PT225 Ch. 2: Providing Culture-Sensitive Health Care to African Americans

African American

Traditionally refers to persons of Sub-Saharan African ancestry born in the United States

Sub-Saharan Africa

Region of Africa from which most enslaved Africans were taken during the transatlantic slave trade

Slave trade timeline

Occurred from the 16th through early 19th centuries

US-born African American

Individual of African ancestry born in the United States

African-born Black American

Individual born in Africa who later migrated to the United States

Caribbean-born Black American

Individual born in Caribbean nations who migrated to the United States

Distinction within Black populations

Differences may exist in geography, culture, dialect, health beliefs, and language

Key principle in care of African American patients

Never assume geographic origin, cultural roots, or first language

Equality

Giving everyone the same resources regardless of need

Equity

Providing resources based on individual need to create fair outcomes

Healthcare equity example

Providing translation services when needed rather than treating all patients identically

Angela Davis quote meaning

It is not enough to be non-racist, healthcare workers must actively practice anti-racism

Common chronic conditions in African American communities

Hypertension, Type 2 diabetes, asthma

Hypertension disparity

Develops earlier and leads to more severe complications in African Americans

Type 2 diabetes disparity

Higher rates of diagnosis and complications including kidney failure and amputations

Asthma disparity

Higher emergency visits, hospitalizations, and mortality rates in Black children and adults

Weathering effect

Long-term exposure to stress and adversity causes physiological deterioration

Social determinants of health

Economic stability, neighborhood conditions, education, access to healthcare, and chronic stress

Tuskegee Syphilis Study

U.S. study where Black men were denied treatment for syphilis, contributing to medical mistrust

Medical mistrust

Distrust of healthcare institutions due to historical and present discrimination

Implicit bias

Unconscious attitudes or stereotypes that affect understanding and decisions

Microaggression

Subtle, often unintentional discriminatory comment or behavior

Example of microaggression

Assuming a Black patient has low health literacy without assessment

Impact of perceived discrimination

Reduces medication adherence, follow-up, and trust

Culturally responsive counseling

Open-ended questions, respect for beliefs, individualized communication

Iceberg theory of culture

Surface culture is visible behaviors, deep culture includes beliefs and values

Surface culture examples

Clothing, food, language, music

Deep culture examples

Health beliefs, spiritual views, illness causation beliefs

Natural illness belief

Illness seen as part of God's plan or natural imbalance

Unnatural illness belief

Illness attributed to evil influence, sorcery, or spiritual imbalance

Folk healer

Individual believed to have spiritual authority to treat illness

Laying on of hands

Religious healing practice involving prayer and physical touch

Role of religion in African American health beliefs

Spiritual well-being is closely connected to physical health

Generational religious shift

Older generations may emphasize church attendance more strongly than younger generations

Belief in divine punishment

Illness sometimes attributed to parental or personal sin in certain belief systems

Caribbean health belief blend

Mixture of American medical practices and traditional spiritual beliefs

Voodoo belief

Spiritual system involving supernatural causation of illness

Traditional medicine use rate

70-80% of African-born individuals may use traditional remedies

Strong physical-spiritual connection

Belief that spiritual wellness influences physical healing

Dialect consideration

Caribbean patients may speak English fluently but maintain strong accents

Healthcare communication strategy

Focus on clarity without assuming misunderstanding

Role-play takeaway

Listen first, assess beliefs about medication use before correcting

Herbalist use

Some patients may consult herbalists alongside prescribed medication

Medication nonadherence scenario

Patient stops medication once symptoms improve

Counseling strategy for nonadherence

Explain importance of completing therapy even if symptoms improve

Avoiding assumptions

Do not assume Black patients share identical cultural experiences

Pain bias research finding

Some providers falsely believe Black patients have higher pain tolerance

Tone of voice impact

Condescending or rushed tone reduces trust and adherence

Dismissive behaviors

Interrupting, minimizing symptoms, avoiding eye contact, visible impatience

Culturally humble pharmacy practice

Recognizing personal limitations and continuously learning

Health disparities definition

Differences in health outcomes linked to social, economic, and environmental disadvantage

Structural barriers

Systemic issues such as housing segregation and limited healthcare access

Redlining impact

Concentrated environmental hazards in historically Black neighborhoods

Asthma environmental factor

Increased exposure to air pollution and industrial zones

Equitable pharmacy practice

Adjusting communication and services to meet individual patient needs

Anti-racist practice

Actively addressing bias rather than simply avoiding overt discrimination

Cultural humility

Lifelong commitment to self-evaluation and respectful patient partnership