Hispanic Americans
The Hispanic population in the United States includes more than 37.4 million people (approximately 13.3% of the population). This population is expected to reach more than 22.3% of the population (or 87.5 million individuals) by the year 2040 (Office of Minority Health and Health Disparities [OMHD], 2007b).
Hispanic is a broad term that refers to groups with cultural and national identities arising from the Caribbean, Cuba, Mexico, Puerto Rico, Central, and South America. The predominant religions are Catholicism and Pentecostalism (Dossey et al., 2000).
Cultural Issues
Hispanics greatly value the family, and the needs of the family are often placed above individual needs. Hispanics have large extended families with close interpersonal relationships. Family members are often present during a hospitalization and they are often involved in decisions about their loved one's care. Hispanics traditionally value religion and believe in self-sacrifice, giving rather than taking, and the acceptance of fate (Dossey et al., 2000; Leininger & McFarland, 2002; Luckmann, 1999).
The Hispanic culture has certain unwritten rules that govern social interactions. These serve as strengths and protective factors for Hispanic patients, their families, and their communities and include the following (Dossey et al., 2000; Management Sciences for Health, n.d.):
La familia (the family), including parents, siblings, grandparents, aunts, uncles, cousins, compadres, close friends, and godparents- Respeto (respect) and deferential behavior toward others based on age, sex, social position, economic status, and authority
- Personalismo (the importance of personal relationships and community)
- Confianza (trust)
- Espiritu (spirit), mind, and body
Health Care Issues
Specific health care issues that may affect the Hispanic client include the following (Management Sciences for Health, n.d.):
- Mental health disorders are viewed as a sign of weakness (Hispanics have a high incidence of mental health problems, especially depression, anxiety, and substance abuse; contributing factors include the stress caused by immigration, acculturation, and biculturalism).
- Disease is thought to result from either supernatural or natural causes. The mind and body are thought to be one, and achieving balance in all aspects of life is sought.
- Stressors are related to social adjustment (acculturative stress, socioeconomic stress due to inadequate financial resources and limited class standing, and minority stress as a result of racism).
- Environmental health problems can arise from high-risk exposure to ambient air pollution, worker exposure to chemicals in industry, indoor pollution, and pollutants in drinking water.
- Alcohol and substance abuse is especially high in Mexicans and Puerto Ricans.
Consider the following statistics (HHS, 2000; Management Sciences for Health, n.d.; OMH, 2007a):
Hispanics and Latinos have a disproportionately high prevalence of asthma, chronic obstructive pulmonary disease (COPD), HIV/AIDS, and obesity.- Diabetes is twice as prevalent among Hispanics as among the majority population.
- The leading causes of death for Hispanics are heart disease, cancer, accidents, cerebral vascular accidents, and diabetes mellitus.
- Hispanics living in the United States are almost twice as likely to die from diabetes as are non-Hispanic whites.
- Although constituting only 11% of the total population in 1996, Hispanics accounted for 20% of the new cases of tuberculosis.
- The incidence of cervical cancer in Hispanic women is double that of non-Hispanic European-American women.
- Hispanics have higher rates of high blood pressure and obesity than non-Hispanic whites.
- The rate of low-birth-weight infants is higher for the total Hispanic population compared with that of whites, and Puerto Ricans have a low-birth-weight rate that is 50% higher than the rate for whites.
When providing culturally competent care to Hispanic Americans, it is important to consider the following (Dossey et al., 2000; Leininger & McFarland, 2002; Management Sciences for Health, n.d.):
- Religion is an important part of the social structure of Hispanic Americans and faith is the major sustainer against the trials of daily life.
- Understand that many Hispanics believe illness may be a punishment for sins or the result of witchcraft or the evil eye.
- Involve family members, since they are likely to be involved in the treatment and decision-making process for a patient.
- Show respect for patients without being condescending.
- Address elders in traditional ways (such as looking below eye level if the patient is older than you are).
- Indirectly ask personal or private questions about alcohol use, mental problems, violence, stressors, or sexual practices (for example, "Have you seen ads about the use of condoms?").
- Indicate interest in Hispanic clients by leaning forward when talking to them, or giving them a comforting pat on the shoulder.
- Ask about their life (family, friends, and work) and share life stories and pictures with them.
- Converse with all members of the family but be respectful of gender.
- Do not give the impression of being too familiar.
- Encourage questions, since many Hispanic patients will avoid disagreeing with or expressing doubts with health care providers out of respect.
- Ask local leaders for their opinions about the types of community services needed by their community.
- Respect traditional healing practices, including the use of spiritual elements such as the worship of saints or the use of talismans.
