Question

Conduct a literature search to locate a journal article related to the health or health care practices of African-American, European American, or Appalachian people.

Present a summary of the journal article, and examine how the information presented may impact your nursing practice.

Please provide a copy of the journal article (or hyperlink) if possible.

Answer 1

Self-Care Among Chronically Ill African Americans: Culture, Health Disparities, and Health Insurance Status.

Little is known about the self-care practices of chronically ill African Americans or how lack of access to health care affects self-care. Results from a qualitative interview study of 167 African Americans who had one or more chronic illnesses found that self-care practices were culturally based, and the insured reported more extensive programs of self-care. Those who had some form of health insurance much more frequently reported the influence of physicians and health education programs in self-care regimens than did those who were uninsured.

African Americans have a long tradition of health and healing practices that shape, in part, what they do to care for themselves in the present day. African American traditional medicine can be traced back beyond enslavement in the United States to their native cultures in Africa.They used magical and herbal cures from their homelands, but over time they also borrowed additional herbal lore and curative practices from Native Americans and adopted colonial European approaches such as purgatives, bleedings, and preventive measures based on classical humoral pathology, leading to an amalgamated ethnomedical system with many regional variants.

Findings reported in this article were based on 3 large qualitative studies that examined the same questions about daily management of chronic illness but included people from different age groups and with varying health insurance status. Respondents were African Americans aged 21 to 91years who had 1 or more chronic illnesses. The most common illnesses were diabetes mellitus, asthma, and heart disease or hypertension.

Self-care practices among African Americans were found to be culturally based. That is, respondents described idea systems and behavioral practices that were shared by the sample with respect to general issues of self-care for protecting health, preventing illness, and promoting healing and recovery from illness. These cultural approaches to self-care formed the basis from which individuals developed strategies specific to the particular parameters of their illnesses. Three culturally based factors that were central to the development of self-care approaches were (1) spirituality, (2) social support and advice, and (3) nonbiomedical healing traditions. These cultural factors were present regardless of socioeconomic status and encompassed a diverse range of activities.

This research has implications for health disparities. In this study, lack of health insurance had a significant, and deleterious, effect on people’s ability to develop complex self-care approaches that reflected both cultural and biomedical precepts of self-care. Combined with their low-income, often unemployed status, uninsured people lacked the economic resources to implement self-care regimens that integrated cultural and biomedical approaches.

It is concluded that the cultural components of self-care have been underemphasized, and further, that the potential to maximize chronic illness management through self-care strategies is not realized for those who lack access to health care.

How will this impact nursing practice?

This research demonstrates several important phenomena regarding self-care among African Americans. Key aspects of African American culture are central to the development of self-care strategies. There is a basic approach to self-care that builds on widespread values and practices, including spirituality, social support and advice, and traditional medicine. Each of these cultural practices is important in shaping people’s understandings of self-care. This finding could advance our ability to plan and provide chronic illness management and also provides a better understanding of the self care practices of African Americans which would further help in planning care.

Reference: Gay Becker, PhD, Rahima Jan Gates, PhD, and Edwina Newsom. Self-Care Among Chronically Ill African Americans: Culture, Health Disparities, and Health Insurance Status. Am J Public Health. 2004 December; 94(12): 2066–2073. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448591/#__ffn_sectitle