between people, can communicate with the dead person’s spirit
Some believe in voodoo death in that death or illness can come to a person through supernatural forces
Voodoo is also known as root work, mojo, spell, fix, or black magic

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

Body must be kept intact after death—I came into this world with all of my body parts and I intend to leave this world with all of my body parts
Falling out due to extreme emotional response. However the person can still hear and understand
Express grief openly and publicly with eulogies at funerals is common

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality

The Black Church is the Black Community
Religion is taken seriously; expect to receive a message in church
Group singing and public testimonials
Most are Baptist or Methodist although they belong to all religious groups including Nation of Islam and Seventh Day Adventist

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality Continued

Use prayer for all situations
Many believe in laying on of hands while praying—power of being able to heal
May speak in tongues
Inner strength comes from faith in God—it is “God’s Will” —fatalism

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices
Health-Seeking Behaviors

The world is a very hostile and dangerous place to live
The individual is open to attack from external forces
The individual is considered to be a helpless person who has no internal resources to combat such an attack and therefore needs outside assistance

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices

May be suspicious of outsider healthcare professionals and therefore see a physician or nurse only when absolutely necessary
Natural and unnatural illnesses
May receive care from a “root doctor” simultaneously with biomedical practitioners

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued

Have a tendency to take medicine on an “as-needed” basis
Barriers to health care include affordability, accessibility, acceptability, adaptability, and past discrimination
Some believe “no pain, no illness”
Able to enter the sick role with ease

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued

Illness brings the family together
Low rates of organ donation due to lack of information, racism, religion, distrust, and fear of organ being taken prematurely
Blood transfusion acceptable unless religion forbids it

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practitioners

Folk practitioners can be grandmothers, respected women or elders in the community, church leaders, root doctors, or voodoo priests and priestesses, who remove hexes
Some may prefer a care provider of the same gender

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practitioners Continued

Folk practitioners are held in high esteem and used by all socioeconomic levels of African Americans
Prefer Western healthcare providers who are known to the family or community
Must establish trust to be effective in return visits