Customize health education incorporating Filipino beliefs and practices

Topic Outcomes:

A. Discuss the importance of Cultural Competence

B. Enumerate and give examples of health beliefs, behaviors, and responses toillness
C. Identify the teaching strategies appropriate for Filipinos
Topic outline:

1. Purnell Model of Cultural Competence

2. Health Beliefs and Behaviors
3. Response to Illness
4. Teaching Strategies

Filipino Cultural Beliefs and Practices in Health Education

Madeleine Leininger, a noted proponent of Transcultural Nursing, posed a question

that remains relevant today: How can nurses competently respond to and effectively care for
people from diverse cultures who act, speak and behave in ways different than their own?
Studies indicate that nurses are often unaware of the complex factors influencing patients’
responses to health care. To keep pace with a society that is becoming increasingly more
culturally diverse, nurses need to have sound knowledge of the cultural values and beliefs of
specific subcultural ethnic groups as well as incorporate transcultural nursing into practice by
recognizing and appreciating differences in individual health care customs and preferences.
(Bastable, 2017) Lack of cultural sensitivity by nurses and other health care professionals have
the potential to waste resources which can also lead to misdiagnosis or other problems.

The Purnell model for Cultural competence represents a popular organizing

framework for understanding the complex phenomena of culture and ethnicity. (Purnell 2013).
He proposed many factors that may affect an individual’s ethnic group. He identifies these
factors as Primary and secondary characteristics of culture.

Primary Characteristics:
 1. Nationality
2. Race
3. Color
4. Gender
5. Age
6. Religious Affiliation

Secondary Characteristics:

Person’s attributes – socioeconomic status, physical characteristics, educational

status, occupational status, and place of residence whether urban or rural.

The Purnell Model depicted in a circle format includes the layers of the following
concepts:
1. Global society – outermost sphere
2. Community – second sphere
3. Family – third sphere
4. Individual – innermost sphere

12 Domains

1. Communication (e.g. dominant language and non - verbal expressions and

cues)
2. Family Roles and organization (e.g. head of the household, gender roles,
developmental tasks, social status, alternative lifestyles, roles of older
adults)
3. Workforce issues (e.g. language barrier, autonomy, acculturation)
4. Biocultural ecology (e.g. heredity, biological variations, genetics)
5. High – risk behaviors (e.g. smoking, alcoholism, physical activity, safety
practices)
6. Nutrition (e.g. common food, rituals, deficiencies, limitations)
7. Pregnancy (e.g. fertility, practices, views toward childbearing, beliefs
about pregnancy, birthing practices)
8. Death rituals (e.g. views of death, bereavement, burial practices)
9. Spirituality (e.g. religious beliefs and practices, meaning of life, use of
prayer)
10. Healthcare practices (e.g. traditions, responsibility of health, pain control,
sick role, medication use)
11. Healthcare practitioners (e.g. folk practitioners, gender issues,
perceptions of providers)
12. Overview/ heritage (e.g. origins, economic status, education,
occupation)

As the diversity in the patient population is growing, there is also an increasing number of diverse
caregivers. Among them are the Filipino health care providers, most of whom are nurses.
Understanding the culture, health care beliefs, and practices of Filipino nurses is important, as it
affects the way they assess the needs and provide care for their clients.

Health Beliefs and Behaviors: Indigenous Health Beliefs

Concept of Balance (Timbang)

This concept is central to Filipino self-care practices and is applied to all social relationships and
encounters. According to this principle, health is thought to be a result of balance, while illness due
to humoral pathology and stress is usually the result of some imbalance. Rapid shifts from “hot” to
“cold” cause illness and disorder. Illustrated below are a range of humoral balances that influence
Filipino health perceptions:

• Rapid shifts from “hot” to “cold” lead to illness

• “Warm” environment is essential for maintaining optimal health
• Cold drinks or cooling foods should be avoided in the morning
• An overheated body is vulnerable to disease; a heated body can get “shocked”
• When cooled quickly, it can cause illness
• A layer of fat maintains warmth, protecting the body’s vital energy
• Imbalance from worry and overwork create stress and illness
• Emotional restraint is a key element in restoring balance
• A sense of balance imparts increased body awareness (Adapted from Becker, 2003).

Health Beliefs and Behaviors: Theories of Illness

Physical and mental health and illness are viewed holistically as an equilibrium model. In contrast, other
explanatory models may include mystical, personalistic and naturalistic causes of illness or disease
(Anderson, 1983; Tan, 1987; Tompar-Tiu & Sustento-Seneriches, 1995).

Mystical Causes

Mystical causes are often attributed to experiences or behaviors such as ancestral retribution for
unfinished tasks or obligations. Some believe that the soul goes out from the body and wanders, a
phenomenon known as Bangungot, or that having nightmares after a heavy meal may result in death.

Personalistic Causes

Personalistic causes are associated with social punishment or retribution from supernatural forces such
as evil spirit, witch (Manga ga mud) or sorcerer (mangkukulam). The forces cast these spells on people if
they are jealous or feel disliked. Witch doctors (Herbularyo) or priests are asked to counteract and cast
out these evil forces through the use of prayers, incantations, medicinal herbs and plants. For protection
the healer may recommend using holy oils, or wearing religious objects, amulets, or talismans (anting
anting).

Naturalistic Causes

Naturalistic causes include a host of factors ranging from natural forces (thunder, lightning, drafts, etc.)
to excessive stress, food and drug incompatibility, infection, or familial susceptibility.
 Health Beliefs and Behaviors: Basic Logic of Health and Illness

The basic logic of health and illness consists of prevention (avoiding inappropriate behavior that leads
to imbalance) and curing (restoring balance); it is a system oriented to moderation. Parallel to this
holistic belief system is the understanding of modern medicine with its own basic logic and principles
for treating certain types of diseases. These two systems co-exist, and Filipino older adults use a dual
system of health care (Anderson, 1983; Mc Bride, 2006; Miranda, Mc Bride & Spangler, 1999).

Health Beliefs and Behaviors: Health Promotion/Treatment Concepts

Health beliefs and practices are oriented towards protection of the body.

Flushing

The body is thought to be a vessel or container that collects and eliminates impurities through
physiological processes such as sweating, vomiting, expelling gas, or having an appropriate volume of
menstrual bleeding.

Heating

Adapts the concept of balanced between “hot” and “cold” to prevent occurrence of illness and
disorders.

Protection
Safeguards the body’s boundaries from outside influences such as supernatural and natural forces.

Response to Illness

Filipinos tend to cope with illness with the help of family and friends, and by faith in God. Complete cure
or even the slightest improvement in a malady or illness is viewed as a miracle. Filipino families greatly
influence patients’ decisions about health care. Patients subjugate personal needs and tend to go along
with the demands of a more authoritative family figure in order to maintain group harmony. Before
seeking professional help, Filipinos tend to manage their illnesses by self - monitoring of symptoms,
ascertaining possible causes, determining the severity and threat to functional capacity, and
considering the financial and emotional burden to the family.

They may even resort to utilizing traditional home remedies such as alternative or complimentary
means of treatment. They may discuss their concern with a trusted family member, friend, spiritual
counselor or healer (Yeo, 1998). Seeking medical advice from family members or friends who are health
professionals is also a common practice among Filipino older adults and their family members,
especially if severe somatic symptoms arise (Anderson, 1983).

Teaching Strategies (Bastable, 2017):

Among Asians/ Pacific Islanders, respect is automatically given to most healthcare providers who are
seen as knowledgeable. Asians are sensitive and formal, so using a nonthreatening approach is
necessary before caring for them. They must be given permission to ask question but are no
offended by questions from others. Language barriers are usually the first and biggest obstacles to
overcome in working with them.

Their approach to learning involves repetition and rote memorization of information. The learning
style of Asians is essentially passive – no personal opinions, no confrontations, no challenges and no
outward disagreements. Nurses should be aware that in the Asian’s wish to save face for themselves
and others, they avoid being disruptive and will agree to what is said.

Decision making, however, is a family affair, Family members, especially the male authority figure

Must be included in identifying the best solution for a situation. Questions need to be asked in
several ways to confirm what they understand any instructional messages given.