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Hmong Health Beliefs and Experiences in the Western Health Care System
Abstract
This ethnographic study was conducted to determine Hmong perspectives and beliefs that influence the Hmong experience in Western medical situations. Hmong perspectives regarding the body as well as descriptions of Hmong experiences within the American medical system were explored using participant observation and interviews over a 2-year time frame. Two focus groups were conducted to confirm findings. Data indicates that the Hmong language lacks terms that translate biomedical body physiology and anatomy. Medical terms and diagnoses lack direct translation and require extensive nondirect terms to approximate meaning. Differences between Hmong traditional beliefs and Western biomedical beliefs create a lack of understanding. Negative health care experiences result in Hmong community members' mistrust and fear of Western medicine.
... The person's soul must be retrieved, usually done by a shaman, or the person may experience death from illness. The Hmong engage in these practices to maintain the soul with its body (Johnson, 2002). There are numerous traditional rituals and practices to appease the upset spirits (Livo & Cha, 1991). ...
... A primary ceremony called, Tu-ua-neng (Shaman) is often performed to determine the source and cause of the individual's illness or to replace the lost soul, or to offer payment in exchange for the cure that resulted from the illness (Cooper, 1998;Johnson, 2002;Lee & Tapp, 2010). The ceremonies require the shaman to transcend into the spirit world in search of the lost soul; once found, necessary requirements are needed to placate the spirit causing the illness. ...
... However, this may not be accomplished without sacrificing animals as payment. The Hmong commonly sacrifice animals for the soul of the sick person, such as chickens, cows, or pigs for their value and strength to battle the spirit in the spirit world (Johnson, 2002). Many considered these ceremonies to be of great value and with high healing potential. ...
The Hmong people have endured a long history of war-related trauma, and they have settled in
different parts of the world. As a consequence, many Hmong people may have experienced
various levels of psychological symptoms and have limited knowledge and resources for
treatment and interventions. Issues of acculturation, cultural identity, traditional beliefs &
practices, seeking traditional medical interventions, and religious beliefs may influence help-
seeking behaviors from professional psychological services. Data, including demographic
information, were gathered from two Hmong American churches located in southeast Michigan.
The results showed that seeking professional services was correlated with both acculturation and
traditional beliefs & practices. Acculturation and traditional beliefs & practices each contributed
unique variance to help-seeking behaviors. This suggests that both low levels of acculturation
and high levels of traditional beliefs & practices could result in people being less likely to seek
mental health services. In this sample, Hmong Americans preferred God over traditional beliefs,
such as Shamanism. The implications of these findings will be discussed.
... This study has shown that, due to this mistrust, healthcare professionals sometimes fail to identify pending deaths and this has led to low referrals to the service. Also, a combination of mistrust of Western palliative medicine and the protective nature of family members, was seen as a contributory factor to poor access to end-of-life services (Johnson, 2002;Worth et al, 2009). ...
... The nursing staff needed to establish relationships, communicate effectively, but they had a significant lack of awareness of end-of-life cultural and spiritual preferences of people from ethnic minorities. This lack of awareness from healthcare professionals of cultural and spiritual preferences has remained high for the past 20 years, and is likely to be contributing to end-of-life care inequalities (Johnson, 2002;Krakauer et al, 2002). According to a Canadian study on the provision of palliative care to indigenous people, some groups of people from ethnic minorities approach end-of-life care in the context of such worldviews, and they value the interconnection of their physical, spiritual, mental and environmental wellbeing (Johnston et al, 2013). ...
... Translating and processing vital information about a diagnosis and prognosis in a foreign language is a challenge (Paal and Bukki, 2017). Like other studies, the authors found that where translation was used, things got lost in translation (Johnson, 2002;Islam et al, 2021). Key words used in end-of-life care do not always translate into another culture or language. ...
Background
Providing end-of-life care in a patient's home is challenging, especially if the nurse is from a different ethnic background from the patient. Evidence shows that people from an ethnic minority background often experience poorer end-of-life care due to care providers not understanding their care needs.
Aim
To explore the experiences of community nursing staff caring for patients with an ethnic minority background at the end of their life.
Method
Using a qualitative descriptive approach, 16 semi-structured interviews were conducted and the data was thematically analysed.
Finding
Participants dealt with large tight-knit families, paternalism and controlling behaviours. There was a mistrust of Western palliative medicine. Language barriers and challenges were faced by the nursing staff, resulting in difficult conversations with the families. Different levels of the nursing staff's spiritual/cultural competencies were also identified. The COVID-19 pandemic intensified the challenges.
Conclusion
This research has shed light on the challenges of individualising end-of-life care in a culturally diverse community in the UK. The nursing staff's cultural/spiritual competencies were challenged.
... The last of the large refugee camps in Thailand closed in 1997, with an additional camp in Thailand relocating an additional 15,000 Hmong people to the U.S. in 2006 (Gerdner, 2010). The vast majority of Hmong people from the refugee camps settled in California, Wisconsin, and Minnesota (Johnson, 2002). ...
... The Hmong people encountered barriers to communication, as well as understanding the American culture, community values, and expectations. This was most evident in the healthcare system (Johnson, 2002). Adapting to enormous change in their sociocultural environment resulted in drastic misunderstandings between Western medical practices and the traditional Hmong immigrants' belief system (Helsel, Mochel, & Bauer, 2004). ...
... Many Hmong were unaware of the organs within the human body and what purposes those organs serve. Describing this phenomenon has become even more of a challenge due to the Hmong language's lack of words to do so (Johnson, 2002). In the present day, when healthcare providers attempt to explain a disease or illness affecting a particular organ or body part, the Hmong-American person is at a loss to understand what that means (Johnson, 2002). ...
A chronic illness, such as kidney disease, has a significant effect on an individual’s perception of their quality of life (QOL). Health-related quality of life (HRQOL) is the subjective perception of an illness and treatment on the physical, psychological, and social well-being of that individual. In this study, we reviewed HRQOL in the Hmong-American (n = 22) and Non- Hmong-American (n = 40) patients receiving dialysis treatments at Mayo Clinic Health System Northwest Wisconsin (MCHS NWWI) utilizing the Kidney Disease Quality of Life-36 (KDQOL-36TM) survey. Our findings indicate a discrepancy between Hmong-American and Non-Hmong-American patients in the Burden of Kidney Disease subscale score of this survey. Language barriers, traditional belief systems versus Western medical practices, lack of understanding regarding illnesses, and a cultural focus on the family as a whole instead of individuality may have a significant bearing on the differences found between Hmong- American and Non-Hmong-American patients.
... Consequently, the Hmong seek shamans to treat the soul and spirit before the physical body. 7,8 Thus, when they do seek translated from Hmong into English by another bilingual study team member to ensure accuracy and capture the meaning rather than a literal translation. Any discrepancies were discussed until group consensus was reached. ...
... Traditionally, clan leaders and/or members of the clan (also called kwv tij) 10 assist members with their decisionmaking, including medical decisions. 7,11,12 As dictated by their culture, Hmong women consult their husbands before making final medical decisions. 7,13 However, as the Hmong acculturate, it is important to reevaluate if these decision-making patterns still exist. ...
... 7,11,12 As dictated by their culture, Hmong women consult their husbands before making final medical decisions. 7,13 However, as the Hmong acculturate, it is important to reevaluate if these decision-making patterns still exist. With acculturation, immigrants tend to shift their beliefs and practices towards the practices of their host country. ...
Introduction:
Information about how the limited English proficiency immigrants make their decisions to seek health care is not well understood. With acculturation, immigrants tend to shift their beliefs and practices towards the practices of their host country. Yet, little is known whether this holds true for the Hmong's health care decision-making.
Methods:
To understand the health care decision-making process of limited English proficiency Hmong, we conducted semistructured interviews with 11 Hmong adults with limited English proficiency. Interviews were audio-recorded, transcribed, and analyzed using directed and conventional content analysis.
Results:
We identified several themes: participants sought advice and information from family members who were proficient in English and Hmong and/or who had a health background for a treatment that they perceived to be potentially life-threatening. However, participants were more reliant on their own decision-making in medical situations that were time sensitive. Participants without immediate family asked for health advice from community members or peers who had personal experience with the health condition or treatment.
Conclusions:
Our findings suggest a cultural shift in Hmong health care decision-making processes from relying on clan leaders and elders to seeking out the advice of adult children and spouses. Understanding this change in cultural decision-making dynamics will help health care professionals provide more culturally competent care in areas where the Hmong community have a prominent presence.
... The concept of chronic illness is not present in traditional Hmong culture, and this lack of framework can have important implications for patient understanding and compliance with treatment (12). Additionally, the Hmong language lacks terms that translate anatomic and physiologic terminology, requiring indirect translation and nonspecific words used to approximate meaning when discussing a Hmong patient's illness with them in their native language (13). There are no Hmong words to describe chronic illnesses such as diabetes mellitus or hypertension (12). ...
... Additionally, medication side effects from treatments for conditions that are largely asymptomatic, such as diabetes mellitus and hypertension, were not well accepted and were frequently reported to cause medication nonadherence. Further, due to cultural communication styles, Hmong patients would consider it rude to tell a health care provider that the medications were not being taken as prescribed (13). Some Hmong individuals may be afraid of hospital experiences and mistrust Western medical providers. ...
... Some fear surgery due to a concern that this will anger the soul and cause it to vacate the body (10). Concerns that doctors experiment on Hmong people also circulate; there is a perception that the student doctors such as medical students or residents who are there to learn are practicing on Hmong people and that the treatments these doctors offer are not for the benefit of the Hmong patients, but for the doctor who needs to learn and practice skills (13). Further complicating this picture, many Hmong report frank mistrust and lack of confidence in the American health care system, which may stem from concerns that their traditional healing methods are not acknowledged or discussed (11). ...
Objective
To evaluate demographic characteristics, care encounters, comorbidities, and clinical differences in Hmong and non‐Hmong patients with gout.
Methods
Using retrospective chart review, all inpatient encounters (Hmong versus non‐Hmong) were reviewed from 2014 to 2017. Acute or chronic gout was the primary or secondary diagnosis for the encounter.
Results
Hmong gout patients were on average 11 years younger than non‐Hmong patients, but after adjustment for age, sex, and type of encounter, they had similar rates of hypertension, diabetes mellitus, and heart disease. Hmong patients had significantly decreased renal function at the time of presentation; the odds ratio of chronic kidney disease for Hmong patients was 2.33 versus 1.48 for non‐Hmong patients (P < 0.05), the mean creatinine level was 3.3 mg/dl versus 2.0 mg/dl (β = 1.35, P < 0.001), and the glomerular filtration rate was 44.8 ml/minute versus 49.3 ml/minute (β = –6.95, P < 0.001). Hmong gout patients were more likely to use emergency care versus elective or urgent care, they were less likely to be using medications for the treatment of gout prior to admission (32.3% versus 58.2%), and the length of hospital stay was increased (8.8 versus 5.2 days; P < 0.05).
Conclusion
Hmong gout patients who had a tertiary care encounter were 11 years younger than non‐Hmong patients with similar rates of comorbidities but had worse renal function despite the age differences. They were more likely to use emergency services, to be insured through Medicaid, and not to use preventive medications for gout prior to their encounter. Intensive efforts are needed in the Hmong population for culturally appropriate preventive care management of gout along with diabetes mellitus, hypertension, heart disease, and kidney disease.
... Many Hmong in the United States still practice traditional medicine, including animistic folk healing and the healing power of shamans (Hamilton-Merritt, 1993;Johnson, 2002). The Hmong believe that the soul or spirit is an essential component of good health; when the soul is lost, frightened, or separated from the body, illness results (Hamilton-Merritt, 1993;Johnson, 2002). ...
... Many Hmong in the United States still practice traditional medicine, including animistic folk healing and the healing power of shamans (Hamilton-Merritt, 1993;Johnson, 2002). The Hmong believe that the soul or spirit is an essential component of good health; when the soul is lost, frightened, or separated from the body, illness results (Hamilton-Merritt, 1993;Johnson, 2002). While most Hmong still believe in animism, many have integrated Christianity and Western medicine into their medical belief systems. ...
... Providers' experiences of Hmong patients' understanding of pain related to spiritual causes are consistent with the published literature on Hmong belief systems. The Hmong belief systems include believing that physical and spiritual wellbeing is influenced by relationships and interactions with spirits (Hickman, 2007;Johnson, 2002). Consequently, this difference in perception regarding the causes and effects of pain resulted in Hmong patients and providers miscommunicating. ...
Introduction
While researchers have studied Hmong patients with limited English proficiency in pain communication, no research has examined primary care providers’ (PCPs’) interpretation of Hmong pain communication. This study examines PCPs’ pain communication experience with Hmong patients.
Method
A qualitative content analysis was conducted with PCPs. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis.
Results
Fifteen PCPs—including seven physicians, one osteopathic physician, four nurse practitioners, and three physician assistants—participated. PCPs’ interpretations of pain communication with Hmong patients were characterized by three themes: (a) the providers experienced pain communication problems related to language, (b) the providers perceived the Hmong to have different beliefs about pain, and (c) the providers used different strategies to improve communication.
Discussion
The findings suggest that challenges are present in achieving effective pain communication between Hmong patients and their PCPs. Ineffective pain communication hinders the delivery of culturally congruent health care for Hmong patients.
... Fleeing Laos after the USA left the Vietnam war, Hmong were settled in Thailand refugee camps before being resettled to other countries (Hamilton-Merritt 1999). During the war and as refugees, many Hmong had their first experiences with Western medicines, with mixed reactions, as people were both impressed by the efficacy of medicines and concerned about adverse effects (Culhane-Pera and Xiong 2003;Johnson 2002). Based on their experiences with Western medicines, Hmong individuals expressed their opinions that Western medicines were both too strong for them, causing harmful effects, and too weak for them, causing them to be ineffective (Culhane-Pera and Xiong 2003;Johnson 2002). ...
... During the war and as refugees, many Hmong had their first experiences with Western medicines, with mixed reactions, as people were both impressed by the efficacy of medicines and concerned about adverse effects (Culhane-Pera and Xiong 2003;Johnson 2002). Based on their experiences with Western medicines, Hmong individuals expressed their opinions that Western medicines were both too strong for them, causing harmful effects, and too weak for them, causing them to be ineffective (Culhane-Pera and Xiong 2003;Johnson 2002). In this same study, Hmong adults expressed the desire to receive individual genetic results if they were to participate in genomic studies so they could understand and directly benefit from the knowledge gained from the research (Culhane-Pera et al. 2017a). ...
... Some participants thought the pharmacogenetic results could increase the general community's trust in Western medicines, although many noted that some people will not necessarily change their minds or habits, particularly those who are concerned about the harms of taking Western medicines. These findings add to data from previous studies that have shown some Hmong individuals generally lack information on Western medicines and the Western medical system (Culhane-Pera and Xiong 2003;Johnson 2002). These concerns about trustworthiness of the medical system could contribute to nonadherance with prescribed Western medicines (Kroll et al. 1990). ...
Pharmacogenetic research has historically lacked racial and ethnic diversity, limiting the application of findings to minority populations. Recent studies, including the Hmong, have gauged communities’ interest in participating in genomic research and receiving their individual results. This study was conducted to create a culturally and linguistically appropriate format to return pharmacogenomic results and identify Minnesota Hmong research participants’ reactions to their personal and collective results. Using a community-based participatory research approach, researchers collaborated with Hmong community members to format the pharmacogenetic disclosure process. Three focus groups were completed with 24 Hmong participants and three major themes emerged using thematic analysis. Many Hmong focus group participants viewed the results positively, finding them useful for themselves and their community as a means to optimize responses to and avoid harms from medicines. However, some participants expressed concerns about harms that the pharmacogenetic information could bring, including anxiety, misunderstanding, discrimination, exploitation, and lack of a clinician involvement in interpreting and applying the result. Many participants interpreted their results through an experiential lens, trusting their experience of medicines more than trusting genetic information, and through a cultural lens, expressing the belief that environmental factors may influence how people’s bodies respond to medicines by influencing their inherited flesh and blood (roj ntsha). Lastly, participants stressed the importance of disseminating the information while acknowledging the complex linguistic, educational, and cultural factors that limit understanding of the results. Researchers, genetic counselors, pharmacists, and healthcare providers should strive to return results in meaningful ways to all members of society.
... Only a few studies have been conducted regarding the Hmong's overall experiences with the U.S. healthcare system, and results provided evidence that the Hmong faced misunderstanding and discrimination by the healthcare system (Johnson, 2002;Thorburn, Kue, Keon, & Lo, 2012). Respondents in the study by Thorburn et al. (2012) reported that they were treated disrespectfully, unfairly, insensitively, or rudely when they were seeking health care services. ...
... Some respondents felt that their mistreatment by the providers was due to their race, culture, language, education, or insurance status (Thorburn et al., 2012). Johnson (2002) discovered similar findings with regard to Hmong's experiences with using healthcare services in the U.S. One elder woman shared that the provider who checked-in on her was "mimicking her facial expressions and crying sounds" and that she experienced feelings of humiliation (p. 129). ...
... Respondents in the study by Johnson (2002) also spoke about the issues that resulted because physicians lacked knowledge of Hmong healthcare beliefs. Hmong respondents reported thinking that Western medicine would provide immediate results, and so when it failed to do so or they felt worse, they simply stopped the medication without telling their doctors. ...
For over 40 years, the Hmong have sought refuge in the United States; however, many Hmong elders continue to honor healthcare and end-of-life beliefs and rituals that they practiced in their home country. With little knowledge by the general public and healthcare systems about these beliefs and rituals, healthcare professionals may struggle to provide the Hmong community with culturally-sensitive care. This study sought to address this gap by conducting in-depth face-to-face interviews with 12 Animist and 8Christian Hmong elders born in Southeast Asia, who now reside in the United States. Results provided insights regarding the heterogeneity among these Hmong elders concerning their end-of-life beliefs and rituals. Both Animist and Christian respondents believed family should provide care at end of life. Animist Hmong elders reported the importance of Shamanistic rituals such as soul calling or spiritual offering while Christian Hmong elders believed in the power of prayers. Healthcare providers need to assess Hmong elders’ preferences for care at end of life, be open to the inclusion of traditional healers in their care and/or decision-making, and understand preferences of family and community members’ involvement in care at the end of life.
... Most ethnic minority patients report the coexistence of meaningful as well as disconnected care relationships [33, 35, 37, 38, 41, 44-46, 52, 56, 65-73]. In fact, every relational process between an ethnic minority patient and his or her caregiver continuously has the chance of reaching reciprocal understanding as well as running the risk of intercultural misunderstanding [35,60,68]. ...
... When ethnic minority patients are confronted with the necessity of a hospital stay, they have to leave their familiar context behind (e.g. families, usual activities and cultural contexts of care) in order to submit themselves to an unknown and frightening environment [39,51,59,68,73]. This hospital environment remains, at least for some part, an unfamiliar environment for most ethnic minority patients regardless potential differences in, for example, the own acculturation process or the number of previous hospitalizations [34,56]. ...
... In general, language difficulties and ethnic minority patients' shame or reluctance in discussing this history as well as the unawareness and limited discussions by caregivers lead to difficulties in this "balancing between" process [38,52,55,71]. Patients' reviving memories and knowledge, their lack of knowledge regarding medical procedures, their fear about the medical treatment and their feeling that the treatment will not be effective, all might lead to the resistance or refusal of specific treatments [42,55,68,75,76]. ...
Background
In our globalizing world, caregivers are increasingly being confronted with the challenges of providing intercultural healthcare, trying to find a dignified answer to the vulnerable situation of ethnic minority patients. Until now, international literature lacks insight in the intercultural care process as experienced by the ethnic minority patients themselves. We aim to fill this gap by analysing qualitative literature on the intercultural care encounter in the hospital setting, as experienced by ethnic minority patients. MethodsA systematic search was conducted for papers published between 2000 and 2015. Analysis and synthesis were guided by the critical interpretive synthesis approach. ResultsFifty one articles were included. Four dimensions emerged, describing the intercultural care encounter as (1) a meeting of two different cultural contexts of care, (2) in a dynamic and circular process of (3) balancing between the two cultural contexts, which is (4) influenced by mediators as concepts of being human, communication, family members and the hospital’s organizational culture. Conclusions
This review provides in-depth insight in the dynamic process of establishing intercultural care relationships in the hospital. We call for a broader perspective towards cultural sensitive care in which patients are cared for in a holistic and dignity-enhancing way.
... Two studies examined the cancer prevalence rates among the largest Hmong American communities in the U.S.-those in Minnesota and California [8,12]. Using the Cancer Registry of Central California, investigators collected data from 1988 to 2000 and found that 38 100,000 Hmong American women were diagnosed with cervical cancer compared to 13.1 per 100,000 Asian American women and 8.6 per 100,000 Non-Hispanic White women [12]. Study results also showed that Hmong American women were often diagnosed at later stages of cervical cancer, with only 54.9 % diagnosed during the early stages in contrast to 68 % of Asian American and 82.2 % of Non-Hispanic Whites [12]. ...
... When treating and counseling Hmong American patients, health care providers should acknowledge and consider the health beliefs and practices of Hmong Americans, including the belief that cancer has spiritual origins and the use of traditional healers [29]. Providers should also recognize and respect the collective decisionmaking process among Hmong Americans, which can be heavily influenced by family members and friends [29,38]. When discussing HPV, health care providers need to be aware that many terms used in Western medicine, even those for body parts, do not have direct translations in the Hmong language [38]. ...
... Providers should also recognize and respect the collective decisionmaking process among Hmong Americans, which can be heavily influenced by family members and friends [29,38]. When discussing HPV, health care providers need to be aware that many terms used in Western medicine, even those for body parts, do not have direct translations in the Hmong language [38]. Providers might need to spend more time explaining HPV infection and vaccination to Hmong American patients, particularly older patients and those with strong traditional values. ...
Previous studies show that certain minority and ethnic communities experience low human papillomavirus (HPV) vaccination rates despite a higher cervical cancer burden. HPV is known to be responsible for almost all cervical cancer cases. Hmong Americans, a growing Asian American population, appear to be at increased risk. The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites. Despite such alarming statistics, there is limited research focusing on HPV literacy and its associated factors in the Hmong American community. This study's objectives are to investigate: (1) the level of HPV knowledge among Hmong Americans; (2) HPV vaccination initiation and completion rates of Hmong Americans; and (3) factors associated with HPV literacy in the Hmong American community. Andersen's Behavioral Model of Health Services Use was used as the study's theoretical framework. A self-administered paper and online health survey was completed by192 Hmong Americans living in a major metropolitan area in Minnesota. Results revealed a mean score of 4.76 (SD 1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate was 46.3 % (n = 56), with 32.7 % completing the recommended three doses. Multiple regression analysis found that participants' level of education, number of doctor visits, and cervical cancer screening literacy were significantly associated with HPV knowledge. This study's results indicate the important role of health providers in educating Hmong Americans patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population.
... These spirits, according to Hmong health practices, affect health and illness. Young babies are considered to be at the greatest risk for illness and are often blessed with khi tes (string) necklaces or bracelets to protect against evil spirits that could cause illness (Johnson, 2002). Traditionally, the Hmong also practice Shamanism, which is the belief in the spirit world and its connection to all living things (Cobb, 2010;Gerdner, 2012). ...
... A balance between the body and the spirit is required for good health. Hmong healers, or shamans, serve to bridge the human world with the spiritual world and resolve issues of illness through ceremonies to bring back the spirits of the ill people (Johnson, 2002). Herbalists also treat illnesses. ...
... In the Hmong tradition there was no concept of chronic illness; one was ill and either recovered or died (Johnson, 2002). Chronic diseases, birth defects, and mental illnesses may be viewed as spiritual illnesses and consequences of bad actions from patients' former lives. ...
The Hmong are an ethnic hill tribe group originally from Southern China with concentrated populations throughout Southeast Asia, especially the mountains of northern Laos. Following the Vietnam War, the Hmong started immigrating to the United States in waves to escape prosecution for fighting communism alongside the United States. Today, the Hmong population in the United States is growing rapidly, with a median age of 20.4years. As the Hmong move and redistribute themselves across the country to be with family or pursue new opportunities, it is more and more likely that nurses everywhere will interact with Hmong children and their families. Historically medically underserved, the Hmong community continues to face barriers to healthcare as a result of culture, language, and lack of access. Nurses who are informed about cultural values and norms of the Hmong and their family and social structures, as well as their spiritual and traditional practices, will be able to establish trust with their pediatric patients and their caregivers. Utilizing strategies including interpretive services, asking detailed social and physical histories, providing extra appointment time, asking open ended questions, and employing teach back methods can help improve communication as well as provide higher quality care that addresses the specific needs of this population.
... Healthcare utilization is disproportionately low among SEA Americans (Centers for Disease Control and Prevention, 2004). The Hmong's experiences of American healthcare system are characterized by misunderstanding and mistrust (Johnson, 2002). Because traditional Hmong conceptualization of health and illness is incompatible with that of Western medicine, it is often difficult, if not impossible, to translate and explain Western diagnoses and treatments to Hmong patients. ...
... These cultural and language barriers have an adverse impact on healthcare utilization. In addition, in a qualitative study of Hmong residents (Johnson, 2002), participants reported that they perceived discrimination from healthcare providers (such as neglect and rudeness from the provider), and believed doctors and "student doctors" (i.e. residents) used Hmong patients for practice and experimentation. ...
... Together, this mistrust and misunderstanding may result in avoidance of healthcare services among the Hmong, including those who have experienced trauma from IPV. In addition, the use of healthcare services among Hmong women may be hindered by their lack of decision-making autonomy within their families, as healthcare decisions are usually made by the oldest male member of the family (Johnson, 2002). Hmong women who have experienced IPV may be reluctant to seek medical care for acute injuries following assault, as well as for long-term health problems that may develop. ...
Although intimate partner violence is prevalent among Southeast Asian American women, little is known about the associations between the experience of intimate partner violence and negative health outcomes in this population. Resnick et al. proposed a model explaining the development of health problems following violent assault. This article assesses the applicability of Resnick et al.'s model to Southeast Asian American women who have experienced intimate partner violence by reviewing cultural, historical, and social factors in this population. Our review indicates that the applicability of Resnick et al.'s model to Southeast Asian American women is mixed, with some components of the model fitting well with this population and others requiring a more nuanced and complex perspective. Future studies should take into consideration cultural, historical, and social factors.
... Previous studies have documented the perceptions of herbal medicinal use specifically among the Thai, Hispanic, Indian, Aydin, Lao, and Asian American ethnicities [3][4][5][6][7][8][9][10][11], however, there have been no studies to date which review herbal medicinal use in the Hmong American population. Previous studies have conducted focus groups [14] and semi-structured interviews [12,15] on cross-cultural interactions with Hmong patients and providers in a small sample size of over 20 subjects. These studies revealed that differences exist in Hmong traditional health beliefs versus Western health views leading to a potential lack of understanding between providers and patients [12][13][14][15][16]. ...
... Previous studies have conducted focus groups [14] and semi-structured interviews [12,15] on cross-cultural interactions with Hmong patients and providers in a small sample size of over 20 subjects. These studies revealed that differences exist in Hmong traditional health beliefs versus Western health views leading to a potential lack of understanding between providers and patients [12][13][14][15][16]. ...
... In 2002, Johnson and colleagues performed focus groups on 19 Hmong individuals and found that they were not knowledgeable about organs or their functions and were not aware of the concept of a chronic illness. [14]. Further, many Hmong do not consider pathophysiology/modern medical treatments which may alter their treatment approach of chronic diseases. ...
To determine the frequency and perceptions of herbal medicine use among Hmong Americans. Cross-sectional telephone survey. Sacramento, California Hmong community. Out of 118 subjects reached, 77 (65.3 %) reported lifetime use of herbal medicines. A majority of respondents agreed that herbal medicines were able to treat the body as a whole. Respondents felt that a leaflet of information indicating uses/side effects would be important to include for herbal medicines. Herbal medicine use was commonly reported among Hmong Americans. Thus, health care providers should be encouraged to discuss these alternative medicines with their Hmong American patients.
... Because of persecution, approximately four million Hmong dispersed into other Southeastern Asian countries including Thailand, Burma, Laos, and Vietnam (Pfeifer, 2003;Fadiman, 1997;Cobb, 2010). They lived in the highlands of these countries using slash-and-burn farming as a way of life (Watt, 2008; 'The Hmong: an introduction to their history and culture ', 2004;Postert, 2009;Fadiman;1997;Johnson, 2002;Cobb, 2010). Their isolated lifestyles prevented them from being exposed to other cultures. ...
... Their isolated lifestyles prevented them from being exposed to other cultures. The locations of where they chose to live have allowed them to have connections to the growing and sale of opium plants to traders (Watt, 2008;Johnson, 2002). Their culture revolved heavily on the practice of a patriarchal system ('The Hmong: an introduction to their history and culture ', 2004;Lee et al., 2000;Johnson, 2002;Rairdan and Higgs, 1992). ...
... The locations of where they chose to live have allowed them to have connections to the growing and sale of opium plants to traders (Watt, 2008;Johnson, 2002). Their culture revolved heavily on the practice of a patriarchal system ('The Hmong: an introduction to their history and culture ', 2004;Lee et al., 2000;Johnson, 2002;Rairdan and Higgs, 1992). In a patriarchal system, men are seen with a higher status and make all the decisions for the household while women have no such role ('The Hmong: an introduction to their history and culture ', 2004). ...
... For traditional animistic Hmong, there are several types of spirits that can influence human life, including ancestral spirits, nature spirits, house spirits, and evil spirits (Bliatout, 1993). The primary attribution for suffering made by traditional Hmong is one of spiritual etiology (Fadiman, 1997;Johnson, 2002). A person or family that suffers from a physical or emotional problem or some other misfortune is thought to be experiencing a spiritual conflict. ...
... Traditional Hmong often consult a shaman for help with illness and other problems (Fadiman, 1997), which can also be due to a soul that is separated from the body as a result of fear, anger, or other causes (Johnson, 2002). The shaman is a healer who performs certain rituals and sacrifices and journeys into the spiritual realm to battle evil spirits and retrieve lost souls (Mottin, 1984). ...
... The animistic worldview of traditional Hmong is obviously very different from the dominant paradigms of Western medicine and psychology, which can create conflicts in health care and social service settings. Johnson (2002) conducted a multimethod ethnographic study with Hmong American patients at a primary care clinic and found that Hmong informants reported highly significant negative experiences with American health care professionals that involved a lack of intercultural communication. Fadiman (1997) powerfully chronicled the clash of cultural worldviews between a Hmong American family in California and their White public doctors. ...
The growing field of positive psychology is encouraging advances in the scientific research of developmental strengths and virtues like forgiveness. However, multicultural and indigenous psychology perspectives can raise valuable questions about positive psychology and the relationship between cultural particularity and virtues like forgiveness. In this article, the authors consider the meaning of virtue in psychology and then focus on the culturally embedded nature of forgiveness as a virtue. They illustrate the value of an indigenous psychology approach by describing some of the dynamics related to conflict resolution and forgiveness in traditional Hmong culture. They then consider ways forgiveness research and intervention might need to be contextualized with Hmong Americans.
... The decision to seek preventive screening may be facilitated or hindered by numerous factors including socioeconomic status, health access barriers, cultural and religious practices, language, length of time in the United States and mistrust or lack of experiences with Western medicine [11]. To date, only a handful of studies have sought to understand cultural influences on cancer screening behavior among the Hmong [12,13]. Despite the importance of the clan structure and significance of patriarchy and patrilineality in Hmong culture, no studies that we know of have explored the role of family influences on screening behavior. ...
... Strong kinship ties characterize families, and two to three families often live in one household or near each other [20]. In Hmong culture, the well-being of the clan and the family take priority over the individual [13]. ...
... Patriarchal practices are thought to be a potential barrier to breast cancer screening utilization among traditional Asian American women [11]. In traditional Hmong culture, the male head of household has a large degree of influence over family members' health decisions [11,13,22]. Decisions about a person's medical care are not individually based; rather, a clan elder or other male head of household (e.g. ...
Hmong women in the United States have low rates of breast and cervical cancer screening, and the factors that influence screening in this population are not well understood. This qualitative study explored family and clan influences on Hmong women's breast and cervical cancer screening attitudes and behavior. We conducted in-depth interviews with Hmong women and men living in Oregon. Interviews were audio-recorded and transcribed. Transcripts of 83 interviews were analysed using content analysis. We identified four key themes. First, Hmong women make decisions about breast and cervical cancer screening independently. Second, Hmong families do not discuss breast and cervical cancer screening. For some, not talking about breast and cervical cancer screening was seen as a way that family and clan influence attitudes. Third, Hmong families can provide encouragement and support for screening. Although women make their own decisions, about one-half of participants reported that family encouraged or supported them or women in their family to get screened. Fourth, some family members, especially elders, may actively discourage screening. This study contributes to knowledge about potential barriers and facilitators to breast and cervical cancer screening for Hmong women. Findings expand our understanding of clan and male family member's influence over Hmong women's screening behavior.
... Furthermore, although some research has examined the association between breast and cervical cancer screening behavior and sociodemographic and health care characteristics among Hmong women [1,7,8], understanding of the factors that may influence Hmong women's breast and cervical cancer screening behavior is limited. Of particular interest here, some Hmong may mistrust Western medicine and the U.S. health care system, possibly due to traditional Hmong health beliefs and practices that conflict with Western medicine, lack of or negative experiences with medical providers in Laos, or historical factors [9,10,[14][15][16][17][18][19][20]. In addition, negative perceptions of and experiences with the health care system, including discrimination, may be barriers to seeking health care [20,21]. ...
... Traditionally, medical decisions are made by male household members, and individuals and families may seek consultation from extended family members and/or clan leaders before making a medical decision. According to Johnson [14], women generally do not have the autonomy to make important medical decisions about their own health; their husbands must be consulted before final medical decisions are made. Consequently, obtaining men's perspectives is important for understanding women's health issues. ...
... Beyond the findings related to breast and cervical cancer screening, we hope the insights gained from this study will help inform future research on barriers to health care that Hmong communities experience more generally. Consistent with the literature [9,10,[14][15][16][17][18][19][20], all indepth interview participants shared reasons why some Hmong people mistrust Western medicine or the health care system. The reasons for mistrust generally concerned unfamiliarity with Western medicine, cultural and traditional practices, as well as negative experiences with the health care system and providers and fear of being studied, as reported elsewhere [14][15][16][17][18][19][20]. ...
Low rates of breast and cervical cancer screening among Hmong women have been documented. Mistrust of Western medicine and the health care system, as well as experiences of discrimination in health care, may be barriers to seeking health care for this population. In this study, we explored medical mistrust among Hmong women and men, their experiences with discrimination in health care, and how these factors may influence Hmong women's breast and cervical cancer screening behavior. We conducted semi-structured, in-depth interviews with women and men who were members of the Hmong community in Oregon. Transcripts of 83 interviews were analyzed using content analysis. Despite personally trusting Western medicine and the health care system, participants shared reasons that some Hmong people feel mistrust including lack of understanding or familiarity, culture, and tradition. Although mistrust was thought to result in delaying or avoiding breast or cervical cancer screening, more frequently trust was described as positively influencing screening. In addition, few participants reported being treated differently during breast or cervical cancer screening because they were Hmong. When discussing health care more broadly, however, some participants described differential (e.g., disrespectful or rude) treatment. Such experiences led to feelings such as anger and sadness and affected behavior, including willingness to seek care and choice of provider. Medical mistrust and perceived discrimination were not major barriers to breast and cervical cancer screening in this study. Additional studies are needed to assess whether our findings reflect the experiences of other Hmong.
... With the differences in arrival to the United States, this impacts how Hmong Americans acclimated and acculturated to the U.S. mainstream as a whole group, resulting in the inability to achieve socioeconomic success [6,7]. High morbidity and mortality seen in Hmong Americans are likely because of the underutilization and rejection of formal healthcare services, low use of preventative care, delay in seeking critical health services, and low health literacy [8][9][10][11]. Health behaviors in Hmong Americans are influenced by sociocultural beliefs and practices that include a complex infrastructure of cultural influences on healing practices, use of traditional medicine, religious beliefs, disease perception, social organization, and family roles [4,8,12,13]. ...
... Although many Hmong Americans engage in shamanistic rituals or traditional folk remedies to help maintain and restore health, not all Hmong Americans take part in such activities. Therefore, mitigation behaviors are particularly important to understand in Hmong Americans when historically issues have been seen with adherence to preventative interventions such as diet and lifestyle modification, medication compliance, cancer screening engagement, and vaccination uptake [8][9][10][11]. ...
Background
COVID-19 mitigation strategies such as masking, social distancing, avoiding group gatherings, and vaccination uptake are crucial interventions to preventing the spread of COVID-19. At present, COVID-19 data are aggregated and fail to identify subgroup variation in Asian American communities such as Hmong Americans. To understand the acceptance, adoption, and adherence to COVID-19 mitigation behaviors, an investigation of Hmong Americans’ contextual and personal characteristics was conducted.
Methods
This study aims to describe COVID-19 mitigation behaviors among Hmong Americans and the contextual and personal characteristics that influence these behaviors. A cross-sectional online survey was conducted from April 8 till June 1, 2021, with Hmong Americans aged 18 and over. Descriptive statistics were used to summarize the overall characteristics and COVID-19 related behaviors of Hmong Americans. Chi-square and Fisher’s Exact Test were computed to describe COVID-19 mitigation behaviors by gender and generational status (a marker of acculturation).
Results
The sample included 507 participants who completed the survey. A majority of the Hmong American participants in our study reported masking (449/505, 88.9%), social distancing (270/496, 55.3%), avoiding group gatherings (345/505, 68.3%), avoiding public spaces (366/506, 72.3%), and obtaining the COVID-19 vaccination (350/506, 69.2%) to stay safe from COVID-19. Women were more likely to socially distance (P = .005), and avoid family (P = .005), and social gatherings (P = .009) compared to men. Social influence patterns related to mitigation behaviors varied by sex. Men were more likely compared to women to be influenced by Hmong community leaders to participate in family and group gatherings (P = .026), masking (P = .029), social distancing (P = .022), and vaccination uptake (P = .037), whereas healthcare providers and government officials were social influencers for social distancing and masking for women. Patterns of social distancing and group gatherings were also influenced by generational status.
Conclusion
Contextual and personal characteristics influence COVID-19 mitigation behaviors among English speaking Hmong Americans. These findings have implications for identifying and implementing culturally appropriate health messages, future public health interventions, policy development, and ongoing research with this population.
... The Hmong have been involved in opium farming and use for centuries (Lee 2005;3-9). Furthermore, it is known to be a powerful ethnobotanical that many elders value (Johnson 2002;Ly 2001;471). However, the importation, cultivation, and use of it is heavily restricted in the United States. ...
... Much of the refugee resettlement disasters from the earlier years (e.g. Bliatout 1982;Johnson 2002;Mote 2004) have largely improved. However, this essay has arguably shown that the Hmong are still in the mist of integrating themselves in the western environment. ...
Refugee resettlement is often a long and traumatic experience that can take years to fully overcome. The Hmong are an ethnic group that struggled to accustom to western society during their initial arrivals in the 1970s onward. Although they have made immense progress, many practices and perspectives still come at odds with those in the west. Many refugee interventions have failed to acknowledge the deep socio-cultural conflicts and challenges that arise within the host country. The Hmong's adaptation in America is still an evolving situation where many are still learning to navigate their culture through the novel environment. Through an ethnographic study using narrative and comparative analysis between the Hmong in California and Thailand, this study explored the challenges and conflicts that continue from socio-cultural, environmental, and legal obstacles for cultural practices in contemporary California. Through the Hmong's own personal narratives, the essay reveals that the Hmong still regularly encounter conflicts and challenges in funeral, spiritual, geomantic, and agriculture practices. Socio-cultural and legal barriers pose the greatest challenge from non-Hmong residents and state authorities who still do not recognize the Hmong traditions. Revealing continuing challenges may further support future initiatives to continue developing culturally relevant solutions for the Hmong and other refugee resettlements.
... Factors that may promote a patient's interest in CIM include the patient's ability to have access to a wealth of health information through health-based apps, direct-to-consumers testing, online access, social media-based advertisement and convenient access to products that promise relief and comfort. Other factors that may elevate CIM use include sub-optimal physician-patient communication, mistrust in western medicine due to certain cultural beliefs, a negative treatment experience with poor outcomes, or the lack of healthcare access [8]. With high rates of CIM use among patients with arthritic conditions, including gout, clinicians should develop patient-shared decision strategies to optimize gout treatment goals and minimize the risk of drug-supplement adverse events. ...
... The representation of racial minorities, including the Hmong, in biomedical research, remains limited. The lack of diverse populations in research has been attributed to specific roadblocks, including geographical isolation, cultural norms, educational barriers and a history of mistrust or community abuse [8,105,106]. Nonetheless, a substantial effort has been allocated to ameliorate these barriers to improve the participation of individuals of diverse backgrounds and to address the communities' needs through biomedical research. ...
Individuals of distinct Asian backgrounds are commonly aggregated as Asian, which could mask the differences in the etiology and prevalence of health conditions in the different Asian subgroups. The Hmong are a growing Asian subgroup in the United States with a higher prevalence of gout and gout-related comorbidities than non-Hmong. Genetic explorations in the Hmong suggest a higher prevalence of genetic polymorphisms associated with an increased risk of hyperuricemia and gout. History of immigration, acculturation, lifestyle factors, including dietary and social behavioral patterns, and the use of traditional medicines in the Hmong community may also increase the risk of developing gout and lead to poor gout management outcomes. Engaging minorities such as the Hmong population in biomedical research is a needed step to reduce the burden of health disparities within their respective communities, increase diversity in genomic studies, and accelerate the adoption of precision medicine to clinical practice.
... Nonadherence may also be associated with mistrust of healthcare providers and Western medicine. Although there is some literature on such mistrust among first-generation Southeast Asian refugees and immigrants [21], to our knowledge, there has been no published research on adherence among Cambodian American youth. One provider talked about adherence to birth control. ...
... Next, young Cambodian patients may also need help navigating the healthcare system, including making appointments and obtaining insurance coverage. In offering guidance, providers should be mindful that, despite being adults, these patients might not have the autonomy to make healthcare decisions independently, given the influence of senior family members in some Southeast Asian communities [21]. ...
There are significant health disparities among Southeast Asian Americans. As an initial step toward understanding the psychosocial factors associated with these disparities, the present study examined primary care providers’ perspectives of health status, healthcare utilization, health-related behaviors, and stressors among one subset of Southeast Asian Americans—Cambodian American women between the ages of 18 and 24 years. Interviews with five primary care providers indicated that cultural, historical, psychological and social issues were associated with health outcomes and health behaviors. Results also pointed to clinical considerations and research directions that would improve treatment and understanding of health problems among young Cambodian American women.
... For example, Culhane-Pera and Lee reported that Hmong patients prefer to use their herbal medicines instead of invasive urological procedures for kidney stones [30]. In addition, the Hmong continue to seek care from shamans for physical, emotional, and psychological complaints as well as health information before seeking care from a western care provider [35,36,44]. ...
... Language Barrier Language was also a barrier identified in nine studies [26,33,36,37,75,81,84,96,101]. Regarding language, women reported three types of barriers: (1) a lack of specific language for discussing cancer (i.e., there is no literal translation of the word Bcancer^in the Hmong language) and health screening; (2) hurtful experiences related to their status as English language learners; and (3) inaccessible or poorquality interpreters. ...
Although disparities in the burden of disease and illness experienced across major racial and ethnic groups in the USA is well known, little is known about subgroups, including the Hmong population. This review sought to determine the current state of health disparities related to health promotion and disease prevention among Hmong adults from 1975 to 2015. Seventy-one descriptive (qualitative, mixed methods, and quantitative) studies were reviewed. Most focused on two areas: (1) health status (mainly breast and cervical cancers) and (2) health-related behaviors. This literature review confirms the existence of health disparities related to health promotion and disease prevention in the Hmong adult population. Effective intervention relies on identifying these disparities. A possible explanation for these disparities is the lack of health data collected on subgroup populations, which include the Hmong adult population. More research and more comprehensive health policies at the organizational level are needed to allow data to be collected on subgroup populations in order to better understand the social determinants that place the Hmong people at risk.
... Culture and traditional health beliefs are thought to influence Hmong women's cancer screening behavior (Parker and Kiatoukaysy 1999, Her and Culhane-Pera 2004, Baisch et al. 2008. The Hmong are traditionally patrilineal and patriarchal where men make the decisions to protect the wellbeing of the family, including health care and treatment decisions (Parker andKiatoukaysy 1999, Baisch et al. 2008); thus, men can potentially influence Hmong women's cancer screening behavior (Cha 2003, Johnson 2002, Lee and Vang 2010. The Hmong's belief in the spiritual etiology of cancer and their fatalistic attitudes toward cancer have also been identified as potential barriers to cancer screening (Parker andKiatoukaysy 1999, Baisch et al. 2008). ...
... The Hmong's belief in the spiritual etiology of cancer and their fatalistic attitudes toward cancer have also been identified as potential barriers to cancer screening (Parker andKiatoukaysy 1999, Baisch et al. 2008). In addition, for many Hmong women, CBEs, mammograms, and Pap tests are unfamiliar and regarded as invasive screening practices (Parker and Kiatoukaysy 1999, Johnson 2002, Cha 2003, Her and Culhane-Pera 2004, Baisch et al. 2008. Hmong women are at high-risk for health problems due to poverty, lack of education, low English proficiency, lack of acceptance of the biomedical model of preventive care, and gender defined roles (Tanjasiri et al. 2001, Lee andVang 2010). ...
Background:
Hmong women are reported to have very low rates of breast and cervical cancer screening compared to other Asian and White women in the USA. Reasons for low cancer screening rates among this population are not well understood.
Methods:
This qualitative study (n=83) explored Hmong women and men's perceptions of breast and cervical cancer and cancer screening, women's experiences with breast and cervical cancer screening, and health care system barriers to screening.
Results:
Hmong women and men perceived breast cancer to be more severe than other types of cancers. Participants believed that breast cancer is curable if detected early. Cervical cancer was not well understood and was of greater concern than breast cancer because of its location within the body and its consequences for reproduction. In general, few participants had personal experiences with breast and/or cervical cancer. Overall, women and men had positive things to say about screenings for breast and cervical cancer, expressing that screenings offered a 'proof of illness.' The majority of women did not report any concerns with the exams themselves, although some discussed embarrassment, pain, and discomfort. Barriers to screening included lack of health insurance, making co-payments, language, and issues related to scheduling appointments. Barriers differed for younger and older women.
Conclusion:
Results of this study provide new insight into perceptions, experiences, and barriers to breast and cervical cancer screening among Hmong women and men. These findings have implications for developing culturally appropriate interventions to increase breast and cervical cancer screening in this population.
... The Hmong refugee community is markedly affected by communication problems between English-speaking medical practitioners and Hmong patients (Fadiman, 1998;Thornburn et al., 2012). This especially involves difficulties in finding appropriate terminology or other expression of medical concepts in the Hmong language (Johnson, 2002). ...
Biomedical communication is an area that increasingly benefits from natural language processing (NLP) work. Biomedical named entity recognition (NER) in particular provides a foundation for advanced NLP applications, such as automated medical question-answering and translation services. However, while a large body of biomedical documents are available in an array of languages, most work in biomedical NER remains in English, with the remainder in official national or regional languages. Minority languages so far remain an underexplored area. The Hmong language, a minority language with sizable populations in several countries and without official status anywhere, represents an exceptional challenge for effective communication in medical contexts. Taking advantage of the large number of government-produced medical information documents in Hmong, we have developed the first named entity-annotated biomedical corpus for a resource-poor minority language. The Hmong Medical Corpus contains 100,535 tokens with 4554 named entities (NEs) of three UMLS semantic types: diseases/syndromes, signs/symptoms, and body parts/organs/organ components. Furthermore, a subset of the corpus is annotated for word position and parts of speech, representing the first such gold-standard dataset publicly available for Hmong. The methodology presented provides a readily reproducible approach for the creation of biomedical NE-annotated corpora for other resource-poor languages.
... For example, there is no word in the Hmong language that refers to "cancer". Therefore, interpreters may need to explain in more words and sentences to deliver the best description of the disease [6]. ...
The people of Hmong descent are one of the largest resettled communities in the United States (US). The Central Valley of California is well known to be the home to the largest Hmong population in the US. However, despite the presence of such a large Hmong community in the Central Valley, our knowledge of their cultural perceptions of medicine is limited. Based on local Central Valley health providers' experiences and observations, the Hmong people have a number of health-related challenges that differ from those of the general population, and this should be considered when dealing with their healthcare needs. In this report, we present a quick guide about the Hmong community and their health-related issues. We hope this will help clinicians and researchers better understand the Hmong community, which in turn would help provide a better quality of healthcare to the Hmong people and stimulate intellectual curiosity among healthcare providers towards this unique Asian ethnicity.
... Clan membership can usually be distinguished by surname. Traditionally, the Hmong values family decision-making, in particular, medical decision-making has generally been considered to be a communal act rather than an individual act (Her & Culhane-Pera, 2004;Johnson, 2002). For example, patients may seek consultation from extended family members and/or clan leaders before making a medical decision. ...
Background. Conducting research with underserved communities with little exposure to research presents a number of challenges and opportunities. Our study used a community-based approach to better understand factors that influence breast and cervical cancer screening among Hmong women. Objective. This article shares lessons learned during the process of developing and conducting qualitative research with a Hmong community with limited experience with research. Method. We conducted 17 key informant and 84 in-depth interviews with Hmong women and men. Research team discussions, insights from Hmong research team members, input from our Community Advisory Committee, and project documents were sources of information about the process of conducting research in this community. Results. Lessons learned concern including a cultural insider as an investigator; building community partnerships and support; establishing and working with a community advisory committee; hiring and training bilingual, bicultural staff; and using culturally appropriate materials and methods in a small, kinship-based community. We used multiple strategies to ensure that this study was conducted in a culturally appropriate manner. Conclusion. The lessons learned from our experiences can provide guidance to researchers on methodological and practical issues in conducting research with the Hmong and can inform future research with the Hmong and other similar underserved populations.
© 2014 Society for Public Health Education.
... Since the late 1970s, the Hmong have migrated to the United States with health beliefs that clash with their Eurocentric counterparts (Fadiman 1997). 1 This crosscultural encounter has presented both challenges and opportunities for professionals and researchers in the United States (Johnson 2002;Smith 1997aSmith , 1997b. Mainstream health professionals have found it difficult to reach out to Hmong American communities and address the observed health disparities ( ;Fadiman 1997;Smith 1997aSmith , 1997b. ...
This paper investigates the cultural politics of knowledge production regarding Hmong American food-related health issues. Textual analysis of ten research papers published in the last twenty years leads to the critique that mainstream scientific discourse, rooted in Eurocentric epistemology, has in effect constituted Hmong Americans as subjugated Others. We demonstrate how this discourse (1) demarcates between the subject and the object from a Eurocentric viewpoint; (2) associates Hmong-ness with tradition while dissociating tradition from American-ness; (3) overlooks multiple differences within Hmong American communities; and (4) keeps silent on institutional racism as a barrier to healthy living. We explicate the power relations inherent in science research regarding marginalized communities, and call for decolonizing knowledge and research.
... A second approach to conducting cross-cultural research is with the assistance of an interpreter (Esposito, 2001;Essén et al., 2000;Gannagé, 1999;Johnson, 2002;Kapborg, 2000;Silveira & Allebeck, 2001). Interviews are completed by interpreters in the participants' native language; the interpreters then translate the conversations into the study language (often English) without first transcribing them in the participants' native language (Dagher & Ross, 2004;Mackinnon, Gien, & Durst, 1996;Miller, Worthington, Musurovic, Tipping, & Goldman, 2002;Olsson, Tuyet, Nguyen, & Stålsby Lundborg, 2002). ...
Achieving conceptual equivalence between two languages is a challenge in cross-cultural, cross-language research, as the research is conducted in a language that is not the researcher's or research team's first language. Therefore, translation provides an additional challenge in cross-cultural research. The comprehension and interpretation of the meaning of data is central in cross-cultural qualitative analysis. The purpose of this article is to provide an overview of the translation process and explore some of the challenges, such as difficulties in finding a suitable translator, and the importance of communication between the researcher and the translator.
... First, a study of 323 Hmong older adults found that 86% of Hmong adults reported speaking English poorly or not at all [12]. Second, Hmong language has no equivalent for many of the medical terms used routinely (such as chemotherapy) in educational materials [13]. Another important consideration is the absence, until recently, of a written Hmong language. ...
Cancer health disparities are a reality for Hmong women who are often diagnosed at a later stage and have low literacy and experienced care that are not culturally appropriate. Lack of attention to cultural appropriateness and literacy levels of cancer screening materials may contribute to disproportionately low levels of cancer screening among Hmong women. The purposes of this study were to evaluate the Hmong Health Awareness Project (HHAP), a program designed to create awareness and acceptance of breast and cervical cancer screening, and to examine participants' perceptions of the utility of the content of the workshops. Hmong researchers partnered with three Midwestern Hmong community centers to implement six workshops. Three teaching techniques: pictographs, videos, and hands-on activities were utilized to teach Hmong participants about cancer screening. Participants included 150 Hmong (male participants = 30 and female participants = 120). Teach-back method was used to assess the participants' understanding of cancer screening throughout the workshops. Qualitative data were collected in focus groups to assess the feasibility of teaching methods and participants' perceptions of the utility of the content of the workshops. Directed content analysis was used to analyze participants' responses. The three teaching techniques were helpful in increasing the Hmong people's understanding about breast and cervical cancer screening. Nearly, all participants perceived an increased in their understanding, greater acceptance of cancer screening, and increased willingness to be screened. Men expressed support for screening after the workshops. Findings can guide future interventions to improve health communications and screening and reduce diagnostic disparities among Hmong and immigrant populations.
... And, while others describe their procedures (e.g. Hinton and Earnest, 2010;Johnson, 2002;Rehm, 2003), minimal attention has been paid to the influence of interpreters on the validity of the data generated (Squires, 2009;Temple, 2002;Temple and Young, 2004;Wallin and Ahlström, 2006). ...
This research note focuses on interpreter-facilitated cross-language qualitative interviews. Although researchers have written about strategies and procedures for working with interpreters, rarely have they offered adequate detail to determine the relative merits of various approaches, and little attention has been paid to the influence that interpreters have on the validity of qualitative data. We advance this body of literature by describing and critically examining the strategies and procedures we used to work with an interpreter to conduct qualitative interviews with Mandarin-speaking grandparents who participated in our study of intergenerational social support during the transition to parenthood. In addition, we examine the influence that our strategies and procedures had on the data generation process and on the validity of the data. Drawing on our experiences, we argue that with adequate preparation, validity checks, and the supplementary strategies that we describe in this article, an interpreter-facilitated interview approach to generating data in cross-language studies can be an effective alternative to more commonly used and more laborious and expensive translation practices.
... However, younger participants disagreed with older participants' about obtaining husbands' consent to get screening and indicated that their husbands were supportive of screening. These differences may reflect acculturation in the United States (Johnson, 2002;Parker & Kiatoukaysy, 1999). Our findings about norms and screening are consistent with findings from samples of minority groups including the Hmong (Peek, Sayad, & Markwardt, 2008;Schroepfer et al., 2010;Schueler, Chu, & Smith-Bindman, 2008). ...
To describe the beliefs, feelings, norms, and external conditions regarding breast and cervical cancer screening in a sample of Hmong women.
In a descriptive design, female Hmong researchers recruited 16 Hmong women (ages 24-73) at a community center. Guided by the Theory of Care Seeking Behavior (TCSB), researchers asked participants semi-structured questions about their beliefs, feelings, norms, and external conditions in a group setting. Researchers documented responses in writing and audio recordings. Guided by theory, we used directed content analysis to categorize responses.
Participants' beliefs' about screening included uncertainty about causes of breast and cervical cancer, uncertainty about Western forms of treatments, and terminal illness as outcomes of such cancer. Many felt embarrassed about breast and cervical cancer screening. Their cultural norms about undressing for an exam and listening to authority figures were different from Western norms. External conditions that influenced participants' for screenings included difficulties in communicating with interpreters and clinicians.
Consistent with the TCSB, Hmong women's beliefs, affect, cultural norms and external conditions helped to understand their use of breast and cervical screening. Findings could guide nursing and public health interventions to improve culturally sensitive, cancer screening for Hmong women.
... Hmong society is kinship-based, divided into clans, and patrilineal. In traditional Hmong culture, the male head of household has a great deal of influence over family members' health and medical decisions (Cuhlane-Pera & Xiong, 2003;Faderman & Xiong, 1998;Johnson, 2002;Lee & Vang, 2010). Consequently, obtaining men's perspectives was important for understanding women's health issues. ...
Despite low breast and cervical cancer screening levels among Hmong women in the United States reported in the literature, understanding of the barriers to screening for Hmong women is limited. Health literacy issues may influence screening behavior for this population. This qualitative study explored sources of information about breast and cervical cancer, including screening, and identified barriers to seeking such information for Hmong women and men. Researchers conducted semi-structured, in-depth interviews with 84 Hmong women and men living in Oregon. Interviews were audio-recorded and transcribed. Transcripts of 83 usable interviews were analyzed using content analysis. Health care providers and the Internet were the most frequently cited sources of information about breast and cervical cancer, including screening. Other sources were family, friends, and other media. Over half of the participants indicated that nothing would prevent them from seeking information about these topics. These findings suggested that health care providers and the Internet may be important sources of information about breast and cervical cancer screening for Hmong women. Additional research is needed to examine further Hmong women's health literacy needs and preferences with regards to breast and cervical cancer screening.
... In addition, there are some in-depth studies car- ried out among immigrant Hmong in western countries for the purpose of implementing culturally appropriate healthcare (e.g. Lee, 1986;Morrow, 1986;Jambunathan, 1995;Jambunathan and Stewart, 1995;Rice, 1999Rice, , 2000Johnson, 2002). Despites these studies of the Hmong women's healthcare system, only few ethnob- otanical studies describe the medicinal plants incorporated in such practices (e.g. ...
Ethnopharmacological relevance
We studied traditional knowledge of medicinal plants used for women's healthcare in three Hmong villages in northern Thailand and determined how prevalent such knowledge is. We documented traditional medical practices and determined which of the species used are culturally important among the Hmong.
Materials and methods
We interviewed six key informants and 147 non-specialist informants about their traditional knowledge of medicinal plants used in Hmong women's healthcare. We selected nine species that were known in all three villages as the domain for questionnaire interviews with 181 additional and randomly selected non-specialist informants. We calculated the Cultural Importance index (CI) for each species and use category. We tested normality of the data, age correlations, and gender correlations with Kolmogorov–Smirnov tests, Spearman's rank correlation coefficient, Kruskal–Wallis test, and Mann–Whitney tests.
Results
We documented traditional knowledge of 79 medicinal plants used in women's healthcare. Of these, three species were culturally important to the Hmong. Our questionnaire interviews revealed significant difference in traditional medicinal plant knowledge between genders and age groups.
Conclusions
The Hmong people in northern Thailand possess large amounts of traditional knowledge related to women's healthcare and plants used for this purpose. However, this knowledge, even for the culturally important species, is not possessed by all Hmong and there were signs of knowledge erosion. Preservation of the Hmong intellectual heritage related to medicinal plants used in women's healthcare requires intensive traditional knowledge dissemination to the young Hmong generation.
... A qualitative research design with a feminist lens is a productive method for gathering meaningful data about women's perspectives in a patriarchal culture like the Hmong's (Madriz, 2000), where women may be less educated than men and feel they have diminished voice (Johnson, 2002). In this qualitative study, focus groups were the chosen interviewing method as they have been found to "stimulate free discussion among participants on the subject of inquiry" (Khan et al., 1991, p. 145) and allow researchers to gather a large amount of information in a limited time. ...
Purpose
The purpose of this study was to explore the perspectives of Hmong women on cancer, using focus groups as the research method.
Methods
Two focus group interviews were conducted and the narrative data were analyzed using thematic content analysis.
Results
Themes that emerged from the focus group discussions included “fatalistic and ‘black and white’ thinking”, “valuing rumors rather than scientific information”, “strong adherence to traditional medicine”, “male leaders controlling health care decisions”, “embarrassment discussing women's bodies”, and “preferred strategies in addressing cancer”.
Conclusion
Many Hmong people in the United States believe that both traditional and Western health care practices are effective, but when health professionals do not address differences in language, communication, and beliefs about health, trust between the provider and client may erode. The findings of this study provide new insight into the importance of cultural accommodation to improve early cancer detection in the Hmong community.
... Traditional knowledge and cultural norms of the Hmong also influence the content and frequency of parent-adolescent sexual health communication. The Hmong born in Laos have little knowledge regarding the anatomical and physiological functions of the human body, and their language lacks words for direct translation of Western disease processes (Benson 1987; Cheon-Kessig, Camerilli, McElmurry, and Ohlson 1988 as in Johnson 2002). This may create challenges in discussing reproductive body parts, their function, and topics such as sexually transmitted infections (STIs). ...
Parent-adolescent communication about sexual health is one strategy to encourage healthy adolescent sexual behaviour. However, this literature has largely overlooked immigrant families. Hmong youth, identified as facing extreme challenges to parent-adolescent communication, are considered. Content analysis was used to examine parent-adolescent communication about sexual health for forty-four pregnant or parenting Hmong adolescent girls. The minority of adolescents recalled an actual conversation about sexual health in their families with mothers most often identified as the source. Their stories reflect discussions about abstinence, puberty, pregnancy, and STIs - with much information being inaccurate. With culture being a recurrent theme, communication was reported to be hindered by cultural traditions, comfort level, applicability, and perceived consequences. The results identify opportunities for culturally-relevant sex education materials in the Hmong community.
... The Hmong, a South-East Asian group originally from Laos, secretly assisted the US military and Central Intelligence Agency during the Vietnamese Conflict (1963)(1964)(1965)(1966)(1967)(1968)(1969)(1970)(1971)(1972)(1973)(1974)(1975) (3) . After the Conflict, communists targeted Hmong because of their help to the USA and many Hmong suffered hardships including genocide, poverty, excessive labour, depression and food insecurity, and consequently fled Laos and settled in refugee camps in Thailand (4)(5)(6)(7)(8) . Conditions of refugee camps varied, but poverty and food insecurity were common, leading to Hmong migration to countries such as Australia, France and the USA (4,6,8) . ...
Objective:
The Hmong are a growing population of South-East Asian immigrants with increasing rates of obesity and diabetes, yet little is known about their dietary consumption patterns. The present study aimed to investigate the dietary intake of Hmong children and whether acculturation and/or time lived in the USA influences dietary intake, BMI and nutritional status.
Design:
Two 24 h dietary recalls were collected on non-consecutive days using the multiple-pass interviewing method and were averaged. Heights and weights were measured, from which BMI was calculated. An acculturation score was computed.
Setting:
Schools, churches, Hmong organizations, and community centres.
Subjects:
Three hundred and thirty-five Hmong children aged 9-18 years from Twin Cities, Minnesota, USA.
Results:
Approximately half of our participants were either overweight or obese. US-born children were significantly heavier, taller, had a higher BMI, and in general consumed more energy, saturated fat and Na than those who were born in Thailand/Laos and were living in the USA for <5 years. Children who were more acculturated to US norms including language use, social connections and dietary habits had higher BMI-for-age and consumed significantly more saturated fat, trans fatty acids, Na and Ca compared with their less acculturated counterparts.
Conclusions:
Diets of most Hmong children appear below the recommendations for fibre, vitamins A, D and E, Ca, P, Mg and K, and are higher in fats, sugars and Na. Living in an obesogenic US environment is a probable reason for poor dietary quality of Hmong and may be a contributing factor to the rising rates of obesity and diabetes in this population.
Introduction:
We investigated race and ethnicity-based disparities in first course treatment and overall survival among Wisconsin pancreatic cancer patients.
Methods:
We identified adults diagnosed with pancreatic adenocarcinoma in the Wisconsin Cancer Reporting System from 2004 through 2017. We assessed race and ethnicity-based disparities in first course of treatment via adjusted logistic regression and overall survival via 4 incremental Cox proportional hazards regression models.
Results:
The study included 8,490 patients: 91.3% (n = 7,755) non-Hispanic White; 5.1% (n = 437) non-Hispanic Black, 1.8% (n = 151) Hispanic, 0.6% Native American (n = 53), and 0.6% Asian (n = 51) race and ethnicities. Non-Hispanic Black patients had lower odds of treatment than non-Hispanic White patients for full patient (OR, 0.52; 95% CI, 0.41-0.65) and Medicare cohorts (OR, 0.40; 95% CI, 0.29-0.55). Non-Hispanic Black patients had lower odds of receiving surgery than non-Hispanic White patients (full cohort OR, 0.67 [95% CI, 0.48-0.92]; Medicare cohort OR, 0.57 [95% CI, 0.34-0.93]). Non-Hispanic Black patients experienced worse survival than non-Hispanic White patients in the first 2 incremental Cox proportional hazard regression models (model II HR, 1.18; 95% CI, 1.06-1.31). After adding insurance and treatment course, non-Hispanic Black and non-Hispanic White patients experienced similar survival (HR, 0.98; 95% CI, 0.88-1.09).
Conclusion:
Non-Hispanic Black patients were almost 50% less likely to receive any treatment and 33% less likely to receive surgery than non-Hispanic White patients. After including treatment course, non-Hispanic Black and non-Hispanic White patient survival was similar. Increasing non-Hispanic Black patient treatment rates by addressing structural factors affecting treatment availability and employing culturally humble approaches to treatment discussions may mitigate these disparities.
Introduction:
There are 25 million individuals in the United States with limited English proficiency (LEP). Language barriers contribute to poorer patient assessment, misdiagnosed and/or delayed treatment, and inadequate understanding of the patient condition or prescribed treatment. LEP also has been shown to result in inadequate pain control, yet there are significant gaps in our knowledge related to pain documentation and pain management in primary care settings. The objective of this study is to describe and compare pain documentation for LEP racial/ethnic minority patients - Hmong-speaking Asian and Spanish-speaking Latinx - to English-speaking White patients with moderate to severe pain at an academic primary care clinic.
Methods:
We conducted a retrospective mixed methods electronic health record study of patients age ≥ 18 with a pain score of ≥ 6; preferred language of Hmong, Spanish, or English; and evaluation in a primary care clinic. Abstracted data included characteristics of the provider, patient, interpreter, and pain care process. Descriptive statistics, analysis of variance, and chi-square tests were used. Clinician subjective assessment was analyzed using directed content analysis.
Results:
Three hundred forty-two patient visits were included. Pain score distribution differed by patient language and race/ethnic group (P < 0.001), with an average pain score of 7.66 (SD 1.25). Interpreter type varied between the LEP groups (P = 0.009). Pain location was documented in a higher percentage of visits overall (87%) and more frequently for English-speaking White and Spanish-speaking Latinx patient visits than Hmong-speaking Asian visits (P < 0.001). Pain quality, onset, and duration were documented more frequently in LEP patient visits than English-speaking White patient visits (all P < 0.001). While overall opioid prescription rates were low, opioids were prescribed 3 times more frequently to English-speaking White patients than LEP patients (P = 0.002). Approximately 20% of patients were prescribed nonpharmacological treatment.
Conclusion:
Pain care process and treatment documentation varied by patient language and race/ethnicity. Future studies could evaluate the impact of pain assessment and treatment documentation on pain outcomes for LEP patients.
The marginalization process of refugees during resettlement has rarely been explored empirically due to the challenges in identifying and accessing the population. To understand how stress and coping throughout the migration and resettlement processes can result in marginalization in refugees resettled in the United States, this study conducted in-depth individual interviews with 16 homeless Hmong refugee families. The findings revealed how cumulated adversities eroded coping resources and how impeded coping capacity fuels social isolation and marginalization. In addition, an enclosed family support system tends to limit types of available help and social interactions and thus frustrates the use of diversified coping strategies that are critical to healthy acculturation. This study underscores the importance of expanded resettlement services that promote both formal and informal social supports and enhance balanced social integration of the refugee community.
Stereotypes and misunderstandings of elders in the Hmong American community have serious consequences; they can cause damage to elders' self-worth and diminish the empathetic assistance they need from their families as well as professional caregivers. Common perceptions of them as frail and senile, for example, overlook the reality that elders make important contributions to their families and society. While many communities need to improve care and perceptions of their elderly, the situation of the Hmong American community is complicated by two factors: research and literature focused on its elderly population is very limited; and Hmong culture, for thirty years, has undergone major transitions in response to immigration and subsequent resetlement in the United States. Furthermore, health and wellness of Hmong American elders go beyond caring for visible or measureable illnesses. For them, sound mental health and social satisfaction are as important as physical health. Additionally, from anecdotal data taken from my personal experience and professional practice, the Hmong American elderly population needs to feel acknowledged, respected, and understood in the context of their overall well-being.1 This chapter will address the situation of Hmong elders in the United States aged fifty and older. As refugees of the Vietnam War who sought political asylum during the 1970s and 1980s, most arrived in the United States when they were in their late teens or older; usually they came as part of family groups, whether immediate or extended. Even though the U.S. Census Bureau defines an elder as someone above age sixty-five, Hmong people tend to regard anyone in their fifties or older as an elder. This perception of age is influenced by two factors: a cultural expectation to take on adult roles at an earlier age than is common in the West; and the deterioration of Hmong health at an earlier age due to traumatic war and refugee camp experiences. Currently, about 2.6 percent of the Hmong American population is above sixty-five years old. Hence, the elderly population aged fifty and above is higher.2 Most important, regardless of their number, the contributions of the elderly are immeasurable to their families, clans, communities, and American society. The roles elders play continue to ensure the vibrant health of Hmong culture as well as the financial prosperity of the Hmong American community. Today, for example, Hmong American elders are involved in organizing Hmong festivals and holiday celebrations that are a thriving part of America's rich cultural diversity in general and of Hmong American life in particular. To increase awareness of and respect for Hmong American elders, in this essay I address their roles, contributions, and emerging needs. To supplement the limited professional literature focusing on Hmong American elders, I integrate their voices from personal interactions, surveys, interviews, and radio programs in which I was involved. In addition, I incorporate professional and personal experiences shaping my personal epistemology, that is, the "conceptions of knowledge and knowing" that derive from what I have learned through my life history. I am a counselor, therapist, educator, researcher, daughter, and daughter-in-law of elderly Hmong Americans. Consequently, my views are influenced by both Western training in counseling and lifelong experiences with Hmong customs and values3. © 2012 by the Minnesota Historical Society. All rights reserved.
Describe cultural beliefs related to diabetes in Minnesota Somali children with type 1 diabetes (T1D), and compare their diabetes control to that of non-Somali children with diabetes. A cross-sectional study involving Somali children ≤19 years with T1D at the University of Minnesota Masonic Children's Hospital and Children's Hospitals and Clinics of Minnesota. A survey was administered to parents of all participants and to children aged ≥12 years. Data were collected by history and from the medical record. Twenty-five Somali children participated, with 24 parent-child pairs (2 siblings). Mean participant age was 12.2 ± 5.2 (36 % female). Seventy-one percent of parents indicated the child was "the same as before" other than having to do diabetes cares. Families were coping well, and the child was not treated differently than siblings. Performance of routine cares was described as the hardest part about having diabetes, but this was not related to traditional culture or religion. One notable exception was difficulty performing carbohydrate counting on Somali foods. Respondents were appreciative of the education provided by the diabetes team. Less than 10 % used herbal supplements in addition to insulin. Mean HbA1c in Somali children was higher than the overall pediatric clinic average, 9.5 ± 1.6 % versus 8.8 ± 1.6 (p = 0.01). The difference was largely due to adolescent patients. The majority of Somali families cope well with diabetes and have a positive attitude towards the diabetes education. Glycemic control in adolescents is worse than in non-Somali peers. There is a need for culture-specific dietary instruction materials.
To investigate Hmong-American immigrant women's utilization of cervical cancer screening, including the impact of cultural health beliefs on screening use.
Overall, 164 Hmong-American immigrant women 21 to 65 years of age were recruited from a large metropolitan area in the Midwest. We used logistic regression, guided by Andersen's Behavior Model, to examine factors associated with the receipt of Pap test.
About 67.1% had received a Pap test within the last 3 years. Fatalism, modesty, education, and marital status were significantly correlated with receiving a Pap test.
The provision of cervical cancer literacy education and related preventive guidelines to this population are urgently needed to reduce cancer-screening disparity.
Health is locally produced by individuals, families, and households through the interplay and strategic utilization of a variety of internal and external resources, yet distally influenced by the larger ecological environment within which these are situated. The specific environmental factors that influence health vary across time and space, but are important to understanding and addressing health disparities. Data for this project come from 33 Hmong women who participated in focus groups conducted as part of an exploratory community-based research study investigating cervical cancer screening disparities in the Milwaukee, Wisconsin Hmong community. Participants identified a number of factors broadly falling into two ecological contexts—culture (beliefs about disease causation, treatment seeking, and modesty) and community (collective decision making, health literacy, and language)—influencing screening decisions. Understanding of these factors is important for developing culturally embedded and locally relevant solutions aimed at effectively increasing cervical cancer screening rates and improving health outcomes for Hmong women.
Limited English proficiency (LEP) is a common barrier that negatively affects access to health care and quality of care. Prior studies have examined interpreter services as a means of ameliorating LEP, but have focused on Spanish-language services, largely overlooking comparisons with other, less-established ethnic groups. Furthermore, few if any studies have assessed the quality of interpreter services provided. Data come from 2,489 Hispanic/Latino, Hmong, and Somali enrollees of public health insurance programs in Minnesota. We employ weighted, regression-adjusted comparisons of enrollee-reported need and availability of interpreters, access to professional and consistent interpreters, and problems with quality of interpreter-assisted communication. Compared with Latinos, Hmong and Somali enrollees reported greater needs and more communication problems, Somali enrollees reported lower availability, and Hmong enrollees reported lower access to professional interpreters. Further training of interpreters for relatively less-established ethnic groups is needed to increase availability of professional, high-quality communication among publicly insured ethnic minorities.
To explore East African refugees' perceptions, ideas, and beliefs about health and health care, as well as the ways in which health information is shared within their communities.
This study consisted of 2 focus groups with a total of 15 participants, including East African community leaders and health professionals.
East African refugees in the United States have strong cultural, religious, and traditional health practices that shape their health behavior and influence their interactions with Western health care systems.
Health care providers who understand refugees' beliefs about health may achieve more compliance with refugee patients.
This study described the prevalence of and risk factors for sensory deficits, cognitive and physical functional limitations, and disability among older Southeast Asian refugees in the United States.
Data for the regression analyses were drawn from the 2003-2007 American Community Surveys. The sample included foreign-born persons aged 55 and older who were classified as Hmong, Cambodian, Laotian, and Vietnamese.
Hmong, Cambodian, and Laotian persons were more likely to report a sensory deficit, functional limitation and disability than Vietnamese persons. Year of arrival, English language proficiency and education were important risk factors. Hmong and Cambodian groups had the most negative health profiles.
Previous studies found that Vietnamese were the most health disadvantaged when compared to other Asian American groups and Whites. When compared to other refugee populations, the Vietnamese were actually the advantaged group. Our results indicated additional research on the disablement process among Southeast Asians is warranted.
To design a functional, patient-centered model of patient complexity with practical applicability to analytic design and clinical practice. Existing literature on patient complexity has mainly identified its components descriptively and in isolation, lacking clarity as to their combined functions in disrupting care or to how complexity changes over time.
The authors developed a cumulative complexity model, which integrates existing literature and emphasizes how clinical and social factors accumulate and interact to complicate patient care. A narrative literature review is used to explicate the model.
The model emphasizes a core, patient-level mechanism whereby complicating factors impact care and outcomes: the balance between patient workload of demands and patient capacity to address demands. Workload encompasses the demands on the patient's time and energy, including demands of treatment, self-care, and life in general. Capacity concerns ability to handle work (e.g., functional morbidity, financial/social resources, literacy). Workload-capacity imbalances comprise the mechanism driving patient complexity. Treatment and illness burdens serve as feedback loops, linking negative outcomes to further imbalances, such that complexity may accumulate over time.
With its components largely supported by existing literature, the model has implications for analytic design, clinical epidemiology, and clinical practice.
Because of the emphasis within the Hmong folk health system on spirituality and nonphysiological etiologies, there has been a significant degree of conflict between Hmong refugees and the Western health care system since the beginning of the Hmong migration to the United States in the mid-1970s. This conflict has been well documented in the literature, but previous research on Hmong health has tended toward a totalization of Hmong health beliefs to emphasize its distinctness from Western biomedicine and subsequently advocate culturally sensitive health care. In doing so, however, researchers have overlooked the burgeoning syncretism of health beliefs among Hmong in the United States. The present study seeks to explain how and why the Hmong health system in Alaska is developing into a syncretism of the folk beliefs and elements from the Western biomedical paradigm. This syncretism has lead to an intricate system of combined physical and spiritual diagnoses that significantly affects the way health care decisions are made within the Hmong community. Alaskan Hmong use contextual factors (regularity, longevity, and spiritual manifestations) as well as the course of traditional and biomedical treatments to assign and reassign spiritual or biomedical root causes to ailments. As this argument unfolds, I also address the use of “syncretism” as a theoretical construct and ultimately argue that it is the most useful concept for understanding changing health beliefs among the Hmong in Alaska, despite the pejorative historical use of the term. Understanding health seeking behaviors through a syncretic paradigm, health care professionals and anthropologists can better account for the multifaceted treatment paradigms that Hmong seek as well as account for changes between traditional and biomedical treatment regimes.
We studied traditional knowledge of medicinal plants used for women's healthcare in three Hmong villages in northern Thailand and determined how prevalent such knowledge is. We documented traditional medical practices and determined which of the species used are culturally important among the Hmong.
We interviewed six key informants and 147 non-specialist informants about their traditional knowledge of medicinal plants used in Hmong women's healthcare. We selected nine species that were known in all three villages as the domain for questionnaire interviews with 181 additional and randomly selected non-specialist informants. We calculated the Cultural Importance index (CI) for each species and use category. We tested normality of the data, age correlations, and gender correlations with Kolmogorov-Smirnov tests, Spearman's rank correlation coefficient, Kruskal-Wallis test, and Mann-Whitney tests.
We documented traditional knowledge of 79 medicinal plants used in women's healthcare. Of these, three species were culturally important to the Hmong. Our questionnaire interviews revealed significant difference in traditional medicinal plant knowledge between genders and age groups.
The Hmong people in northern Thailand possess large amounts of traditional knowledge related to women's healthcare and plants used for this purpose. However, this knowledge, even for the culturally important species, is not possessed by all Hmong and there were signs of knowledge erosion. Preservation of the Hmong intellectual heritage related to medicinal plants used in women's healthcare requires intensive traditional knowledge dissemination to the young Hmong generation.
Breast cancer is the most frequently diagnosed cancer among women in the United States, where 1 in 8 women will face breast cancer in their lifetime.1 In 2010, this translates to approximately 207,090 women who will be diagnosed with this disease, and about 54,010 who will die of breast cancer.1
While Caucasian women have the highest incidence of breast cancer in comparison to any other cultural group, Asian American and Pacific Islander (AAPI) women, in aggregate, are more likely to die from breast cancer than any other ethnic group.2,3 Furthermore, Asian American females are the first American population to experience cancer as the leading cause of death in the United States.3,4 Death rates have increased in AAPI women by 200% since 1990.5 In addition, AAPI women collectively have the lowest screening rates of all ethnic populations, with roughly 45% reporting that they have ever had a mammogram.4 Hmong women, an ethnic group within the AAPI population, are among those at the highest risk for health problems due to high rates of poverty, language isolation, and cultural barriers.3
A national health initiative, Healthy People 2020,6 was created to increase health promotion and disease prevention that address issues such as these. A primary objective identifies cancer as one of the ten leading health indicators. The goal is to reduce the number of new cases, as well as the illness, disability, and death caused by cancer. The ability to decrease cancer death rates depends on the existence and application of various types of resources, and providing culturally and linguistically appropriate information on prevention, early detection, and treatment to the public is essential in order to meet this goal.6
A new and more specific goal presented by Healthy People 2020 is to decrease the incidence of late stage breast cancer. This is of particular importance in Asian-born Asian American women with breast cancer, in which approximately 79% have a greater proportion of tumors larger than 1 cm at diagnosis.7 It has been shown that many tumors greater than 1 cm have lymph node involvement and are considered later stage disease.
Another goal established from Healthy People 2020 is to increase the proportion of women aged 40 or older who have received a breast cancer screening based on the most recent guidelines. It is essential that a high percentage of females over age 40 comply with these mammographic screening recommendations in order to reduce breast cancer burden and death rates.
Given the diversity and health disparities of the Hmong population, it is important to develop culturally competent health promotion programs, including breast cancer screening, to address and support the health needs of this group. Coalitions can be the cornerstones of creating successful change within a community. They represent a range of local interests and bring together organizations and individuals to build a foundation that works to influence social change of a communal concern. It is conceivable that coalition building can establish an effective breast cancer-screening program within the Hmong population.
Religious practices such as prayer represent the most prevalent complementary and alternative therapies in the United States. However, biomedicine has sometimes viewed faith and related religious worldviews as relevant only when they obstruct implementation of scientifically sound biomedical care. Recent efforts to arrive at a new synthesis raise challenges for pediatricians. This article reviews theories of child faith development, and models of child spirituality from different disciplinary perspectives. It provides sources illustrating how spirituality and religion may inform children's lives; play a part in children's moral formation, socialization, and induction into a sacred worldview; and provide the child with inner resources. It also suggests some of the positive and negative effects of spiritual and religious engagement. Second, this article examines aspects of spirituality and religion that parents may bring to bear in relation to their children's health. Third, this article addresses the spiritual and/or religious identity of the provider. These topics are discussed in the context of cultural competence and the related importance of religious diversity. The authors suggest 1) some approaches for appropriate inclusion of spirituality in clinical practice, 2) challenges for medical education, and 3) areas requiring further research.
The author reports on a survey of 97 Hmong adult refugees in the United States. Thirty of these refugees showed symptoms of chronic maladjustment, and 13 showed another DSM-III axis I disorder; two manifested a paranoid psychosis, and six had a major depression. There were few axis II diagnoses. Medical conditions were frequent and often psychophysiological in nature, but they were not associated with axis I disorders. Axis IV psychosocial stressors were not associated with axis I diagnoses, but subjects with an axis I disorder tended to show lower adaptive levels on axis V. The demographic condition most strongly associated with an axis I diagnosis was current status as a welfare recipient.
Folk medicine comprises "unofficial health beliefs and practices" which rely heavily (but not exclusively) on oral transmission. It is one form of alternative medicine, and a major source for many other forms such as phytotherapy and mind/body medicine. While many folk medicine ideas and practices are associated with particular ethnic groups, many others are widely distributed throughout American society. Folk medicine is not dying out in the modern world. Because it has both medical benefits and risks, effective medical care with folk medicine requires awareness and discussion of its influence.
This article contributes to the cross-cultural literature on fright sickness and soul loss with an analysis of cases among Quechua indians (runa) in a rural community in the southern Peruvian Andes. One of the aims of this article is to incorporate an emic understanding of the intersection of the cosmological and social landscapes into discussions of Quechua conceptions of health and illness. It outlines Quechua constructions of body, self, and cosmos that are relevant to explaining the concepts of soul/spirit, interior/exterior, and runa/nonruna that are related to soul loss. The illness suffered by victims of fright sickness embodies the Quechua construction of self and is linked not only to broader sociopolitical realities of Peru but also to cosmological beliefs. The diagnosis of spirit loss and fright in this cultural context reveals a crisis of identity: sufferers represent nonruna, or nonhumans. They succumb to fright or soul loss because of an emic concept of vulnerability that transcends the characteristics of gender and age usually associated with soul loss cross-culturally. Treatments, therefore, involve a reaffirmation of ethnic identity and a reintegration of patients into their families in terms of a culturally specific understanding of identity, community, and cosmos. rights reserved
Vietnamese, Cambodian, and Hmong refugee populations in the United States face serious physical and psychosocial health issues. Literature on these populations is largely descriptive of illnesses and of cultural beliefs or behavior patterns related to illness. There is minimal literature linking beliefs and behaviors to the underlying cultural themes. The purpose of this paper was to search the literature for cultural themes from which culturally relevant health promotion strategies could be designed.
Literature was reviewed from the fields of health, social, and political science, history, and Southeast Asian folklore. Search methods included review of 147 writings from library and MEDLINE search and 123 interviews with refugees and key professionals in the field. This manuscript includes 106 selections as well as content from 93 interviews.
From the literature emerged two cultural themes common to these population, kinship solidarity and the search for equilibrium. The use of these cultural themes as carriers of health messages is suggested. Examples of ways to link the message with the cultural theme are presented, including the use of folklore, recognition of cultural illnesses, and use of cultural knowledge in addressing new situations such as inner city urban survival. Cultural themes are a means of conveying health messages addressing such issues as transition in family structure, depression, and substance abuse.