Special Considerations when working with Black/African American Patients . . .

“Black or African American” refers to people having origins in any of the Black racial groups of Africa. It includes people who indicated their race or races as “Black, African American, or Negro,” or wrote in entries such as African American, Afro American, Nigerian, or Haitian^[21]. Thus, it is important to consider that the African American population itself is diverse and includes immigrants from Nigeria, Ethiopia, South Africa, the West Indies and the Caribbean. ^[7]

African Americans suffer from some distinct health disparities. Compared with the majority of White Americans, African Americans^[22]:

• have a higher incidence of hypertension, sickle cell anemia, and diabetes.
   
• have higher combined overweight and obesity rates; 65% of African-American men and 56.5% of African-American women are overweight or obese, compared with 61% of white men and 49.2% of white women.
   
• have far higher rates of cardiovascular disease (CVD) mortality for both men and women (compared with other racial/ethnic groups also).
   
• have substantially higher prevalence of diabetes, with double the incidence of complications such as lower-limb amputations and end-stage renal disease.
   
• have a cancer death rate about 35% higher.
   
• have more rapidly progression of certain diseases, including prostate and breast cancer.

This is only a small representation of the disparities in health faced by many African Americans. While not all of these can be attributed to cultural concerns, communication difficulties and provider biases may contribute to some of these issues.

African Americans have a complex history in the United States. As such, there is not single shared culture among this richly diverse group. Research indicates, however, there are some common considerations that may be helpful when engaging patients of this racial group.^{[3, 7, 16, 23]} Again, we emphasize that these are generalizations that may be useful in formulating questions or determining patient preferences but should not be used to stereotype patients. The African American population in Houston primarily identifies with the cultural norms associated with members of this racial/ethnic living in the Southern United States. Thus, the following information is more relevant to African Americans in the South:

Communications

Non-verbal . . .

• Personal space needs can be hard to determine. Ask the patient what is too far /too close. This helps avoid feelings that you are “in {their} face” or “far away because I am black.”
   
• Patient may be reluctant to make eye contact. Make special efforts to seek and maintain eye contact and speak directly to the patient

Verbal – Show respect . . .

• Ask patient to self identify race to determine preference for Black/African American/ Negro/etc…
   
• Refer to patient as Mrs., Mr., Ms. or Miss unless requested to use first name or other name.
   
• To African American women in the northern parts of the U.S., use of the term “Ms.” may be offensive. Be certain to ask the patient how she prefers to be addressed.

Language and Literacy

Do not make assumptions about person’s level of literacy (high or low)
During conversations, pause to assess comprehension of the discussion
Ask patient to repeat instructions/explanations in their own words

Special Considerations

• Prejudice/discrimination
   
• Avoid use of “loaded” words like “boy”, “gal”, or “you people”
   
• Use respectful terms, such as “person,” “man,” “woman,” “gentleman,” or “lady”
   
• Be aware that your patient may be sensitive to perceived disrespect based on race
   
• Do not make assumptions about beliefs, such as use of alternative medicines or “voodoo”

Mistrust of health care system

• Due to the history of the Tuskegee syphilis study (See NPR, CDC.) and other civil rights violations, African Americans may have some distrust of the health care system. (If you do not know about the Tuskegee study, we strongly encourage you to review it.)
   
• Be prepared to take time to explain the necessity of any tests or procedures and the anxiety this may provoke in patients.

Planning Treatment

Family and religious community . . .

• Family structures vary in the African American culture.
   
• Religious beliefs vary in the African American culture
   
• Ask patients to identify whom to include in their treatment plan

Complementary and Alternative Medicine . . .

• Particularly in the South, patients may believe in “high” blood (caused by overly rich food) or “low” blood (anemia), conditions caused by diet
   
• These conditions are often treated with folk remedies, such as consuming white foods, vinegar, herbal remedies, laxatives
   
• Be certain to ask clarifying questions when patients mention these conditions
   
• Be respectful of these cultural beliefs when making suggestions to your patient and try to make medically neutral suggestions to build rapport .

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