Why culture and language matter: the clinical consequences of providing culturally and linguistically appropriate services to children in the emergency department

doi:10.1016/j.cpem.2004.01.004

Clinical Pediatric Emergency Medicine

Volume 5, Issue 2, June 2004, Pages 76-84

https://doi.org/10.1016/j.cpem.2004.01.004 Get rights and content

Abstract

As the proportion of racial, ethnic, and cultural minorities in the United States continues to expand, pediatric emergency medicine providers are increasingly likely to encounter cultural and language barriers in practice. This paper reviews a conceptual framework encompassing the decision to seek emergency care, the process of providing such care, and the adherence to treatment plans and follow-up. The ways in which cultural and language barriers can negatively impact each element of this model are discussed in detail. Specific examples include provider ignorance of dangerous folk beliefs, communication barriers secondary to inappropriate interpreter use, and discriminatory assumptions regarding child abuse, pain management, and sexual activity. The practitioner is then provided with concrete recommendations to reduce these negative effects.

Section snippets

Conceptual model

Figure 1 summarizes how culture and language affect children’s access to and use of emergency services. The process of emergency care begins with recognition of a biomedical illness, and usually ends with follow-up by a patient’s primary care provider. In the 1960s, Anderson et al5 suggested that people’s use of health services is a function of their predisposition to use services, factors that enable or impede use, and their need for care. This model was later revised to include health

Parent recognition of biomedical conditions

Several folk illnesses can overlap with the signs and symptoms of biomedical conditions. For example, in Latino culture, there are several childhood folk illnesses that are believed to cause fever and other symptoms of biomedical illnesses. These include mal de ojo, mollera caida, and empacho.4 Mal de ojo occurs when a person with “strong eyes” intentionally or unintentionally looks at a child. The illness is believed to occur because an individual who secretly covets him or her has placed a

Accurate history and diagnosis

Multiple studies demonstrate the wide range of adverse consequences that limited English proficiency (LEP) can have on health and use of health services in the pediatric ED, including impaired health status,19, 20 a lower likelihood of having a usual source of medical care,19, 20, 21 non-adherence to medications,22 a greater likelihood of a diagnosis of more severe psychopathology and leaving the hospital against medical advice among psychiatric patients,23 a lower likelihood of being given a

Summary

This review highlights how culture and language can be clinically important in the emergency care of children. By providing culturally and linguistically appropriate services to children in the ED, clinicians can improve patient-provider communication regarding folk beliefs and practices, diagnostic evaluations, treatment plans, and follow-up. Enhancing communication through the use of trained interpreters can also improve the quality of emergency care for LEP parents and children and may

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Why culture and language matter: the clinical consequences of providing culturally and linguistically appropriate services to children in the emergency department

Abstract

Section snippets

Conceptual model

Parent recognition of biomedical conditions

Accurate history and diagnosis

Summary

J Pediatr

Soc Sci Med

Soc Sci Med

Soc Sci Med

J Pediatr

J Emerg Med

J Pediatr

Ann Emerg Med

J Adolesc Health Care

Chest

Am J Emerg Med

J Pediatr

Current Population Survey. Population by Sex, Age, Hispanic Origin, and Race: March 2000

Statistical Abstract of the United States1999

Yearbook of Immigration Statistics, 2002

Behavioral Model of Families’ Use of Health Services

Revisiting the behavioral model and access to medical careDoes it matter?

J Health Soc Beh

Clinical implications of a folk illnessEmpacho in mainland Puerto Ricans

Med Anthropol

The importance of cultural and linguistic issues in the emergency care of children

Pediatr Emerg Care

The use of folk healing and healers by six Latinos living in New EnglandA preliminary study

J Transcult Nurs

Utilization of curanderos among foreign born Mexican-American women attending migrant health clinics

J Cult Divers

Use of Native American healers among Native American patients in an urban Native American health center

Arch Fam Med

Lead poisoning from Mexican folk remedies—California

MMWR Morb Mortal Wkly Rep

Lead poisoning associated with use of traditional ethnic remedies—California, 1991–1992

MMWR Morb Mortal Wkly Rep

Language of interviewrelevance for research of southwest Hispanics

Am J Pub Health

Health care usage by Hispanic outpatients as function of primary language

West J Med

Racial/ethnic differences in children’s access to care

Am J Pub Health

Language concordance as a determinant of patient compliance and emergency room use in patients with asthma

Med Care

Studies in linguistic ambiguity and insecurity

Urban Health