Hispanic/Latino Cultural Competency: Review of Literature Findings

Created by: Patrick Edlin

Large & Growing population

– 24% of people ages 0-17 (~18million Hispanic/Latino kids)

– ~17% of people ages 18-64 (~33 million Hispanic/Latinos)

– 7.6% of people age 65+ (3.4 million Hispanic Latinos)

– 44% of people age 65+ in a Medicare Risk HMO were Hispanic/Latinos

Concentrated in key markets

– Over 75% of Hispanic/Latinos are in 7 States

– CA, TX, FL, NY, AZ, IL, NJ, CO

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Demographics

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Hispanic Population Distribution

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2011 Population Graph The Hispanic consumer much younger

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Hispanics/Latinos come in all colors

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The term ‘Hispanic’ was made up by the U.S. government in the 1970s in the U.S. census 48

The term ‘Latino’ was a term used by the U.S. government in the 2000 census; however the term ‘Latino’ has roots referencing Latin America – countries with language rooted in Latin and in America which included Spanish, Portuguese and French speaking countries48

In 2006 the Latino National Survey surveyed preference

– 35% preferred Hispanic

– 13.1% preferred Latino

– 32% were okay with either

– 18.1% didn’t care

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Latino v Hispanic

Hispanic/Latino is considered an ethnicity- not a race

– This means that Hispanics can be White, Black, Asian, Etc..

In the 2010 Census Hispanics identified as the following48

– 53% White only – 2.5% Black/African American – 1.4% Indian – 0.4% Asian – 0.1% Pacific Islander – 36.7% Some other race – 6% 2 or more races – 4% No response

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Ethnicity v Race Race status can influence health19

Studies show that race is a determinant social economic status which can have an adverse effect on health. For example: Hispanic blacks are more likely to live with non-Hispanic blacks and be exposed to an array of disadvantages such as lower quality of education and higher possibility of environmental exposures

Que significa a ser latino? ?

Be LOUD

Be Proud Dance

Eat

Family & Community

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Hispanics are loud and excited people –Both volume and physical expressions tend to

be more colorful than their non-Hispanic counterparts

– Caribbean Hispanics are known to be louder than South Americans, Central Americans, and Mexicans

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To be LOUD!

Verbal26,61

Elderly are to be treated with respect. It is culturally preferable to address senior members in society as Mr./Mrs. Last Name The use of Senora can be considered offensive in many Hispanic countries as it implies the client is old. The English Mr. Ms. Are preferred. Hispanics are tend to be non-confrontational and respect authority figures. They also may tend to accept but not always agree with /understand authority figures. Hispanics like to establish warmth and trust prior to addressing issues

• Hispanic nonverbal communication styles tend to be different from Anglo individuals

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To be LOUD!

Non-verbal26,61

Proximity- Hispanics tend to stand closer and provide less personal space than Anglos Greetings- Hispanics often greet with kisses on the cheek and hugs Eye-contact - prolonged uninterrupted eye contact is considered rude and disrespectful Hispanics tend to be present focused as opposed to future focused Hispanics tend to be polychronic time oriented meaning they engage in multiple activates at one time- causing occasional tardiness Puerto Ricans and Salvadorians use verbal cues such as pursing their lips to call over/beckon someone

Hispanics remember English language commercials as well as the general population

The same commercial shown in Spanish bumps up ad recall by as much as 30%

Hiring Spanish- speaking talent to deliver the script resonates 30% better with Latinos

UNDERSTANDING THE BILINGUAL BRAIN54

90% of Hispanic parents want their children to be bilingual

Communication in a way that will Resonate Know what resonates with Hispanic consumers

Source: Nielsen Neuro Nielsen State of the Hispanic Consumer

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Language is a factor 57

• Hispanic/Latino teens respond best to bilingual ad messages, especially from English - language celebrities “who happen to slip in some Spanish”—because it mirrors their own usage patterns21

• Language is an important aspect that one should be sensitive because it has less to do with competency and more to do with the cultural meanings people attach to language. For Hispanics/Latinos in the U. S., Spanish is a key marker of personal, social and political identity. As a result, Spanish-language TV remains important for even those who are fluent English speakers and who regularly watch English-language TV. In communicating with Hispanics, it is not an either/or question but a matter of carefully integrating both languages to best communicate with the Hispanic/Latino consumer in the U. S. 59

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Communication

• Family plays a big role in the Hispanic household – Hispanics do not distinguish between immediate and

extended families5

• Hispanic families spend more time doing things together than their non-Hispanic counterparts – Leisure activities occur mainly in the context of family and

friendship groups51

• Hispanic families are more likely to live in a multigenerational household14

– Hispanic children are 2x as likely to have grandparents or adult (non parent) relatives living in their homes5

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To have family and community

• Household roles often depend on gender and age –Male head- financial decisions – Female head– makes food and pharmaceutical choices

• Although the matriarch often determines when a family member needs medical care, the male head still gives permission to seek treatment52

–Children – children of un-acculturated Hispanics often act as cultural and linguistic broker between their parents and ‘industry’ • ‘industry’ can be either healthcare provider or customer service

representative 16

To have family and community

• Machismo- traditional patriarchal structure where father or eldest male relative is granted the most power where women are expected to be submissive28

– Understand that it is important to target health messages to men as well as women. Hispanics typically subscribe to values of “machismo” and “marianismo” which culturally define the desirable male and female qualities. True to these values, men are often reluctant to consult physicians for health problems until someone is so ill that they must visit an emergency room. Fathers/husbands may make other family members, especially their wives and daughters, to wait until the last minute for care or take an uncooperative stance on the health care needs of family members.41

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To have family and community

• Hispanics are very social people – Latinos are more likely to be eating socially with family

or friends and less likely to eat alone. Even those who have to eat alone because various constraints aspire to eat socially whenever possible56

• Hispanics hold collective values and group orientation permeates Hispanic life

• Individuals often look to one another for opinions • It is not uncommon for Hispanics to stay with

family or family friends while traveling

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To have family and community

• Community involvement is essential to gaining the trust of the Hispanic community

• When less acculturated Hispanics immigrate or migrate to an area they rely on more acculturated Latinos to serve as advocates and counselors30

• The grass roots development of Latino communities create tight knit social groups that tend to be less trustworthy of unfamiliar business3,30

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To have family and community

• “Relationships are extremely important in the Hispanic culture. If you treat Hispanic customers with both respect and cultural understanding, they will remain loyal to your business and tell their friends and family that you have gone the extra mile to make them feel welcomed”2

• “Politeness toward all is essential because the decision-maker – the only one whose approval counts- may be a less than obvious person”3

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To have family and community

• Food is a cultural identifier for Latinos –Hispanics allocate more money to food than non-

Hispanics ($452 more per year)66

– Food varies between countries and is a way Latinos help distinguish between each other

• Despite differences between countries, freshness is something 82% of Latinos actively seek56

– The embracing of prepackaged foods increases with acculturation

• Hispanics tend to cook from scratch67

• Fresh fruit is a staple in most Latino households

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To eat

FRESH CENTER-STORE • Chicken • Pork • Fin Fish • Avocados • Citrus • Bananas • Tomatoes • Herbs,

Spices, Seasonings

• Ethnic Grocery

• Dry Pasta

• Pasta sauce

• Yogurt

• RTE Cereal

• Cream Cheese

• Dry Soup & Noodles

• Mayonnaise & Spreads

FRESH CENTER-STORE

• Specialty Fruit • Beans • Sapote • Cactus Leaves • Rice

Hot Pasilla Peppers Guava

Hispanic Specialty Cheese

• Hispanic Sweet Goods

• Tortillas and Wraps

• Ethnic Dairy • Ethnic Frozen • Canned Meat • SS Milk Products

What foods are Hispanics buying?67

High-indexing Staples In The Hispanic Basket

Additional High-indexing “Basket Building” Hispanic

Products

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To dance & party

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To dance & party

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Although Hispanics are not getting much recreational activity, many times they are physically active at work

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The Hispanic Consumer Attitudes and Values around Health

Values

• Cost takes precedence over quality for the Hispanic consumer34

• In addition to cultural attitudes, cost is a factor in Hispanics using ‘traditional medicine’

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• “The average diabetes patient visits our [Walgreens] pharmacists 30 times a year while they visit their PCP 2-4 times a year…” CEO of Walgreens34

• In many Latin American countries the pharmacy is a source of care including being prescribed medications

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Convenience is a factor

• Hispanics less likely to trust others with personal information

• Hispanic males are less likely to share personal information than Hispanic women

• Puerto Ricans less likely to share personal information regardless of benefits received in exchange34

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Privacy Concerns

• Hispanics use social media as a tool to communicate with family and friends more often than non-Hispanics

• Mobile information is more readily utilized by Hispanics including access to health information34

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Internet THE forum for Hispanic health

• Spirituality is central to the way Hispanics interact with the health care system – Spirituality is not always religion

• It is common for Hispanics to believe in an interconnection between ‘good acts’ and health28

– Many believe that bad health can be caused by bad acts – In contrast, many also believe that bad health can be overcome by

good acts

• The tie between spirituality and health can be illustrated by the following ‘diseases’ and traditional remedies – A reliance on traditional healing system is common not only

because it is culturally approved but also because of the lower costs

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Spirituality, traditional medicine, and health

• Mal ojo or evil eye is caused by a person with a "strong eye" and occurs when someone admires a child without touching them.52

– The cure involves passing an egg over the body and then placing it in a bowl under the child's pillow overnight. If the egg is cooked in the morning then the child had "mal de ojo".52

• Mal puesto is when someone uses witchcraft to put a bad disease on a person. The hex can be placed by a bruja (witch) or someone who knows about witchcraft. Symptoms can be varied.52

– The cure involves prayers, massages, herbs, making crosses on the arms with olive oil and chili powder, and medicinal enemas.52

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Traditional Diseases and Cures

• Envidia- Many Mexicans believe envidia, or envy, causes illness and bad luck. Envy can be provoked by success, but can result in misfortune and illness. Some research concludes that low economic status is associated with the belief in envidia.63

• Susto- Also known as fright sickness, susto arises from a traumatic or frightening experience and is thought to cause soul loss, whereby the soul leaves the body and wanders freely.63,64 Symptoms include anxiety, depression, insomnia, introversion, irritability,lethargy, and anorexia. Tuberculosis is sometimes classified as susto. 63,64

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Traditional Diseases and Cures

• Humoral Imbalance- In general, physical and mental illness is thought to result from an imbalance between a person and the environment, expressed as either “hot” and “cold” or “wet” and “dry”.64 The four humors contained in the body include blood (hot and wet), yellow bile (hot and dry), phlegm (cold and wet), and black bile (cold and dry).63 To correct an imbalance, people consume foods or herbs with the opposite quality (e.g., “cold” conditions are treated with “hot” medications).52

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Traditional Diseases and Cures

• Empacho - Illness can also result from a “dislocation” of different parts of the body. Empacho, an example of dislocation, is a form of upset stomach or indigestion, thought to be caused by eating the wrong food at the wrong time of day, eating undercooked food, or swallowing gum. The most common treatment is rubbing the stomach or back gently with cooking oil and pinching the spine.52,63

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Traditional Diseases and Cures

Vicks - In Latino culture, Vicks Vapor Rub is a cure all

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Traditional Disease and Cure

Latino Health Disparities

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• Hispanics live longer. Despite having a lower income than white Americans, Hispanics live longer than whites. Hispanics have an average life-expectancy of 75.1 years for men and 82.6 years for women compared to white Americans of 74.8 years for men and 80.1 years for women (U. S Census Bureau, 2008a).

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Hispanic Paradox

• Hispanics show higher incidences of Diabetes versus Non Hispanics.

• The sub-segment of Puerto Ricans show higher incidences of chronic illness, than the Mexican sub-segment, All Hispanic and All Races.

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Disparities - Incidence Disparates All

Races All Hispanic

P.Rico Mexican

Current Asthma Prevalence

8.0 6.6 16.5 5

Asthma Attack Prevalence

4.2 3.3 7.8 2.3

Lifetime Asthma Diagnosis

12.7 10.8 23.6 8.5

Coronary Heart Disease

6.3 White/ 6.6 Black*

5.5 7.7 5.5

Heart Attack 3.1 2.4 4.0 2.4 Heart Disease 11.1 8.1 11.5 8.1

Stroke 2.6 2.7 3.4 2.7 Diabetes 8.5 12.3 14.3 13.3 Cancer 8.0 3.8 4.3 3.5

Arthritis 21.4 16 21.9 15.7

Source: NHIS Ages 18+ 1998-2012

1. Cancer 2. Heart Disease 3. Unintentional Injuries 4. Stroke 5. Diabetes 6. Chronic Liver Disease & Cirrhosis 7. Chronic Lower Respiratory Diseases 8. Alzheimer's Disease 9. Nephritis, Nephrotic Syndrome & Nephrosis 10. Influenza & Pneumonia National Vital Statistics Reports, Vol. 62, No. 6, December 20, 2013, Table 2, Page 55.

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10 Leading Causes of Death for Latinos

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