Introduction
In today’s contemporary world adorned with multicultural societies, meeting the different needs of culturally diversified people becomes a problem. People have different needs and without proper systems put in place to address them, there will be underserved populations in the end. There is a need to study one’s socio-cultural background to establish how it affects one’s beliefs and behaviors concerning the needs being addressed (Carrillo, Green, and Betancourt, 1999, p.829). For, instance, to assure quality health to cross-cultural populations, physicians need to understand cultural influences towards one’s beliefs concerning health. By integrating these beliefs into modern medicine, physicians will address health problems more efficiently from a broad perspective. Fortunately, education stakeholders have developed cross-cultural curricula to deal with these issues. In society today, numerous underserved populations cannot have their issues addressed probably due to cultural settings and lack of proper systems to address them. For instance, some family members cannot get their sick loved ones to eat and they do not know how to do it. Some parents have issues with taking their children to primary care sites. Think of the Hispanic males who cannot access primary care and education.
This paper deals with Denver Health Men’s Health Initiative on the Hispanic population that cannot access primary care and education among other basic needs. It seeks to elaborate on how these problems have evolved to levels that call for attention. It also addresses the impediments that stand in the way of teaching and solving the problems experienced by Hispanic males. Finally, this paper will offer proposals on how to improve the current situation and pinpoint the role of nurses in alleviating the situation. Fundamentally, Hispanic males cannot access primary care (Office of Women’s Health, 2007). Hispanic males are unable to acquire basic needs like primary care compared to their white counterparts but this is surmountable with proper planning and creating awareness. This problem is relevant to nursing as we move towards the provision of quality healthcare for all.
Background of these Problems and their Evolution
Historical perspective plays a crucial role in examining the health status of any population subset especially Hispanics in this context. Hispanics’ disparities in healthcare access date back to the migration era when thousands of them moved to the United States of America. A great number of U.S Hispanics share the American history of a healthy nation though some risk factors for particular diseases and low proclivity for others stands out (Duran, 1998, p. 184). Hispanics fundamentally migrated to America due to economic opportunities that existed in America, long before independence. Before 1995, the massive historical racial groupings between whites and Hispanics served only to conceal important information relevant to healthcare provision. There has been a lack of sufficient information about Hispanics due to a lack of demographic identifiers like census and medical records among other issues (Duran, 1998, p. 186). This offers the background of health disparities experienced by Hispanics even to date. How has this evolved and made its way to current times?
Duran (1998) posits that, the classification of people as ‘black’, ‘white’ or ‘others’ masked important health information concerning Hispanics (p. 186). These groupings resulted in blacks being classified as minorities. In principle, minorities in any population setting are disadvantaged when it comes to accessing some basic services like health. This situation has persisted to contemporary times whereby, Hispanics still cannot access primary care due to these groupings. For a long time, involving Hispanics in medical research has been minimal leading to a lack of sufficient information about this group of people. Duran (1998), notes that the absence of information about Hispanics contributes largely to the unavailability of competitive healthcare services of the same (p. 189). This is true given the fact that dealing with a disease successfully requires past information to conclude based on what happened in the past. All these factors have contributed to the present underserved Hispanic populations that cannot access primary care.
Such occurrences prompted the establishment of the Denver Health Men’s Health Initiative. This initiative seeks to provide health to all people regardless of whether someone can afford it or not. Denver Health Initiative’s mission is to provide healthcare for vulnerable and underserved populations like Hispanics. It is a well-known foundation in America since its inception in 1998. This is an arm of the famous Denver Health, which has been running since 1860 (Denver Health Foundation, 2008). Apart from offering health services, the Denver health Foundation offers health education for the coming generation. The role of nurses comes in handy in this context.
Barriers towards Provision of Quality HealthCare to Hispanics
The problem of Hispanics lacking access to primary care is complex. There are deep-rooted problems including education needs that nurses can handle properly. Numerous barriers are standing in the way of offering education and healthcare to these people. Pena-Brow, in 1997, carried out research to identify obstacles facing Hispanics in accessing primary health care. The outstanding obstacles are; socio-economic status, educational achievement, language, culture, family, alternative treatment, healthcare status, perception of illness, utilization of healthcare services, and conceptual framework (Pena-Brow, 1997, p. 14). How do these obstacles stand in the way of accessing healthcare services for Hispanics?
Essentially, access to quality healthcare services depends largely on socioeconomic status especially, level of education, income, and occupational achievements. Pena-Brow (1997), notes that most Hispanics migrated to America in search of better economic opportunities. Consequently, they could not afford a good education, which has left a big chasm between the level of education concerning Hispanics and white people (p. 15). As a result, these low levels of education cannot secure good-paying jobs for Hispanics. This implies that Hispanics cannot access quality healthcare services. Statistics indicate that a Hispanic is 2.9 times more likely to live in impoverishment as compared to whites (Pena-Brow, 1999, p. 15). Interestingly, the high poverty rates among Hispanics are not from their lack of participation in the labor force. On the contrary, these rates are due to their inability to secure high-paying jobs.
Language forms the second outstanding barrier towards access to health by Hispanics. Trotter (1998) asserts that communication forms the backbone of healthcare provision. People receiving healthcare should be in a position to communicate effectively with the providers of the same (p. 8). Unfortunately, most Hispanics do not speak English as their first language. This calls for a translator; an exercise that requires expertise and this is conspicuously lacking in the healthcare profession. It is hard to create rapport between doctor and patient without proper communication. The other side of this challenge is that few Hispanic health professionals are aggravating the issue further.
Culture is another chronic problem towards the provision of quality healthcare to Hispanics. The National Coalition of Hispanic Health and Human Services Organizations (1995), note that culture contributes immensely to healthcare provision (p.305). For example, think of people in a population where the majorities speak a different language and no one seems to understand you. Moreover, the color of your skin makes you stand out in a crowd. Think of healthcare systems designed to cater to a particular coterie of people that excludes you, adorned with bureaucracy with protocols to follow to access what you want. This is the view held by many Hispanics towards American healthcare systems (The National Coalition of Hispanic Health and Human Services Organizations, 1995, p. 305). Culture forms the framework, by which individuals relate with the surrounding environment daily. Unfortunately, Hispanics found themselves in a different culture that could not accommodate them efficiently.
The family setting contributes largely to the well-being of an individual. Hispanics place more emphasis on family needs than on individual needs. Moreover, The National Coalition of Hispanic Health and Human Services Organizations (1995), points out that Hispanics understand family as an extended unit going beyond the immediate family (P. 306). This is a setting where people can come for moral, financial, or any kind of support. These extended families have different expectations from a doctor concerning their patients. According to Jaramillo and Erkel, (1990), Hispanics believe that if a medical professional has no concern about their personal feelings then they would prefer not to seek help from such professionals (p. 25). Regrettably, some medical professionals are of this caliber, meaning that most Hispanics will resort not to seek medical health from such ‘uncaring’ practitioners.
Alternative medicine is widely spread among Hispanics and this acts as a substitute medicine to contemporary medicine. Hispanics mistake alternative medicine for ‘folk medicine’, which they take to mean consulting a witch doctor (Pena-Brow, 1997, p. 20). It is a common belief among Hispanics that God can heal any form of sickness and some people possess powers to heal. Consequently, instead of the Hispanic patient taking alternative medicine commonly known as Curanderismo, he or she will consult a ‘folk healer’ (Jaramillo and Erkel, 1990, p. 25). This acts as a drawback in accessing primary care among Hispanics.
Hispanics’ perception of illness mounts nearly insurmountable challenges in primary healthcare provision. They take illness to be a state of discomfort that will vanish with time. According to Jaramillo and Erkel (1990), Hispanics mistake strong bodies and absence of pain for good health (p. 25). This implies that convincing a Hispanic to take preventive measures will be an uphill task. Consequently, most of them have poor health status and this may explain in part why Hispanics have a low life expectancy. Drug laws pose a challenge to the provision of good healthcare to all. In some countries, drugs sold over the counter need a prescription in America as per the Drug Law. This implies that the majority of foreign-born Hispanics will not get these drugs due to differing opinions on the same, dictated by different laws (Pena-Brow, 1997, p.28).
Hispanics underutilize the available healthcare services despite tremendous steps that America has made towards healthcare for all. This entails utilizing prevention healthcare services. However, as aforementioned, Hispanics have a different opinion concerning good health. Pena-Brow (1997), posits that other impediments to the utilization of available healthcare facilities include geographical inaccessibility, poor transportation network, and isolation from mainstream culture (p. 30). These barriers not only bar Hispanics from accessing quality healthcare but also bar teaching methods that would alleviate this situation.
Proposed Solutions
Even though currently there is little research work going on to address the issues of Hispanic problems, there are several recommendations that if implemented will alleviate the current situation. Hispanic health profile identifiers are still conspicuously missing from national data on health profiles. Maybe this can explain why there is minimal research to address the issue. The first recommendation is to assure continued healthcare provision to Hispanics who continue to use public clinics. It is recommendable for nurses to increase low-cost health services to Hispanics. It would even be better if nurses would provide free medical services to this disadvantaged group. There is a need to implement policies that will ensure healthcare insurance coverage remains an employee benefit. Centers for Disease Control (CDC) (1994) points that, health practitioners need to come up with programs that suit Hispanics just as marketers tailor their products to reach these populations (p. 5).
Overcoming the language barrier will be a breakthrough in healthcare provision. Hispanic nurses should consider helping their fellow Hispanics to overcome the language barrier. Alternatively, practitioners should think of involving trained translators to create rapport between patients and nurses (The National Coalition of Hispanic Health and Human Services Organizations, 1995, 81). Incorporating language studies in the healthcare profession could also help to overcome the language barrier.
Cultural barriers are almost disappearing with the emergence of the global community and technology development. However, it is recommendable to use nurses who understand patients’ culture or better still if they share a common cultural background. Sensitize families on the importance of preventive strategies. Reform healthcare settings to accommodate Hispanics with their beliefs and behaviors. Nurses, by their training and their mission of ‘health for all’ should be in the front line in creating a conducive environment for Hispanics as they seek medical attention (Pena-Brow, 1997, p. 63). For instance, if a patient feels that the doctor is not caring enough courtesy of his or her belief, so be it. This calls for understanding on the part of practitioners regardless of whether one is Caucasian or Hispanic.
Other recommendations include collecting and documenting enough data about Hispanic health profiles. This will boost research efforts in solving inherent problems amongst this underserved population. There is a dire need to involve Hispanics in policymaking to address their problems better. This would include among other things intensifying education on American healthcare systems and drug laws. Stakeholders have to knock off the notion that American health systems are a bunch of bureaucratic systems full of protocols. This is a notion held by many Hispanics and until they drop it and see themselves as part of mainstream society, health disparities will remain outstanding. Pena-Brow (1997), notes that nurses need to translate Hispanic healthcare problems into policy propositions that will offer a conclusive long-lasting solution.
Recommendations to Overcome Teaching Barriers
Most of the barriers discussed result from a lack of enough information concerning the problem of Hispanics’ failure to access primary healthcare. Through education, nurses can avail this information. Formal learning theories come in handy in this case. There is a need to incorporate formal learning theories in the nursing profession to improve healthcare access for Hispanics. Formal learning theories involve the use of mathematical incarnation of normative philosophy. It answers the question of why someone would prefer one thing to another (Schulte, 2008). It also deals with how people use observations concerning the surrounding environment to make the right conclusion.
This definition resonates well with the role of nurses in helping to provide primary healthcare to Hispanics. Nurses need to come up with strategies that will foster information conveyance to Hispanics and other involved stakeholders. From the discussion given above, it is clear that Hispanics lack crucial information on healthcare provision and systems. For instance, they do not know the difference between good health and strong bodies void of pain (Jaramillo and Erkel, 1990, p. 25). Nurses would employ formal education theories and integrate demographic variables to teach Hispanics on issues of health. People have differing opinions based on the environment they were brought up. Hispanics may have grown in environments that do not take health issues seriously. Nurses should seize this opportunity and teach Hispanics the way forward as they mingle with them in course of healthcare provision. Even though there is no absolute truth, nurses would create some sense to Hispanics regarding health issues.
There are alternative strategies of teaching like organizing seminars and carrying out campaigns to sensitize Hispanics on health issues. Behaviorism learning strategy resonates well in this context. Behaviorism states that the mind is a ‘blank page’ that concludes experiences (Dombeck and Wells-Moran, 2006). Nurses could exploit this strategy, and take Hispanics through their experiences; compare them with better lifestyles full of good health, and convince them to adopt healthier living styles. Through continued teaching and convincing, Hispanics will adopt this new behavior and start living healthy lifestyles and with time, this will become their culture.
Conclusion
From the discussion given in this paper, it is clear that Hispanics cannot access primary health care. This is because of divergent barriers that stand in their way. Some of the barriers are external in origin and they can do little about them. For instance, down history, Hispanics have been the minority group in America. This implies that just like any other minority group in any social setting, they lack access to some basic services like primary care. Denver Health Foundation has come to the rescue of such disadvantaged people who cannot access basic care. This cultural health-learning group seeks to offer healthcare services to poor people even those who cannot afford healthcare services due to high costs.
However, most of the barriers emanate from within, and with the right information, they can surmount them. This is where the role of nurses comes in. Nurses, with their special training, have the best chance to turn events here. This implies that they can use their training to teach Hispanics the importance of healthy living. Formal education theories in this case play a major role because they help to establish that, Hispanics choose a given lifestyle based on what they believe in. However, this is not the absolute truth because Hispanics make conclusions from their experiences. Theirs may be wrong experiences and with strong convictions, nurses can change these beliefs. According to Dombeck and Wells-Moran (2006), the mind is a blank page and perceptions ingrained in it may change with time. Based on this argument, nurses could change the behaviors of Hispanics drastically.
Reference List
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