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Influence of Culture on Healthcare

Influence of Culture on Healthcare


Improving client outcomes in the health sector needs to take into account the cultural background of patients to inform the best healthcare plan for the diverse patients.  To aid healthcare workers in serving the multicultural population, the Purnell Model for Cultural Competence was created in 1995 (Purnell, 2000).

I interviewed Miss Aiyana, a Native American of the Cherokee sub-group. She was born and brought up in Oklahoma and can trace her ancestors and their journey to America. The forty-three year old female patient speaks both English and the local language. Though she understands the English culture, she is aware of the Cherokee traditional cultural practices.

The Purnell Model

Cultural competence involves acquiring skills and knowledge to understand the culture of diverse patients and having an open mind that prevents the health professional from asserting undue influence of their own culture onto the patient’s medical plan (Purnell, 2003). This is especially important for cultures that would be considered minorities from the dominant cultures of a country.

The model contains twelve domains that help a medical professional to understand a patient’s cultural background before offering any medical advice or treatment (Purnell, 2003).


Heritage covers where a group lives and how that impacts on the health conditions of a patient. Sunny, windy, cold or humid areas create prevalence of certain diseases and health condition. Where do you live? “I live in Tennessee but I was born and brought up in Oklahoma until I was twenty-five. Both areas are generally characterized by high altitudes or woodlands and tend to be dry areas”


Communication deals with both verbal and non-verbal cues of a patient. This is important as it affects how a patient is able to communicate with the health professional and how they understand what is said to them.What do you communicate with the people of your neighborhood? “I prefer to listen and give short answers. I am not good at small talk but if I have a question that needs clarification, I will ask”

Family Roles and Organization

The family organization of a community helps to understand the role of each member and how the roles they play predispose them to certain health conditions.It also brings out the issue of gender roles and individualism. What roles do you play as a woman in your community? “My community is matriarchal in nature and therefore there is a quite some balance between men and women unlike in the dominant American culture. However, taking care of the household is the work of the women while the men provide and protect their families”.

Workforce Issues

The nature of work in a particular group gives insight on whether a person is active or sedentary which informs their health status. What is the nature of your work Miss Aiyana? “I work two jobs. One is at the local casino and the other is a cashier at the mall”

Bio-Cultural Ecology

Bio-cultural ecology demonstrates the roles of humans on the bio-diversity and hence creates the link between people and the area of residence. It also shows the reliance of people on their environment to provide for food and medicine. What is your relationship with the environment which you live in? Aiyana plants an assortment of herbs in her small compound generally for health and cooking purposes. Her meats and dairy products are from the local farms.

High-Risk Behaviors

Every social group has effects from its culture that predisposes it to certain health conditions. Such behavior includes the use of recreational drugs, alcohol, tobacco or lack of physical activity (Purnell, 2013). How are your eating and drinking habits? “I use tobacco regularly and alcohol occasionally. Our community has used tobacco since the beginning of time and alcohol is for social occasions”.


Nutrition is central to the well-being of an individual. Eating habits expose the way a community perceives food as taboo, as part of the healing process and the ritual around food. What are your eating habits? “For breakfast I have coffee, lunch is a sandwich, a yogurt and a fruit and I generally skip dinner. However, when I have night shifts at the casino I eat fast food that is readily available. The weekends are filled with fried or grilled foods with the family”

Pregnancy and Child Bearing Practices

Pregnancy and child bearing presents certain health conditions to women and understanding the cultural background relating to such issues will lead to better health outcomes. Do you have children? “Yes, I have three sons” How was your pregnancy and child bearing experience? Aiyana said that she refrained from some food that are considered taboo to eat while pregnant as they would result in harm to the mother and baby. She also refrained for tasking work and attended all her antenatal appointments.

Death Rituals

Death rituals demonstrate the rituals around death and how death is viewed in a community. According to the Native Americans, what are the community death rituals? “Wailing by the women marks the official confirmation of death. A grave will be dug and the male relatives would camp at the gravesite to wade off evil spirits. The body would be washed and lavender oil applied to it before it was wrapped in clothing for burial. The mourning period is marked by singing and meditation”


Spirituality is linked to health as some communities relate health as a gift from God and disease is a punishment from God. What is the link between spirituality and health in your culture? Aiyana believes that health is indeed linked to spirituality and health is physical, spiritual, emotion and psychological. We believe in spirits, visions, dreams and signs. We have traditional spiritual leaders who interpret the spirits for us.

Health Care Practices

The healthcare practices of a people will dictate the uptake of any other medical help they receive from outsiders. What are some of your health care practices? “Health practices for me have to link the spiritual, physical, emotional and psychological of the human being. I therefore practice yoga for the physical and psychological aspect and my family is a strong support system for the emotional aspect and the community for the spiritual”

Health Care Professionals

Healthcare professionals describe the type of the health professional and the services each of these professionals offer to the individuals in the community. What is the nature of health care professionals in your community?Aiyana goes to modern hospital when she feels the matter is serious and is open to both male and female professionals. For minor issues like the flu, I self-treat with cultural herbs given by the tribe’s medicine men.


The concern for a Native American patient would be the nature to avoid modern hospitals and the current change to a sedentary lifestyle (Yracheta et. al, 2015).

Since Native Americans identify health as a wholesome need in the physical, mental, spiritual and emotional aspects, the recommendation would be to merge all these aspects while providing healthcare.

With the new knowledge of the Native American culture, I will be keener to study the patient’s non-verbal cues as they may not talk much. I would also listen carefully when they talk to reflect their nature.




Purnell, L. (2000). A Description of the Purnell Model for Cultural Competence. Journal of Transultural Nursing 11(1), 40-46.

Purnell, L. (2003). Transcultural Diversity and Healthcare in L. Purnell and B. Paulanka (Eds), Transcultural Health Care: A Culturally Competent Approach. (2nd Ed). Philadelphia: F. A. Davis.

Yracheta, J. M., Lanaspa, M. A., Le, M. T., Abdelmalak, M. F., Alfonso, J., Sánchez-Lozada, L. G., et al. (2015). Diabetes and Kidney Disease in American Indians: Potential Role of Sugar-Sweetened Beverages. Mayo Foundation for Medical Education and Research 90(6), 813 – 823.

Miss Aiyana. (2020, July 9th). (Student Name, Interviewer)