Toward multiculturality. Implications for the pediatrician

The use of folk remedies among children in an urban black community: remedies for fever, colic, and teething

BACKGROUND

Folk remedy use is universal, occurring in all cultures. Folk remedies have been and still are relied on in the black community. In this study, folk remedies refer to herbs, over-the-counter medications, and items traditionally used for cooking that are used to treat a variety of ailments.

OBJECTIVE

To identify folk remedies used to treat fever, colic, and teething among black children in Detroit, Michigan.

METHODS

Structured interviews were conducted with caregivers of healthy black children <2 years of age who were patients of the general pediatric clinic at Children's Hospital of Michigan. Descriptive analysis of the frequency distribution of the responses was performed.

RESULTS

One hundred seven caregivers agreed to participate. All participants were familiar with the use of folk remedies. Most caregivers learned of these remedies from their mothers or grandmothers. Older parents were more likely to use folk remedies, but there was no difference in remedy use among different levels of maternal education.

CONCLUSIONS

The knowledge and use of folk remedies were active in this black community. Their use seems to be cultural, rather than attributable to decreased access to health care. Physicians should be aware of these remedies, to educate families about remedies that may be harmful. Most remedies used pose no threat to health. In some cases, remedies may be blended with traditional medical treatments to ensure better patient compliance.

Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients

BACKGROUND

Health care providers and health care training institutions need more specific, relevant, and useful information for providing culturally sensitive health care.

OBJECTIVE

We sought to determine what patients considered to be culturally sensitive health care.

RESEARCH DESIGN AND PARTICIPANTS

We conducted 20 focus group interviews with 135 mostly low-income primary care patients from three different ethnic/cultural groups (African American, European American, and Latino American). Focus group interviews were recorded, transcribed, and analyzed into themes by two researchers using the constant comparative method.

MEASURES

Participants' responses were grouped into primary and secondary themes.

RESULTS

Results revealed the following universal themes of health care delivery by physicians that all three racial or ethnic groups identified as indicators of culturally sensitive health care: people skills, individualized treatment, effective communication, and technical competence. Results also revealed some ethnic group-specific themes. Other factors including physical environment characteristics (eg, culturally sensitive art, pictures, music, and reading materials) and office staff behaviors were unique indicators of culturally sensitive health care identified by African American and Latino American participants but not by European American participants.

CONCLUSIONS

These findings can be incorporated into training programs for health care providers, possibly resulting in more effective health care delivery to patients from diverse cultural backgrounds. Future research is needed to evaluate the impact of incorporating patient-identified cultural sensitivity into health care delivery on important outcome measures such as patient satisfaction and treatment adherence.

Cross-cultural surveys of adolescent health and behavior: progress and problems

Adolescent health surveys administered in different countries or regions often are described as cross-cultural. Although most include youth of different ethnic and cultural groups, few attempt to define these constructs or to collect data that allow their characterization. This paper explores four challenges shared by large-scale surveys of adolescent health-related behaviors and beliefs. First, adolescent health investigators have used the terms culture and ethnicity loosely. The growing interest in contextual analysis demands standardization of the definitions as they apply to adolescents, followed by correct usage of the terms. Hypotheses regarding the associations between race, ethnicity, culture, health-related behaviors, and health outcomes should be clearly stated and incorporated into conceptual models. Second, cross-cultural analyses are interpretable only when the study designs and sampling methods provide adequate representation of cultural and ethnic minorities and when the survey items allow differentiation of factors related to race, ethnicity, culture, and socioeconomic factors. Third, cross-cultural research may expose traditions, beliefs, and behaviors that are supported by one population yet criticized by another. Investigators must recognize their own personal biases and must work collaboratively to analyze and interpret their data correctly. Fourth, generalizations about cultural/ethnic comparisons can evoke powerful emotional reactions. Interpretation and dissemination of research findings should be done sensitively and with the help of experts from the cultural/ethnic groups that have been studied.