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Culturally Competent Planning

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Cultural health beliefs and related behaviors among racial and ethnic minorities are often hidden from mainstream health professionals and may hinder efforts to eliminate health disparities in the United States (Rahill & Rice, 2010). Studies have shown that health problems facing newly arrived Haitian immigrants are not adequately attended to apparently due to cultural health factors that prevents these immigrants from seeking modem health care ((Woart, 1997). For example, there is evidence that Haitians experience substantially higher incidence of some cancers, have low rates of cancer screening, and are often diagnosed at later stage of disease, as compared with other racial and ethnic groups in the United States (Allen, Mars, Tom, & Apollon, 2013). Haitians encounter distinctive barriers to health services, which places them at risks for being underserved. Language barriers, unfamiliarity with preventive care, confidentiality concerns, mistrust and stigma concerning Western medicine, and a preference for natural remedies (Allen, Mars, Tom, & Apollon, 2013), all account for barriers to health services for the Haitian population. Newly migrated Haitians also fear seeking healthcare may jeopardize their opportunities to stay in the United States.
There are numerous health concerns within the Haitian American community. With the Haitian American population growing quickly, it is imperative that nurses are cognizant of these concerns, and are able to adequately care for these patients. It is known that Haitians commonly suffer from cardiovascular disease, Type II diabetes, hypertension and obesity. 12-18% of Haitians have metabolic syndrome compared to 32% of the overall American population. When compared to US born Blacks, Haitian women are diagnosed with advanced invasive cervical cancer at a higher rate. Mental health is also a very important health concern as many Haitians rarely consult mental health professionals for psychological and emotional disturbances; instead, they consult with family, clergy and/or Voodoo practitioners. Additional health concerns include sexually transmitted infections. Haitian Americans have been found to have high incidences of sexually transmitted diseases, including HIV/AIDS, as well as cancer and tuberculosis (Cook Ross Inc, 2003).
Although there are many high-quality electronic sources of health care information to address the needs of the Haitian community, electronic sources with the capacity to translate to Creole are sparse. The Center for Disease Control and Prevention website contains valuable information including risk factors, prevention, and disease management of hypertension, diabetes, and dyslipidemia, all of which as aforementioned, are a concern to this population. Unfortunately, this website does not accommodate for non-English reading Haitians. The U.S. committee for refugees and immigrants website includes a multitude of useful information about sexually transmitted infections, tuberculosis, obesity, diabetes, and heart disease. Unlike the CDC website, the U.S. committee for refugees and immigrants website allows for information to be translated to Haitian Creole.
There are various resources in the South Florida community for the Haitian population. The Center for Haitian Studies, Health, and Human Services, Inc. (CHS) is a duly registered Florida non-profit corporation, which provides health and social services to the underserved populations of Miami-Dade County. In keeping with its mission, CHS provides a wide range of services including health education, research, primary health care, obstetrical and gynecological care, pediatric care and mental health care services. CHS, in collaboration with the Department of Community Service (DOCS) of the University of Miami Miller School of Medicine conducts an annual health fair on the grounds of CHS. This health fair attracts between 300 and 500 members of the community who, for the most part, have no other means of receiving this type of specialized care from the best specialists in South Florida (Center for Haitian Studies, 2015). Another advantageous resource to the Haitian community in South Florida is the Sant La. Sant La promotes access to health care services through a number of programs. These programs include Community Health Workers, who do outreach and connect clients to necessary health services in the Haitian community. Sant La also provides client assistance in preparing Medicaid and Kidcare applications in office and at Health fairs (Sant La, 2015).
Coupled with low levels of literacy among some Haitians and other language barriers, media outlets may be ideal sources for disseminating health information to large audiences. As one radio host asserted, "Radio is the bridge to the community” (Allen, Mars, Tom, & Apollon, 2013). When asked where they would go to find out about health care, in a 2004 study conducted by Florida Atlantic University, Haitians conclusively chose their Haitian radio station. Participants suggested radio, TV, adult program, churches, and health fairs in churches to disseminate health information to the Haitian population (Florida Atlantic University, 2004). In collaboration with Haitian doctors and nurses in the community, health fairs held at churches promoting health and wellness would be of benefit to the Haitian community. Radio live streaming, available for those unable to meet at these health fairs would expand the number of people receiving the information. After information sessions, a question and answer segment would ensue. In social settings, tardiness is commonplace and often expected in the Haitian community (Cook Ross Inc, 2003). Perhaps allowing a few extra minutes past expected start time would profit the health fairs. In accommodation to the Haitian adults, an area designed for children (away from the adults) would be suitable. Haitian adults prefer not to share space with children, believing that children should not be within hearing distance of adult conversations (Cook Ross Inc, 2003). Cultural competence in health care is crucial to providing efficacious individualized care. A transcultural caring perspective is now considered essential for nurses and other healthcare professionals to deliver quality health care to all clients (Blais & Hayes, 2011). When providing care to the Haitian client, healthcare professionals must be culturally sensitive, taking into consideration the health care beliefs of this underserved population. The nurse must also be cognizant about the diverse barriers faced by this population and provide accommodations when necessary.

References:
Allen, J., Mars, D., Tom, L., & Apollon, G. (2013). Health Beliefs, Attitudes and Service Utilization among Haitians. Journal of Health Care for the Poor and Underserved, 24(1), 106-19. Retrieved from http://search.proquest.com.library.capella.edu/docview/1372487304?accountid=27965
Blais, K., & Hayes, J. S. (2011). Nursing in a Culturally Diverse World. In Professional nursing practice: Concepts and perspectives (6th ed., pp. 380-403). Boston: Pearson.

CDC. (2015). High Blood Pressure Educational Materials for Patients | cdc.gov. Retrieved from http://www.cdc.gov/bloodpressure/materials_for_patients.htm

Center for Haitian Studies. (2015). Center for Haitian Studies - Since 1988. Retrieved from http://www.centerforhaitianstudies.org

Cook Ross Inc. (2003). Background on Haiti & Haitian Health Culture [PDF]. Retrieved from http://www.med.navy.mil/diversity/Documents/2010%20Haiti%20backgrounder.pdf

Florida Atlantic University. (2004). Perceptions of Access to U.S. Health Care of Haitian Immigrants in South Florida. Florida Public Health Review, 1, 30-35.

Rahill, G. J., & Rice, C. (2010). Correlates of Picuriste Use in a Sample of Health-Seeking Haitian Immigrants and Adult Children of Immigrants in Miami-Dade County, Florida. American Journal of Public Health, 100(1), 140-145. doi:10.2105/AJPH.2009.162479
Sant La. (2015). Services. Retrieved from http://santla.org/index.php?option=com_content&view=article&id=41&Itemid=173

USCRI. (2015). Haitian Creole. Retrieved from http://www.refugees.org/resources/for-refugees--immigrants/health/healthy-living-toolkit/haitian-creole.html

Woart, A. (1997). Cultural health beliefs, health care pluralism, and patterns of health care utilization among Haitian immigrants in Metropolitan Boston (9722661) (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (9722661)

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