What is cultural competence
The Purnell model for cultural competence is a complexity and holographic theory that includes an organizing framework and a model that all healthcare providers can use in various settings and disciplines. The model takes the form of a circle with an outer layer and several inner rims. It has 12 cultural constructs that act as the organizing framework for the model (Purnell, 2003). This essay will list each of the 12 domains and describe the characteristics of a selected group in that domain. The paper will then address a health risk common to that group and illustrate how assessment data can help in formulation of culturally competent primary prevention strategies.
The 12 domains and its characteristics Haitian Immigrants
1. Inhabited localities and topography
Haiti is a country located in the Hispaniola Island. Its only neighboring country is the Dominican Republic. Geographically, the country is smaller than Maryland. Its climate is tropical and the terrain is predominantly mountainous.
French is the business language in the country while Haitian Creole is the social language. The Creole is rarely written as it has an underdeveloped writing system.
3. Family roles and organization
Even though the man has the ultimate control of the family, the Haitian society is highly matriarchal. However, when Haitians migrate to the US, the relationships grow into an egalitarian one. However, singe-parenthood is rampant in Haiti. Single mothers have to support their families which mean that most women earn a wage. When they migrate to the US, Haitians stay with relatives. Their generosity means that Haitian families in the US are ready to accept refugees.
4. Workforce Issues
Haiti has strictly defined gender roles. For example, in healthcare settings, most physicians are men while most women serve as nurses. A man would expect his female colleague to serve him beverages at the workplace without any hesitation. Women working as nurses are less likely to confront a male physician even when it is necessary. When they migrate to the US, women find jobs faster than men leading to reversal of roles that may lead to family conflict. In the US, Haitians work as low-skilled laborers especially in the service industry..
5. Bicultural ecology
Haitians highly resemble African Americans, but they don’t identify with them. Their life expectancy is 49.5 years (Charles, 2000). The diseases that are common among them include malnutrition, cervical and gastrointestinal cancer, diarrheal diseases, vector borne diseases, like malaria and dengue, diabetes, hypertension, and sexually transmitted diseases
6. High Risk Behaviors
Acceptance of male polygamous lifestyle of men has led to high prevalence of sexually transmitted diseases in Haiti. This is aggravated by the fact that most men do not like using contraceptives. Additionally, Haitians rarely exercise, making them prone to lifestyle diseases like hypertension, and diabetes. 67 percent of the population is overweight. Obesity is a sign of wealth and health in Haiti (Charles, 2000). Smoking is another high risk behavior. 30 percent of Haitians smoke tobacco. Haitians rarely seek medical attention from biomedical practitioners unless the symptoms are very severe.
Due to economic constraints, malnutrition is common in the country. Lunch is the heaviest meal of the day. The country’s cuisine has both African and French Influences.
8. Pregnancy and childbearing practices
In Haiti, pregnancy is not viewed as an illness meaning that women rarely seek prenatal care. Sexual activity is not restricted during pregnancy (Charles, 2000). Pregnant women are not allowed to eat spicy food. Also, Haitian women rarely take pain medication during labor. There are poor breastfeeding practices among Haitian women due to the belief that breast milk causes several diseases
9. Death Rituals
When someone dies, the entire extended family is involved. The oldest member of the extended family takes charge of funeral preparations. The body cannot be taken anywhere before the entire family gathers. Haitians do not prefer cremation due to their belief in resurrection. The mourning period takes seven days.
80 percent of Haitians are Catholics while 16 percent are Protestants. Haitians are highly religious since religion helps in the maintenance of their cultural identity. However, Voodoo is considered the national religion of Haiti as almost all people practice Voodoo.
11. Healthcare Practices
Due to the prevalence of Voodoo in Haiti, diseases are believed to have both natural supernatural causes. Urban migrants are more receptive to modern medicine while rural ones prefer traditional medicine (Charles, 2000). Traditionally, they get concerned about an illness only when it compromises their ability to work. Thus, they seek medical attention when an illness has already progressed. Haitians do not believe in preventative care.
12. Healthcare practitioners.
Haiti has a wide variety of ethno-medical or traditional health care practitioners. These include bone-setters, herbalists, voodoo practitioners, and midwives.
Culturally Competent Primary Prevention Strategy for STDs among Haitian Immigrants
One of the most common health risks among Haitians is sexually transmitted diseases due to the polygamous nature of males in the Haitian society and their disinterest in contraceptives. Furthermore, those suffering from sexually transmitted diseases stop taking antibiotics or antiretroviral drugs once the symptoms subside, exposing them to adverse health effects. The data obtained from this community can be used to develop a culturally competent primary prevention strategy designed to target and modify both the sexual and drug taking behavior of the Haitians. Behavioral interventions would focus on reducing risky behaviors rather than promoting good sexual health. These include dissemination of knowledge about how STDs are transmitted and the situations that put persons at risk of contracting STDs. The culturally competent primary prevention strategy would also focus on changing attitudes about the use of contraceptives, teaching condom use skills and condom use negotiation skills (Pacquiao, 2000). The outcome objectives include reduction of risky sexual behaviors such as unprotected sex and having multiple partners.
The Purnell model for cultural competence is efficient since it can be used by healthcare practitioners in multiple settings and disciplines to deal with culture-based public health issues. This paper has demonstrated how it can be used to create a culturally competent primary prevention strategy for dealing with the high incidence of STDs among Haitian immigrants caused by culturally oriented behavioral problems. The model would target behavior change among the immigrants with a view of reducing risky behaviors and attitudes that make this vulnerable to STDs.
Charles, A. (2000). Haiti in Focus: A Guide to the People, Politics, and Culture. Northampton, MA: Interlink Publishing Group
Pacquiao, D. (2000). Impression management: An alternative to assertiveness in intercultural communication. Journal of Transcultural Nursing, 11(1), 5-6.
Purnell, L. (2003). Transcultural diversity and health care. In L. Purnel and B. Fulanka (Eds.), Transcultural health care: A culturally; competent approach, (2 ed.,pp. 1-7). Philadelphia, PA: F A. Davis
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