Filipino Cultural Characteristics

and Health Care Beliefs and

Practices in Health Education
Objectives

 Know the different definitions of culture.

 Educate about the Filipino culture and community.
 Educate about the Filipino health practices and beliefs.
 Discuss nursing interventions related to the Filipino culture.
 Culture

 “Totality of socially transmitted pattern of thoughts, values, meanings, and beliefs”

(Purnell 2005).
 It is not limited to any specific ethnic group, geographical area, language, religious
belief, manner of clothing, sexual orientation, and socioeconomic status (Fisher 1996). 
 “Culture is inscribed in our bodies and in our minds” (Tan 2008).
 “The relationship of culture and health is important to understand as it impacts an
individual’s worldview and decision-making process (Purnell 2005).
 Like in other fields of medicine, the impact of cultural beliefs is increasingly being
recognized as an essential component in the genetic counselling process (Cohen et al. 
1998; Edwards et al. 2008; Penn et al. 2010).
Filipino Culture

 Being an archipelago consisting of 7,107 islands, cultural influence in the

Philippines is important to recognize given the existence of 175 ethnolinguistic
groups each with their own unique cultural identity and health beliefs and practices
(Summer Institute of Linguistics 2012).
 Evolved as a mixture of indigenous as well as imported and borrowed elements.
 The cultural background of Filipino nurses may have a strong influence on their
selection of nursing as a profession, because caring for others is emphasized and
valued, especially among females.
Cultural Awareness

 Cultural awareness is a prerequisite prior to achieving cultural competency. It is

the understanding that a cultural divide exists between the patient and health
professional (Winkelman 2009). 
 Cultural awareness is the first step towards gaining intercultural competences.
  Observing and being conscious of similarities and contrasts between cultural
groups. In medicine, we are especially interested in the way in which culture may
affect different people's approach to health, illness and healing.
Cultural Sensitivity

 Being aware that cultural differences and similarities between people exist
without assigning them a value – positive or negative, better or worse, right or
wrong.
 Is a set of skills that enables us to learn about and understand people who are
different from ourselves, thereby becoming better able to serve them within their
own communities.
Cultural Competence (also known as cultural
responsiveness, cultural awareness, and cultural
sensitivity)

 Refers to a person’s ability to interact effectively with persons of cultures different from his/ her
own.
 With regard to health care, cultural competence is a set of behaviours and attitudes held by
clinicians that allows them to communicate effectively with patients of various cultural
backgrounds and to plan for and provide care that is appropriate to the culture and to the
individual.
 Cultural competence is a key aspect of nursing practice because nurses care for patients of many
different cultural backgrounds. Nurses should have knowledge of cultural beliefs, attitudes, and
traditions of the patients and families they serve in order to communicate effectively and plan
and provide appropriate, individualized patient care
 Cultural safety

Is an approach to medicine that goes beyond cultural sensitivity and competence to include several additional
layers of commitment: 
 (1) Self-reflection on the part of the practitioner, which is fundamental to understanding the power
differentials inherent in health service delivery. It acknowledges that we are all bearers of culture and that
our actions can easily damage culture, just as a callous remark can cause emotional harm.
 (2) Taking a cultural safety approach implies a health advocacy role: working to improve health care access;
exposing the social, political, and historical context of health care; and interrupting unequal power relations.
 (3) It also implies awareness that the patient exists simultaneously within several health care systems: the
influence of their family, community and traditions. These will interact with, and possibly conflict with, your
interventions.
Cultural humility

 Redefines cultural competency as an ongoing process, involving a life-long

commitment to self-evaluation and self-critique: we must be willing to learn and
to maintain humility in our approach to patients.
 Cultural humility also implies a desire to fix power imbalances: recognizing and
addressing the possibly divergent perspectives at play in a physician-patient
encounter.
Transcultural Nursing

 A humanistic and scientific area of formal study and practice in nursing which is

focused upon differences and similarities among cultures with respect to human
care, health, and illness based upon the people's cultural values, beliefs, and
practices, and to use this knowledge to provide cultural specific or culturally
congruent nursing care to people ..Leininger (1991) notes the main goal of
transcultural nursing is to provide culturally specific care.
Explanatory models (EM) of Illness 

 Provides a framework on the understanding of a patient on the cause of his/her

illness, and this may include the meanings and values he/she associates with the
condition (Winkelman 2009; Kleinman et al. 1978).
 Eliciting the EM of genetic illnesses is an important first step since it ensures that
the patient and the health care provider (e.g., genetic counselor) are
communicating in the same contextual framework, thus minimizing the cultural
barrier that initially exists between the two (Winkelman 2009; Abad 2012).
Traditional Perceptions of Health and Illne
ss
(Philippines)
 Definition of health is considered to be in a state of balance.
- Factors that play a role in balance include hot and cold factors, food, and diet.
Balance is a key concept in the Filipino culture. It is also referred to as Timbang and relates to hot and
cold shifts and diet. When there are too many hot and cold shifts, then the person may become ill
(McBride, n.d.).
Balance is disrupted when a person becomes ill. Another factor that can affect the balance of someone is
sudden changes in weather patterns (McBride, n.d.)
 Illness is when the body, mind, and spirit are out of balance or when the person and the
environment are in a sense of disharmony (Spector, 2013, p. 86).
According to the Filipino population, illness is also defined as the body being out of balance
which usually pertains to a rapid change in hot and cold (McBride, n.d.)
Three Theories of Illness

 Mystical Theory
- Is that if there are unfulfilled obligations from ancestors then this could result in mystical
experiences and behaviours. It also goes as far to say that during sleep the soul can be lost or if you
are having nightmares then they are often the result of consuming a heavy meal and it could
eventually lead to death (McBride, n.d.).
 Personalistic Theory
- is that evil spirits or witches seeking retribution or social punishment can cause illness. This theory
can be protected by wearing religious objects or using holy oils (McBride, n.d.).
 Naturalistic Theory
- This theory states that stress, infection, food and drugs, and natural events such as thunder,
lightning, and drafts are all causes of illness (McBride, n.d.).
Birthing and Postpartum Beliefs and Rituals

 Taking vitamins could deform the fetus and therefore many women do not take any
vitamins while they are pregnant (Purnell, 2009, p. 137).
 Another belief is that certain foods can cause the baby to develop different ways or
have skin marks. An example of this is the belief that if women eat blackberries while
they are pregnant, the baby will have black spots on them (Purnell, 2009, p. 137).
 There are also many beliefs about spirits and bad luck. For example, funerals are
often avoided while pregnant because there is a belief that the spirits of the dead
possibly affecting the baby (Purnell, 2009, p. 137).
 Another belief is that if you either name the baby before it is born or name it after a
dead person then it is bad luck (Purnell, 2009, p. 137).
 It is a common belief for women that the delivery will be difficult if they sit by a doorway (Purnell,
2009, p. 137).
 Along with this, many women who are from rural regions prefer the squatting position during the
birthing process (Purnell, 2009, p. 137).
 Mothers are encouraged to eat hot soups around the time of breast feeding because it is believed to
promote milk production (Purnell, 2009, p. 138). This ritual goes along with the hot and cold beliefs
that are important for maintaining health in the Filipino population.
 For the first month after the baby is born, the only place that the mother and baby are supposed to go
is to the doctor (Purnell, 2009, p. 138).
 In order to ward off evil spirits, a rosary, garlic, or salt is placed near the baby's crib (Purnell, 2009,
p. 138).
 Common Filipino Cultural Beliefs 

Filipino word depicting cultural beliefs English translation

Namamana Inheritance
Lihi Conception or maternal cravings
Pasma Hot and cold syndrome
Sumpa and gaba Curse
Namaligno Mystical and supernatural causes
Kaloob ng Diyos God’s will
Inheritance (Namamana)

 Acquiring a behavioural or disease trait from a parent. It is a belief that when a

relative has the condition, it is possible that he/she will pass on the trait to the
younger generation.
 The passing on of a trait to the younger generation.
Conception or maternal cravings (Lihi)

 During the lihi period, also referring to the first trimester of pregnancy, the

pregnant woman experiences a number of physical discomforts including feelings
of dizziness, nausea, irritability, and general weakening of the body (Jocano 1973
). It is also during this time that the pregnant woman develops intense craving for
certain foods and intense liking for certain objects.
 It is believed that an offspring will take the features of the food that the mother
has craved for while she is in the lihi period. 
 Hot and Cold Syndrome (Pasma)
 The interaction of hot and cold elements is the basis of the pasma concept (Tan 2008)
 Pasma is roughly defined as an “exposure illness” which occurs when a condition considered to be “hot” is
attacked by a “cold” element and vice versa (Tan 2008). 
 An individual’s homeostasis is attained by a balance between the hot and cold elements, and an illness is
caused by a dominance of either hot or cold. 
 Childbirth and the process of delivering a baby are considered by the Filipino folk belief as “dangerously
hot” in nature (Tan 2008).
 It is a belief that childbirth leaves the woman with open pores making the mother susceptible to the
entrance of “lamig” or “hangin” which are elements of cold. Manifestations of this will depend on where
the lamig settles in the woman’s body and results in pasma or the palpable “knots” in muscles or
subcutaneous tissues (Jocano 1973; Tan 2008).
 In post-partum psychosis, or colloquially known among Filipinos as nabaliw, the cold elements
of lamig or hangin settles in the mind causing post-partum depression and psychosis disrupting well-being.
Curse (Sumpa and Gaba)

 In sumpa, the curse is inflicted by a human being.

 In contrast, gaba is a curse inflicted by a divine being and it is usually God.
 This is inflicted to a person because he/she committed a social sin.
 The impact of sumpa and gaba is shared with the whole family and extends to the
next generation (Tan 2008). To end its effect, the inflicted person and family
members may pursue ritualistic activities and wear amulets.
Mystical and Supernatural Causes (Namaligno)

 Namaligno is a Filipino belief that a disease is caused by an

intervention of a supernatural or a mystical being (Abad 2013). 
 Namaligno is used as an explanation in conditions which remain to be
mysteries because of the absence of an apparent cause.
God’s Will (Kaloob ng Diyos)

 When a Filipino individual experiences an unexpected event in their life, whether

negative or positive, it is typically attributed to the grace of God.
 Highlights the Filipino value of religiosity and faith to a higher being, as someone
who is all-knowing and almighty.
 Should not be seen as a weakness on the part of the patient but willingness to
offer his/her predicament to God to attain a higher level of enlightenment. This is
quite similar to the Filipino attitude of bahala na. For both kaloob ng
Diyos and bahala na, what actually happens is that people do whatever they can
and then resign themselves to whatever will happen (Tan 2008).
Filipino Health Practices

 Traditional forms of self medication

- Oils or ointments, which serve as cure in relaxing, heating, and comforting the muscles or providing
relief for dizziness, colds, headaches, sore throats, and so forth .
 Folk healing techniques

- Ventosa is used for treating joint pains believed to be caused by the presence of bad air. 
 Alternative therapy
- People go for Hilot for relief of pain and aches instead of seeking medical attention. In an alternative
context, Hilot may refer to a practitioner or the practice of chiropractic manipulation and massage for
the diagnosis and treatment of musculoligamentous and musculoskeletal ailments.
 Home remedies
 Form of medicinal plants are also popular for Filipino nurses who believe that plants can heal
common ailments.
 Readily available and cheap.
 Seeking the help of a local healer who may utilize a variety of treatments including the use of
herbs and roots (McKenzie and Chrisman, 1977)
- Various types of healers common throughout the Philippines include midwives, masseurs, and
specialists for supernaturally caused ailments.
 Hilot
- Uses three forms of treatment: faith healing through prayer, herbal medicines, and massage and body
manipulation
Health Beliefs and Behaviors: Health
Promotion/Treatment Concepts

 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.
Health Beliefs and Behaviors: Health Behaviors

 Response to Illness
 Filipino older adults tend to cope with illness with the help of family and friends, and by faith in
God.
 Before seeking professional help, Filipino older adults 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.
 Utilizing traditional home remedies such as alternative or complimentary means of treatment
(Yeo, 1998)
Coping Styles

  Patience and Endurance (Tiyaga): the ability to tolerate uncertain situations

 Flexibility (Lakas ng Loob): being respectful and honest with oneself
 Humor (Tatawanan ang problema): the capacity to laugh at oneself in times of
adversity
 Fatalistic Resignation (Bahala Na): the view that illness and suffering are the
unavoidable and predestined will of God, in which the patient, family members
and even the physician should not interfere.
 Conceding to the wishes of the collective (Pakikisama) to maintain group
harmony.
 Responses to Mental Ilness
  Devastating shame (Hiya)
 Sensitivity to criticism (Amor Propio)
Common Perceptions of Filipinos about Mental
Illness

 Unwillingness to accept having mental illness, which leads to the avoidance of needed mental health
services due to fear of being ridiculed.
 Involvement of other coping resources such as reliance on family and friends or indigenous healers, and
dependence on religion which can diminish the need for mental health services.
 Prioritizing of financial and environmental needs which preclude the need forh mental health services.
 Limited awareness of mental health services resulting in limiting access.
 Difficulty in utilizing mental health services during usual hours because of the unavailability of
working adult family members.
 Mental illness connotes a weak spirit, and may be attributed to divine retribution as a consequence of
personal and ancestral transgression.
 Lack of culturally oriented mental health services.