Transcript What are “health beliefs”

Are We on the Same Page??:
Health Beliefs
and Access to Care
Susan Chauncey Horky, LCSW
University of Florida
Pediatric Pulmonary Center
“Core Cultural Variables”
Bodily care
Decision making
Views of disability
Time orientation
Family priorities
Definition of health
Parenting beliefs
Spiritual beliefs
Communication
Ability to
navigate systems
Insurance
Health
On-site
Beliefs
factors
Transportation
Awareness of
Services
Get to know the
patient and family
• Learn about the patient’s cultural
environment
• Learn about the patient’s social
environment
Overview
What are “health beliefs” (and how
do they affect client decisions about care?)
How can we work with
patients’ health beliefs ?
•Get to know the patient and family
•Understand how a patient weighs
healthcare choices
•Negotiate and compromise
•Increase our own self awareness
What are
“health beliefs”?
Broadly defined: health beliefs
are the considerations on which
patients base decisions and
choices about their health care.
A Fable
Once upon a time a monkey and fish were
caught up in a great flood. The monkey,
agile and experienced, had the good
fortune to scramble up a tree to safety.
As he looked down into the raging waters,
he saw a fish struggling against the swift
current. Filled with a humanitarian desire
to help his less fortunate fellow, he
reached down and scooped the fish from
the water. To the monkey’s surprise, the
fish was not very grateful for this aid...
Factors weighed in healthcare choices
• Do I really think I am sick?
• How much do I think the
doctors ideas will help?
• If so, how bothered am I
by my sickness
• Do I think something else
would help more?
• Am I concerned about
unwanted effects of treatment?
Beliefs
Feelings
•Perceptions
•Experiences
•Expectations
Knowledge
Origins of Beliefs
Individual
Beliefs
Family
Culture
Social
Environment
Social Factors Affecting Health Choices
Poor continuity of care
Differential referrals
Language differences
Transportation problems
Cultural communication
barriers
Less preventionoriented
Fewer minority clinicians
And researchers trained
Environmental problems
Hours care is available
Stresses
Healthcare not most
immediate need
Lack of childcare
Poor pt-provider relationship
Different health beliefs
MDs give different
messages
Not aware of resources
Research conducted on
majority populations
No or poor insurance
Differential treatment
Difficulty navigating systems
Difficulty missing work
Cultural Variables Affecting Health
Choices
Cultural Variables Affecting Health Choices
Discipline/
Explanatory models Expectations for
Parenting beliefs
survival
Common-law
marriage
Definition of
family
Autonomy vs.
group orientation
Decision making:
who and how
Role of biomedical healthcare
Time
orientation
Views of health
and illness
Gender roles and
expectations
Communication
styles
Views of
disability
Attitudes towards
giving up hope
Personal vs.
Views on
institutional needs aggression
Views of
authority
Private vs.
public
Alternative
treatments
Handling of
emotions/coping
Explanatory Models
Paternalistic
((Individual or social)
Naturalistic
God
Soul loss
Wet/Dry
Evil spirit
Soul theft
Hot/Cold
Curse
Spirit possession
Ghost
Breach of taboo
Sin
Evil eye
Witch
Humoral imbalance
Emotional imbalance
Harmony/Disharmony
Communication Variables
Eye contact
Physical contact
Personal space
Hand gestures
Verbal expressiveness
Verbal responsiveness
Direct or indirect style
Alternative treatments
(Herbal or Folk Remedies for Asthma )
• Avoid triggers (including
exercise)
• Avoid milk products
• Aloe tea
• Eucalyptus
• Mullein
• Milkweed
• Burn hornets nest and
inhale smoke
• Inhale smoke from skunk
cabbage root
• Hog hoof tea
• Pillow made of staghorn
sumac
• Dried, split skin of poisonous
snake, held to chest
• Wild Plum bark tea
• Break a hot loaf of bread over
child’s head
• Cow dandruff, burned and
inhaled
• Burn two wing feathers of a
buzzard
• Place clip of hair in tree
Latino Medicine
Rich heritage of healers and healing
Yerbero
Sobrador
Partera
Curandero
Gypsies (Roma)
• For some Gypsies, it is important to use different bathing
items (soap, towel, washcloth) for above and below the
waste
• In many Gypsy families, older family members make (health
and other) decisions, even if the individual is married and in
his or her twenties
• Illnesses may be caused by lack of spiritual and moral
cleanliness, leading to presence of the devil or bad spirits
• Emotions, including those in routine conversation, and
those related to pain or death are often expressed loudly,
African American Healthcare
Strong history of herbal
medicine
Health is a dynamic process of
mind, body and spirit – not a
mind/body dichotomy
Strong religious beliefs,
prayer is a primary way
of dealing with health problems
Health and happiness are connected to
living a life that is pleasing to God.
African American Healthcare
African Americans have
had many harmful
experiences in the
healthcare system,
as well as in society
at large
Mideastern Cultures
Arab Americans may speak loudly if they are
stressing importance, and with a high intense
pitch if they are angry
Mideastern families may appear “demanding”
as a way of showing caring for the patient
Arab childrearing may appear alternately
permissive and restrictive
Cambodian healthcare
To show the bottom of one’s feet
to a Cambodian individual may be
construed as an insult
Cambodians may have great
reluctance to sign forms, due to
cruelty and injustices during the
Khmer Rouge
Many Cambodians believe that the
soul resides in the head, so
touching or performing
procedures on the head should be
avoided
• Get to know the patient and family
• Understand
howwe
eachwork
patient weighs
How do
healthcare choices
with client’s
• Negotiate
and compromise
health
beliefs?
• Increase our own self awareness
Get to know the
patient and family
• Create emotionally
safe environment
– Allow patient to talk
about feelings and
stressors
– Show interest in the
patient’s whole life
–Identify whether nonadherence results from
poor coping, a social
constraint or a belief
system
–
–
–
–
Show respect
Listen
Validate and legitimize
Ask open ended
questions
– “Float” general
statements
– Reflect and re-state
– Clarify and focus
– Show an interest in
details
– Allow silence
– Summarize
– Empathize
– Avoid jargon
– Attend to intonation
“Incorporation of the patient’s
perspective… will require a fundamental
rethinking of medicine such that
patients will define their own medical
goals, actively participate in
management and treatment
considerations, and are considered
expert in judging their own functioning
and well-being.”
Eliciting General Health Beliefs
• Do you think you’re sick?
• How much does your sickness
bother you?
• Do you think my ideas will help?
• Are you worried about side effects?
• Are there problems with my ideas?
• How important is your health, given
everything else going on in your life?
• Where were you born? How
long have you lived here?
• What language (s) do you feel
most comfortable with?
• What rolecultural
does religion factors
play in
Assessing
your life?
• Do you have a support system?
• Is your income sufficient to
meet your needs?
Eliciting Cultural Health Beliefs
• What do you think
caused your problem?
• Why do you think it
started when it did?
• What have you tried?
• How can I help you?
• What would you like
from this visit?
• How does it affect your
• I know little about
life?
your culture. Are there
things we’ve discussed
• What worries you
that run contrary to
most about it?
your beliefs?
• What do you think will
help?
Understand how your patient
balances priorities
Am I sick?
(And how bothered am I by my illness?)
Social stresses
Higher risk factors
Higher cultural priorities
Religious beliefs
My child’s illness…
…is a sign I haven’t prayed enough
…is a sign of specialness
…is a punishment for past sins
…is a cross to bear
…will be cured by God
…is a test of faith
…is meant to be
Will the doctor’s ideas help?
(Will something else help more?)
Depends on:
Personal Experience
Home remedies may have
worked well
Hospitals are untrustworthy,
places to die
Explanatory model
Naturalistic – imbalances
Paternalistic- God or spirits
Locus of Control
Patients feel little control
Are there unwanted effects
of treatment?
 “Unnaturalness” of medication
 Intrusion into life
 Side effects
 Lack of spontaneity in life
 Becoming “immune” to medication
 Dependence on medication
 Attempt to find lowest possible dose
“Over time, medical diagnoses and
recommendations were altered in ways that
allowed them to fit in with the exigencies
and constraints of the women’s daily
lives…(such) alterations of treatment
behavior were commonly accompanied by
re-interpretations of the illness explanation
that produced coherent rationale for the
customized regime.”
The role of health problems in life
Health problem
Life
Life
Health Problem
Negotiate and Compromise
Elicit client’s
explanatory
model
What does
client think
will help?
What’s the
maximum client
would manage?
Explain your
explanatory
model
What do
you think
will help?
What’s the
minimum you
could live with?
• Talk about the patients condition; don’t struggle about
whether the patient is taking the medications you
recommend
• Present information in patient’s context
– “Tightening of the airways causes an asthma attack, but
that is most likely to happen when airways are inflamed;
without medication your airways are always inflamed
even when you don’t feel it”
– “This medicine will allow your body to remain in
balance”
• Don’t argue about harmless alternative treatments
• With children, know your bottom line
Self Awareness
 What client behaviors make me uncomfortable?
 How do I respond when I’m uncomfortable?
 What are my own prejudices and biases?
 What keeps me from truly putting myself in others’ shoes?
 Do I really believe that other ideas are valid?
 What are my own cultural beliefs
 When I judge others, what am I feeling?
 How do I feel when clients don’t do what I say?
Perhaps the most important thing that we can
do is understand what keeps us from accepting
and respecting our patients’ views
Self Awareness
How would I feel about simply accepting
what the patient is doing?
My boss
I really have to hurry...
I had to
will be angry
adapt, so
if I suggest
others that we do what
You’re just making should, the client wants
excuses for them
too
What if
this family
disdains
me?at
This family seems hostile
I just want to get out of
the room
I want to be
I understand his
empathic but I feelings, but my views
just don’t
are based on science
understand how
If I support the family
someone can
think that
I feel so the child won’t get good care
uncomfortable,
I know what I should
e got to seem knowledgeableI just don’t
be saying, but it
know what
and in charge
feels awkward
to say
What is the relationship between:
Access to
care
Health
Beliefs
?