Culturally-responsive providers consistently work to develop awareness of cultural norms, including their own and those of western medical culture. They combine this awareness with an understanding of the dimensions of culture to more easily identify variations in patterns of communication and health beliefs/behaviors of patients. The most responsive providers explore health within the full context of people’s lives, including the role of heritage consistency within the generations of a family.

What is Heritage Consistency?

The term heritage consistency is used to describe how much or how little a person’s lifestyle reflects his or her traditional culture. If one is very “consistent” with their heritage,  then one maintains more of the core values, beliefs, attitudes, and behaviors of one’s cultural heritage. If one is more “inconsistent,” then he or she deviates from that cultural heritage. Usually, the more one acculturates to American society, the less consistent they are with their original culture.  Asking questions that reveal heritage consistency is an important means of zooming in on the individual patient’s experience which helps avoid stereotyping.

Three Key Factors Related to Heritage Consistency

Especially when working with immigrants and refugees, it is important to determine three key factors related to heritage consistency: socialization, acculturation, and assimilation into the dominant U.S. culture.  Though close in meaning, the three are distinct.

Socialization: The process of being raised within a culture and acquiring the characteristics of that group. Formal K-12 education in the U.S. is a key means of socializing children in our society.

Acculturation:  This is the process of becoming a competent participant in the dominant culture. Acculturation is necessary to survival so it is involuntary. The degree to which one becomes acculturated and the speed of the process are affected by an individual’s circumstances and choices. Children, who can easily avail themselves of socialization via public schools, tend to acculturate quickly in the U.S. They have an easier time learning a new language. Grandparents, on the other hand, often acculturate slowly. They find adaptation more stressful and thus are often less willing to engage the dominant culture. They may seek the safety of their own close-knit ethnic communities, even resisting learning the language of their new country. Finally, literacy – in one’s native tongue as well as the language of the new country – affects the acculturation process.

Assimilation – Very much like acculturation, assimilation refers to the extent of identification with the dominant culture. Beyond becoming a competent participant in the dominant culture, an assimilated person chooses to identify with the members of the dominant culture. Behaviors that indicate this include marrying into the dominant culture, engaging in the civic activities of the dominant culture, living and working within dominant-culture communities, and so on. “The process of assimilation is complete when the “foreigner” is fully merged into the dominant cultural group.” (McLemore, 1980, p. 4)2

Many European Americans today – Irish Americans, Italian Americans, French Americans, etc. – are disconnected from their cultural heritage. Exploring the assimilation experience of one’s forebears can be very eye-opening. America’s history is truly a history of immigration, acculturation and assimilation (with notable exceptions/variations).

Indications of Heritage Consistency

The following list of questions can help establish heritage consistency for a particular patient/family. Used skillfully, they reveal attitudes about health and illness as well as important family dynamics. For older children and adolescents, it can be especially stressful straddling two cultures. These questions can be especially helpful in facilitating discussion about acculturation and assimilation with bi-cultural children struggling with identity confusion.

1. Did the person’s childhood development occur in the person’s country of origin or in an immigrant neighborhood in the United States?
2. Do extended family members encourage participation in traditional religious or cultural activities?
3. Is the individual’s family home within their ethnic community?
4. Does an individual/family frequently visit the country of origin or return to the “old neighborhood” in the United States?
5. Was/ is the individual raised in an extended family setting?
6. Has the individual’s name has been Americanized?
7. Was the individual educated in a school with a religious or ethnic philosophy similar to the family’s background?
8. Does the individual engage in social activities primarily with others of the same ethnic background?
9. How fluent is the individual in the family’s language of origin?
10. Does the individual possess personal pride about his/her cultural heritage?

(This list adapted from Cultural Diversity in Health and Illness, 7th Edition)

Summary:

Along with the socio-economic factors of poverty, literacy, and health literacy, culturally responsive care takes into account the heritage consistency of individual patients within the context of family dynamics. In an effort to avoid applying cultural generalizations too rigidly, providers explore the indicators of cultural consistency with their patients from different cultural backgrounds to understand how closely each individual adheres to the traditional culture in which they were raised.  Deviations in attitudes and life experiences affect each person’s health beliefs and behaviors including their ability and/or willingness to comply with the treatment plan their doctor recommends.

Sources:

• The 12 questions to use for indications of heritage consistency are adapted from the Cultural Diversity in Health and Illness by Rachel E. Spector. 7th Edition,
• Heritage consistency is a concept developed by Estes and Zitzow (1980) “The degree to which one’s lifestyle reflects his or her respective tribal culture.”