Understanding the Hispanic Culture
Over the past 30 years, the Hispanic population has exhibited tremendous growth in the United States. Hispanic is a term created by the U.S. federal government in the early 1970s in an attempt to provide a common denominator to a large, but diverse, population with connection to the Spanish language or culture from a Spanish-speaking country. The term Latino is increasingly gaining acceptance among Hispanics, and the term reflects the origin of the population in Latin America.
Traditionally, the Hispanic family is a close-knit group and the most important social unit. The term "familia" usually goes beyond the nuclear family. The Hispanic "family unit" includes not only parents and children but also extended family such as: grandparents, uncles, aunts, cousins, godparents. In most Hispanic families, the father is the head of the family, and the mother is responsible for the home. Individuals within a family have a moral responsibility to aid other members of the family experiencing financial problems, unemployment, poor health conditions, and other life issues.
Family ties are very strong: when someone travels to another town or city to study or for a short visit (e.g., vacation, business, medical reasons), staying with relatives or even with friends of relatives is a common practice. Families often gather together to celebrate holidays, birthdays, baptisms, first communions, graduations, and weddings. Hispanic families instill in their children the importance of honor, good manners, and respect for authority and the elderly. Preserving the Spanish language within the family is a common practice in most Hispanic homes.
Spanish speakers tend toward formality in their treatment of one another. A firm handshake is a common practice between people as greeting and for leave-taking. A hug and a light kiss on a cheek are also common greeting practices between women, and men and women who are close friends or family. The Spanish language provides forms of formal and nonformal address (different use of usted vs. tu for the pronoun you, polite and familiar commands, the use of titles of respect before people's first names such as Don or Dona). In nonformal settings, conversations between Spanish speakers are usually loud, fast, and adorned with animated gestures and body language to better convey points.
Hispanics usually give great importance to and place great value on looks and appearance as a sense of honor, dignity, and pride. Formal attire is commonly worn by Hispanics to church, parties, social gatherings, and work. Tennis shoes and jeans, however, are becoming more popular among Hispanic women, particularly in non-formal settings. Hispanics tend to be more relaxed and flexible about time and punctuality than U.S. people. For instance, people who are invited for an 8 a.m. event may not begin to arrive until 8:30 a.m. or later. Within the Hispanic community, not being on time is a socially acceptable behavior. Hispanics tend to be reserved about public speaking because of their heavy foreign accent.
Rituals and Religions
In the Hispanic world, religion has traditionally played a significant role in daily activity. More than 90% of the Spanish-speaking world is Roman Catholic. In recent years, other faith denominations have experienced growth within the U.S. Hispanic community. The church influences family life and community affairs, giving spiritual meaning to the Hispanic culture. Each local community celebrates its patron saint's day (October 31, Nov 1st and 2nd), with greater importance and ceremony than individuals do for personal birthdays. As in other parts of the world, traces of the religions of the Indians and African-Americans of Latin America are found in the Catholicism that Hispanics practice.
Celebrations and Holidays
Hispanic countries celebrate the more popular international holidays, notably Easter (Holly Week), Christmas Eve (december 24th), Christmas (december 25th), New Year's Day (December 31st) , and the Three Kings' Day (January 6th), Children's day April 30th and Mother's day at May 10th. In addition, each country celebrates its Independence Day (El Dia de Independencia. Mexico in sept 15th). The term fiesta nacional refers to an official national holiday; las fiestas refer to festivals - local, regional, or national - that may be held only one day or may last several days. Most holidays are centered on or have their origins in religion December 12th (Guadalupe Virgin for Mexicans). Many celebrations of the Catholic Church are officially designated by the government as holidays. National government offices may be closed or have limited hours for local or regional holidays.
In Hispanic countries, a light meal is served for breakfast. Lunch, referred as el "almuerzo", usually is the main meal of the day for Spanish-speakers. In some countries, it is customary for adult family members and children to come home from work or school for about two hours to be together for this meal. La siesta, which is a rest period taken after lunch, is known to be a common practice among adult Hispanics. In the early evening, la "merienda", a light snack of coffee and rolls or sandwiches, is served. This meal is often very informal and may be just for children. In the evening, often as late as 9:00 p.m., "la cena", a small supper, concludes the day's meals. Once settled in the United States, most Hispanics adopt the three-meal system. Midday and evening meals are important family or social events. Especially when guests are present, the meal may be followed by the "sobremesa", a time to linger and talk over coffee or perhaps an after-dinner drink. Usually when food or additional servings are offered to Hispanics, they tend to accept only after it is offered a second or third time.
Teaching and Learning Implications
To fully engage Hispanic audiences in the learning process, particular attention should be given to gaining and maintaining trust. Greater acceptance of educational efforts will occur by learners if Hispanic community leaders are involved in the planning, delivery, and evaluation of these educational efforts. Be aware that the physical distance between Hispanics when holding a conversation is much closer than in other cultures.
Exhibiting respect for learners is another important aspect of the Hispanic culture. Teachers need to pay individual attention to learners (e.g., greeting each learner, handing papers to each individual rather than passing them down the row, being sensitive to different cultures among Hispanics, writing educational materials at appropriate reading levels). They have as important date May 15th Teacher's appreciation day. Differences in educational levels, language skills, income levels, and cultural values among Hispanics need to be considered by Extension educators when planning educational programs. Even though Hispanics share the same language, their cultures may vary considerably.
Churches, local libraries, and recreational centers (with child-care arrangements, if needed) may be appropriate places to hold educational programs with Hispanic audiences. Among Hispanics, information is passed mostly by word of mouth. Grocery stores and churches are the main places people meet, visit, and exchange information.
Communication and Social Interaction
- Personalismo - This refers to the tendency of Hispanics to place utmost value on individuals as opposed to institutions. They tend to trust and cooperate with individuals they know personally, and many dislike impersonal and formal structures. Hispanic customers may identify a health worker by name rather than by job title or institution. In a professional situation, many expect formality in address (Mrs. X), but also personalismo (how are your kids doing in school?). The quality of a social interaction is often seen as more important than length.
- Respeto - The special consideration and respect that should be shown to elders and authority figures within the community. When speaking Spanish, elders should be addressed as usted, not tu.
- Simpatía - This describes many Hispanics' preference for smooth social relations based on politeness and respect, as well as avoidance of confrontation and criticism. Overt disagreement is not considered appropriate behavior. Some expect offers of gifts or food to follow a pattern of offer, refusal, insistence, and final acceptance, so receivers do not appear greedy or givers insincere.
- Many Hispanics are characterized by warm, friendly, and affectionate relationships. Personal space is close and frequently shared with family members or close friends.
- Some Hispanics may get agitated or emotional when nervous or frightened. They may communicate intense emotion and appear quite animated in conversations - a behavior that is sometimes misperceived by non-Hispanics as being "out of control". Latinos' voice pitch and inflections are sometimes misinterpreted as confrontational. Many are very loud and outspoken in expressing pain.
- Many Hispanics, particularly if they were not raised in the US, may avoid direct eye contact with authority figures or in awkward situations.
- Many will nod affirmatively but not necessarily mean agreement. Silence may mean failure to understand and embarrassment about asking or disagreeing.
- Many may understand English better than they can speak it, especially under stress.
- Modesty and privacy are important. Stigmatized health issues should be discussed through an interpreter and not family members. When a family member is used as interpreter, if the issue is personal, try to use a family member of the same gender. Sexuality issues are hard to discuss. Often the word for sex (sexo) is not even used - "tener relaciones" (to have relations) is used instead.
Health Beliefs and Practices
Concept of Health
- Health is generally viewed as: being and looking clean; being able to rest and sleep well; feeling good and happy; having the ability to perform in one's expected role as mother/father, worker, etc. In Puerto Rico, the phrase "llenitos y limpios" (clean and not too thin) is used.
- A person's sense of "bienestar" (well-being) is thought to depend upon a balance in emotional, physical, and social arenas. Imbalance may produce disease or illness. Some attribute physical illness to "los nervios", believing illness results from having experienced a strong emotional state. Thus, they try to prevent illness by avoiding intense rage, sadness, and other emotions. Depression is not talked about openly; a person may say, "I am sad" (triste).
- Eating well and drinking fruit juices are common health promotion practices. Exercise is often not perceived as a health promotion practice and is discouraged during illness. As with other issues, this will vary by educational level.
- Individuals may not seek help until they are very sick.
- Hispanic cultures view illnesses, treatments, and foods as having "hot" or "cold" properties, although how these are ascribed may vary by country. Some consider health as the product of balance among four body humors (blood and yellow bile are "hot", phlegm and black bile are "cold"). One would balance a hot illness with cold medications and foods, etc. This might result in not following a doctor's advice to drink lots of fluids for a common cold, if one believes such drinks add more coldness to body. Instead, hot liquids (teas, soups, broth) could be recommended. Colombians often use meat broth instead of chicken soup when sick; also drink "agua de panela" (unprocessed sugar and water) for respiratory/flu symptoms.
- Prevention strategies could build on this concern for balance - e.g., adopt a balanced diet to prevent diabetes and other diseases associated with overweight.
Some common illnesses and their accepted causes:
Ataque - severe expression of shock, anxiety, sadness
Bilis - vomiting , diarrhea, headaches, dizziness, migraine, nightmares, loss of appetite, inability to urinate, brought on by livid rage and revenge fantasies. Believed to stem from bile pouring into bloodstream in response to strong emotion.
Empacho - lack of appetite, stomachache, diarrhea, vomiting, caused by poorly digested or uncooked food. Treated by massaging the stomach and drinking purgative tea, or by azarcon or greta, medicine that has been implicated in some cases of lead poisoning.
Mal de ojo (evil eye) - Vomiting, fever, crying, restlessness, brought on by an admiring or covetous look from a person with an evil eye. Children susceptible. Preventable by wearing particular jewelry.
Pasmo - tonic spasm of voluntary muscle; chronic cough or stomach pain; arrest of child's growth and development, all brought by exposure to cold air when body is overheated.
Susto (fright) - anorexia, insomnia, hallucinations, weakness, painful sensations, brought on by traumatic experiences. Treatment may include a barrida (spiritualistic cleansing by sweeping body with eggs, lemons, bay leaves), herb tea, prayer.
Asthma may be called fatiga by Puerto Ricans.
Health promotion, prevention, and treatment
- Preventative medicine is not a norm for most Hispanics. This behavior may be related to the Hispanic "here and now" orientation, as opposed to a future-planning orientation.
- Some commonly known Hispanic sayings suggest that events in one's life result from luck, fate, or other powers beyond an individual's control.
Que será, será (What will be will be);
Que sea lo que Dios quiera (It's in God's hands);
Esta enfermedad es una prueba de Dios (This illness is a test of God);
De algo se tiene que morir uno (You have to die of something).
- Persons with acute or chronic illness may regard themselves as innocent victims of malevolent forces. Severe illness may be attributed to God's design or bad behavior or punishment. Genetic defects in child may be attributed to parents' actions.
- Family and friends may indulge patients, allowing them to be passive - a stance that may conflict with the view that active participation is required to prevent or heal much disease.
- Other Hispanic sayings support health promotion, and illustrate the considerable status given to health and prevention:
La salud es todo o casi todo (Health is everything, or almost everything);
Es mejor prevenir que curar (An ounce of prevention is worth a pound of cure);
Ayúdate que Dios te ayudará (Help yourself and God will help you).
- "Helping yourself" may lead to placing responsibility for cure with the entire family. The challenge for health professionals is to assess the amount of control patients believe they have over their health and to design interventions that build on traditional support systems.
- Vaccination is very important and adhered to for children.
- Western medicine is expected and preferred in case of severe illness, but some Hispanics may also use native healers. "Curanderos" utilize prayers, massage, and herbs to treat physical, spiritual, and emotional ailments. "Espiritistas" are believed to have spiritual or psychic powers to cure illness by communicating with dead souls.
- A "botanica" is a resource store for herbs and other traditional remedies. Some Hispanics may go there before going to a physician or clinic. In many Latin American countries, pharmacists prescribe medications, and a wider range of medications is available over the counter. People may share medicines, or write home for relatives to send them medications. Individuals may discontinue medication if doesn't immediately alleviate symptoms, or after their symptoms abate. Many believe taking too much medicine is harmful.
- Due to history, some Hispanics may distrust the health system (many Puerto Rican women experienced involuntary sterilization, or were adversely affected by birth control pill trials), or view it as an extension of a repressive government (Central Americans), or fear it as a point of contact with immigration authorities. Some may confuse public health programs with welfare and avoid them due to stigma.
- The five leading causes of death for Hispanics in Rhode Island are: cancer, heart disease, homicide, AIDS, and unintentional injuries. For the general population they are: heart disease, cancer, stroke, chronic lung diseases, pneumonia and influenza.
- Nationally, Hispanics are about twice as likely to have non-insulin dependent diabetes than are non-Hispanic whites, and are more likely to have undiagnosed diabetes.
- Hispanic men are more likely to have undiagnosed, untreated, or uncontrolled hypertension than the national average.
- Incidence of AIDS among Hispanics was 4 times more likely in RI than among the general population. Cases of gonorrhea were 2 times more prevalent.
- The incidence of tuberculosis for Hispanics in RI was 5 times greater than for the general population (17.5% vs. 3.5). Some patients may mistake the tuberculin test for a vaccine, and not realize the importance of medical follow-up. Some authorities recommend arranging for the reading of results of the test at work or school, for the client's convenience. Also, the use of the Bacillus Calmette-Guerin (BCG) vaccine in many Latin American countries may complicate the clinical detection of tuberculosis infection among Hispanics.
Behavioral Health Risk Factors
- Hispanics are less likely than the general RI population to smoke (20.3% vs. 22.4%). Some authorities attribute this to the low incidence of smoking among Hispanic women. One researcher states that Hispanics are more likely to smoke in social settings rather than in response to "need" or nicotine addiction.
- Hispanic Rhode Islanders are less likely than the general population to be overweight, but more likely to be obese.
- Hispanic Rhode Islanders are a third less likely than all Rhode Islanders to exercise regularly (30.4% vs. 45%), and engage in less leisure-time physical activity. One researcher notes that a high percentage of Hispanics work in manual labor that does not contribute to aerobic fitness.
- Hispanics were more likely than other Rhode Islanders to eat 5 servings of fruits and vegetables per day (29% vs. 24%).
- Hispanic Rhode Islanders are nearly 50% less likely to drink alcohol than the general population.
- Hispanic Rhode Islanders are more likely than the general population to use safety belts or child safety restraint (81% vs. 76%).
- Women participate in more screening activities than men. Women's breast and pelvic cancer screening procedures may be seen as intrusive and embarrassing, thus may be delayed or not done. In Rhode Island, the percentage of women ages 40 and over screened for breast cancer and the percentage of women screened for cervical cancer is higher in the Hispanic population than in the general state population.
- Many Hispanic men are resistant to the concept of health screening. Wives may be very influential in men's screening decisions. Elderly might be influenced by children. Health screening recommendations for children are generally followed.
Maternal and Child Health
- The birth rate of Hispanics in RI is about twice as high as for the general population (116.4 vs. 57.5 per 1000 women ages 15-44).
- A greater percentage of Hispanic mothers than all mothers in RI delivered babies without prenatal care in the first trimester. (14.8% vs. 10.3%). Yet the rate of low birth weight babies was only slightly higher in the Hispanic population in RI (6.8% vs. 6.3%)
- Hispanic teenagers ages 14-18 were over 3 times as likely to give birth than all teenagers in the state.
- Hispanic babies are over 3 times as likely to be born into poverty (78.1% vs. 25.5% for general population).
- Breast feeding is less common among Hispanic women than among non-Hispanic whites. Many Latin American women believe colostrum is harmful for babies. In Colombia, breast feeding is expected in low to middle socioeconomic groups.
Diet and Food Practices
- The typical diet is high in fiber, relying heavily on beans and grains (rice) rather than on meats for protein.
- Leafy green vegetables not a usual part of the diet.
- Relatively little intake of dairy products. Milk is consumed in coffee.
- Generally eat a lot of tropical fruits, fruit juices, and starchy root vegetables (e.g., potatoes, cassava, plaintains). Sofrito (blend of spices) is used to season stews.
- Puerto Ricans do not typically eat tortillas. More than 100 varieties of herbal teas are used to treat illness and promote health. For colds, flu and viruses, many use a mixture of honey, lemon and rum as an expectorant and antitussive. Egg yolk, sugar, and milk, malta, or fruit juices may be used as nutritional support for illness.