Special Considerations when working with Hispanic/Latino Patients . . .

Hispanic or Latino is defined as “a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.” In data collection and presentation, federal agencies are required to use a minimum of two ethnicities: “Hispanic or Latino” and “Not Hispanic or Latino.”^[21] The Census additionally categorizes a person who is of Hispanic / Latino ethnicity by any one of the federally defined racial categories, such as White, Black/African American, American Indian, etc.

As with other racial/ethnic groups, Hispanic/Latinos face significant health disparities, such as: ^[22]

• Diabetes is twice as prevalent among Hispanic/Latinos as among the majority population.
   
• Hypertension is common in Hispanic/Latino populations.
   
• Overweight and obesity are common in some Hispanic/Latino groups: for example, combined overweight and obesity are found among 63.9% of Mexican-American men and 65.9% of Mexican-American women. This contrasts to rates of 61% among European-American men and 49.2% among European-American women.
   
• The incidence of cervical cancer in Hispanic/Latino women is double that of non-Hispanic/Latino European-American women.
   
• Although Hispanic/Latinos have a lower incidence of breast, oral cavity, colorectal, and urinary bladder cancers, their mortality from these is similar to that of the majority population.

This represents only a few of the health disparities faced by this group. Cultural concerns, communication difficulties and provider biases may contribute to some of these issues. The following page outlines some universal considerations that may be helpful when treating patients of Hispanic/Latino descent. Again, there are great historical and cultural diversities within this group. Individuals will fall within the continuum of acculturation. We wish to reiterate that these are generalizations that may be useful in formulating questions or determining patient preferences but should not be used to stereotype patients. These recommendations come from a variety of sources that have been cross referenced for consistency:^{[3, 7, 14, 23]}

Communication

Personalismo: (personal relationships) . . .

• Latinos tend to appreciate personal discussion before formal interview.
   
• Due to the personal nature of the clinical encounter, the patients often want to have relationship with provider
   
• Taking time to ask about family, work, personal life prior to the medical interview will set patient at ease

Other concerns . . .

• El respeto (respect) – use titles (Mr., Mrs., Ms. as appropriate)
   
• Patients also expect respect to be expressed based on age, sex, professional status, etc.
   
• Time orientation is present focused and “in the moment.” May be more focus on activity than “clock” time. Be sure to emphasize when adherence to clock time for medicines or appointments is critical
   
• It can be taboo to express negative feelings. Take time to visit with patients to get as much insight as possible. Ask follow up questions such as, “How do these recommendations fit into your present treatment plan?” rather than whether they agree/disagree.

La Familia (The Family)

• The family is central to social networks and decision making in this culture
   
• Patients may bring family to appointments. Be certain to ask to whom medical results should be given and who is included in the treatment plan
   
• Eldest male may be key decision maker. Respect these family preferences in clinical encounters

Other

• Due to issues of modesty –patients may want same sex caregiver. Be sure to ask as patients may be reluctant to do so out of deference.
   
• “Con permiso” – (“with your permission”) As mentioned in the general recommendations, it is always important to respect patients by asking for permission before touching or proceeding with examinations/procedures

Religion

• Many patients have strong spiritual beliefs and may wish to include clergy in their care
   
• As many Latinos are Catholic, churches are often a good vehicle for outreach initiatives

Complementary and Alternative Medicine

Folk Medicine . . .

• Especially with recent immigrants, there may be a disposition to using folk medicine
   
• Folk medicine may include herbal remedies or eating of hot/cold foods to restore an imbalance
   
• Many patients may automatically incorporate curanderos or espiritistas (spiritual healers) as part of their care
   
• Be certain to ask patients what treatment options they are pursuing in addition to conventional medicine

Etiology / Health beliefs . . .

• Patient education may be required. In many cases, Latinos may view fat as healthy and strong contrary to many concerns regarding cholesterol, cardiovascular issues, diabetes, etc.
   
• These patients may hold beliefs in mind-body connections
   
• Be certain to elicit patient health beliefs when using the LEARN model

Definition of Terms Used

Curandero/a and espiritistas are traditional healers in Mexican American and other Latino/Hispanic cultures.

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