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The western influence on the minority groups in the united states of america

More frequent experiences of health care provider racism predicted being fearful of western health care services, as did lower levels of education. Being treated poorly because of cultural background was significantly associated with the outcome variable. Here, lower levels of poor treatment were associated with improved satisfaction with health care treatment. Discussion Numerous reports point to the existence of discrimination in health care interactions and inequalities in treatment options and outcomes for particular minority populations [ 37 — 924 ].

This study aimed to identify the self-reported health care experiences and outcomes for a general population of cultural minority Americans in a Midwestern state. Furthermore, and uniquely, the study examined the influence of cultural strength on health care encounters. Survey responses Participants, regardless of cultural background, reported high levels of cultural strength, which was a composite of pride, connection and importance to their lives.

Gauging cultural strength is often challenging given that individuals identify or engage with their cultural group s in various ways [ 36 ]. The three-pronged definition utilised in the study was intended to capture level of identity, the practice of that identity and the significance afforded to that identity.

Despite the self-reported high levels of cultural strength in the study, participants generally felt that their culture was less important or perhaps less relevant to their health care visits. While no significant mean differences were detected across groups here, a greater proportion of Native American participants did, however, believe that culture was important to their health care visits. This may reflect a preference for holistic traditional healing methods, perhaps as a complementary aspect of conventional care [ 37 ].

There appeared to be agreement across cultural groups that health care services should facilitate staff diversity and possess knowledge of different cultures, though Asian-American participants found these proposals to be less important.

The diversification of health care staff and attainment of cross-cultural knowledge are recommendations of the cultural competence literature [ 8 ].

  • The labor force has always been divided on the basis of race, ethnicity, and gender;
  • Third parties that have emerged on both the left and the right include the Green, Socialist, Farm-Labor, Reform, and Libertarian parties;
  • Historical marginalization has also perhaps prompted a degree of mistrust for social institutions among some Native Americans;
  • Perspectives cognitives et conduites sociales;
  • Often referred to as a melting pot, the United States is popularly regarded as a nation that assimilates or absorbs immigrant populations to produce a standard American;
  • Presses Universitaires de Rennes.

Participants also showed a slight preference for health care professionals from their own cultural background, supporting previous work [ 3839 ]. Yet findings from our study also indicate, that despite this inclination appearing on average to be unmet, participants generally still reported strong satisfaction with the health care treatment received. This is not an unusual outcome. In mental health settings, the evidence for the additional benefit of cultural matching on treatment outcomes is meagre [ 38 ].

Self-reported experiences of health care racism are measured and defined in various ways in the literature, which often impedes precise comparisons in volume. However, both higher and lower levels of reported racism have been observed elsewhere [ 42 ].

Perceived health care racism among Native American participants was largely in correspondence with findings from the available literature [ 1842 ].

Interestingly, a much larger proportion of participants in the study reported being treated poorly because of their cultural background than those reporting perceived racism. A perception of being treated poorly is a broad concept and can refer to any experience of discrimination during a health care encounter beyond direct racism i.

Prior studies have shown that these experiences are more common among patients of colour compared to white patients [ 183943 ]. Both the Native American and African American populations endure pronounced health inequities and are disproportionately represented in lower socio-economic strata, legacies of systemic discrimination, and historical injustices.

This may have prompted greater experiences and expectations of poor treatment. Native Americans have reported higher levels of health care discrimination compared to other minority groups in prior research [ 1844 ]. Discrimination towards First Nations peoples in health care settings worldwide has been documented [ 45 ]. There are a number of potential reasons that underlie the higher rates of poor treatment perceived by Native American participants.

Due to history of colonisation, marginalisation and exclusion, Native Americans may be subject to more frequent mistreatment than other minority groups in the U. Another contributor may be the fact that the Indian Health Service, which provides health service delivery for members of recognised tribes, has been described as underfunded, inaccessible to some, and offering a limited range of services [ 46 — 48 ].

Moreover, Native Americans who subscribe to more traditional-oriented health models and healing practices may perceive conventional health services as unable to meet their needs. Historical marginalization has also perhaps prompted a degree of mistrust for social institutions among some Native Americans. This is a phenomenon that has been noted in other Indigenous populations [ 2425 ]. Despite participants on average being generally satisfied with the treatment they were receiving, the proportion of Native Americans and African Americans who reported some degree of perceived poor treatment is concerning.

Past experiences of perceived racism were significantly related to a fear of conventional health services. However, previous racism was not meaningfully correlated with treatment satisfaction nor a preference for cultural-matching.

Perceptions of poor treatment were instead significantly associated with treatment satisfaction, reflecting prior research [ 10 ]. Moreover, cultural strength was strongly associated with a preference for cultural-matching. Past experiences of racism in health care settings perhaps generates a level of apprehension regarding future appointments.

However, clinically poorer treatment is in fact related to diminished treatment satisfaction. This finding is unsurprising - the perception that a health service is providing an individual with a lesser or restrictive service is likely to engender lower levels of satisfaction.

The finding that past racism was less connected to treatment satisfaction may suggest that participants viewed perceived episodes of racism during a health care visit as detached or coincidental to the actual medical treatment they were receiving. Furthermore, past racism was not associated with a preference for a culturally similar practitioner.

Individuals with this level of cultural attachment may prefer a culturally-matched clinician, the assumption being that this clinician is part of the in-group and likely to be familiar with unique cultural considerations and needs [ 39 ].

Prior research has found a strong association between cultural affiliation and the the western influence on the minority groups in the united states of america of traditional health practices [ 37 ]. Aside from the relationship between cultural strength and preference for cultural matching, cultural strength was not associated with treatment satisfaction nor fear of conventional health settings in this study. Another finding of note was the relationship between education and fear of services.

Possessing a lower level of education predicted a greater fear of conventional services. Less educated participants may have lower levels of health literacy [ 52 — 54 ] and perhaps feel judged or intimidated by health service processes.

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In addition, people with low educational attainment may be unaware of or avoid health services and only come into contact with them during emergency situations. Moreover, a large survey of First Nations in Canada discovered that those with lower levels of education were more likely than educated participants to perceive non-Indigenous services to be ineffectual [ 49 ]. Furthermore, older age is associated with lower educational attainment, particularly in Indigenous populations [ 55 ].

In this study, Native American participants were significantly older than participants from the other cultural groups. In the United States, Native Americans have lower graduation rates compared to other cultural groups, and those who are older tend to have lower educational attainment [ 56 ]. This may have contributed to the relationship between education and fear of health services.

This can promote shame and lack of questioning by some patients who may not question their treatment as a result [ 57 ]. Lower levels of education. However, were not meaningfully associated with treatment satisfaction nor a preference for cultural matching. Implications and limitations The bulk of the sample reported few if any, experiences of racism in health care settings.

However, participants who had experienced racism were more likely to be afraid of visiting typical health care services. Further research is required to unpack the nature of the perceived racism experienced so that service providers can identify and actively minimise these episodes. It may also be necessary to hire multicultural community health liaison officers to provide assurance and assistance to minority individuals who are fearful of attending health services.

The notable minority of Native Americans and African Americans who reported poor treatment is of some concern. First Nations peoples worldwide experience this discrimination. These types of poor treatment often have a historical and political significance that has failed to be addressed.

Again, further research is necessary to identify where exactly during the health care experience patients believed they were being treated poorly or differently. It is also important to identify whether perceived discrimination is a result of genuine prejudice explicit or implicit on behalf of the service. For example, a service with restricted options for treatment or unhelpful staff may be reflective of underfunding. Similarly, general ineptitude may be confused for cultural bias.

Either way, the hiring of staff from diverse backgrounds may alter the attributions made by minority patients for poor interpersonal experiences, alleviating feelings of being judged or misunderstood for some minority patients. Indeed, patients who are culturally strong appear to preference health care professionals from their own cultural background. Although the evidence for culture matching on treatment outcomes is equivocal, it may be that cultural matching affords a patient with a level of comfort or security during the clinical interaction.

Cross-cultural training for staff may be another consideration. Again, the evidence for such training on patient the western influence on the minority groups in the united states of america is weak [ 5859 ].

The focus of training could instead be on the social determinants of health for racial and cultural minorities and how health professionals can better recognise barriers to access and treatment adherence [ 60 ].

A stronger commitment to patient-centred care which aims to provide health services that reflect the needs of the patient and not the mainstream health system, is recommended.

The study has a number of limitations. Sampling was non-representative, although undertaken at popular, central public place shopping mall and a well-attended cultural event. The study may have also over-selected for individuals who were confident, educated, literate and who possessed a higher English language proficiency.

The availability of bi-lingual researchers and the option to have the survey read to participants may have alleviated some of these concerns. Several interviews were carried out in Spanish. The study captured the bulk of minority individuals who were in proximity to our research stalls. The sample sizes are small by cultural group because such groups are underrepresented in the particular region the study was held.

This precluded identifying correlates of health care experiences by cultural group. While this prevented the identification of explicit incidents, it allowed participants to consider any incident they perceived to be discriminatory or substandard.

Similarly, the components of cultural strength were determined by participant perception as opposed to a more objective or detailed measure of cultural attachment i. The intent of the study was to gather preliminary information on health care experiences via a succession of relevant questions. However further research exploring the psychometric properties of the questionnaire at large may be warranted.

Specific items may need to be refined.

America’s Racial and Ethnic Minorities

Open-ended questions may need to be included to allow for greater context. This process may benefit from direct consultation with minority and underserved communities.

Nonetheless, participants on average reported adequate access to services. The study had a number of strengths.

United States of America

It provided a rare insight into minority health care expectations and experiences in a region with comparatively lower proportions of racial and cultural minorities.

Additionally, the study explored the impact of cultural strength on health care interactions and outcomes. Conclusion In this study, participants on average, reported that they had good access to health care services, were not afraid to visit conventional services, experienced low levels of racism and poor treatment and were generally satisfied with their treatment.

Participants also reported high levels of cultural strength, and viewed staff diversity and staff knowledge of different cultures as important. The importance of culture to health care visits was somewhat important as was a preference for practitioner cultural matching.