Culture plays a key role in our ability to influence behavior in a patient. We cannot afford to let cultural barriers limit our ability to meet the needs of our patients, or reduce their opportunity to benefit from the services we can provide. Perhaps nowhere are cultural differences more sharply drawn than in our approaches and definitions of health and healthy living. By deepening our understanding of culture we can strengthen the promise of high-quality primary health care that is accessible, effective, and cost efficient for all patients.

Involve family members

Hispanic families traditionally emphasize interdependence over independence, and cooperation over competition. Family members are more likely to be involved in the treatment and decision-making process for a patient. Allow for several family and friends to participate in a consultation, and communicate with the group. The patient may not be the key decision-maker for describing symptoms, deciding among treatment options, or complying with recommended treatment. Determine the matriarch and patriarch, and notice if the acculturated children or non-family members are the spokespeople.

Show respect

Always be respectful, and explain without condescending. Health providers, as authority figures, need to take seriously the responsibility and respeto conferred on them by many Hispanic patients. One way Hispanics show respect is to avoid eye contact with authority figures. Do not misinterpret this respectful behavior as a sign of disinterest. Address elders in traditional ways (such as below eye level if you’re younger than they are), and be mindful of parents and elders when an acculturated child or a health mediator is the spokesperson. The older Hispanic adult patient may terminate treatment if he or she perceives that respect is not being shown.

Indirectly ask personal/private questions about alcohol use, mental problems, violence, stressors, or sexual practices. Ask for a description of what was first heard and experienced. Or ask indirect questions such as "How often does your husband go out?" or "Have you seen ads about the use of condoms?"

Get personal

Hispanics typically prefer being closer to each other in space than non-Hispanic whites do. When non-Hispanic providers place themselves two feet or more distance away from their Hispanic patients, they may be perceived as not only physically distant but also uninterested and detached. Overcome such perceptions by sitting closer, leaning forward, giving a comforting pat on the shoulder, or other gestures that indicate an interest in the patient.

Ask about their life (family, friends, and work) and share life stories and pictures. Converse with all of the family members present, but be respectful of gender. Do not give an impression of being too familiar, however. Make personal notes in medical records to cue other providers of family names or special events to discuss during another visit.

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