Disabilities as viewed by four generations of one Hispanic family
Salas-Provance, Marlene B
Forty members of one Hispanic family ranging in age from 21 to 96 years were interviewed by a bilingual professional who was also a family member. The interviews were conducted in the homes of the participants in the language of their choice, The results indicate that culture plays an important role in folk and medical belief systems regarding health and illness. Stereotypical attitudes of this cultural group toward the causes and treatment of disabilities, including communication disorders, were both supported and rejected. Analysis of the responses to the closed-ended questions indicated that a large number and variety of folk beliefs were held by participants
and varied according to factors such as age, income, education, and gender. In contrast, strong beliefs in medically based causes and cures of disabilities were apparent across the generations and showed little variation by age, income, education, or gender. Responses to open-ended questions indicated that medical beliefs were more frequently reported than folk beliefs. Clinical implications of the results of this research reinforce the need for professionals to increase their cultural awareness, knowledge and skills in order to provide culturally sensitive clincial services.
Key Words: folk beliefs, health and illness, culture, Hispanic, disability
Definitions of health and illness differ among cultures. How a disability is viewed varies in such areas as perception of severity, impact on life, beliefs regarding etiology, and preferences for treatment (Bullough & Bullough, 1982; Cheng & Hammer, 1992; Cuellar & Arnold, 1988; Groce & Zolla, 1993; Loustaunau & Sobo, 1997; Lynch & Hanson, 1998). Historically, medical anthropology and transcultural nursing have been the primary sources for information on cross cultural attitudes toward health and illness (Baca, 1969; Campinha-Bacote, 1993; Edgerton, 1970; Garro, 1986; Helman, 1995; Johnston, 1977; Leininger, 1970; Pachter, 1993; Spector, 1996).
Although there is a significant amount of literature on attitudes toward people with communication disorders such as stuttering, deafness, or cleft palate, respondents have been primarily middle-class Anglos representing groups such as university students, clinicans, teachers, employers, or parents (Cooper & Cooper, 1985; Crowe & Walton, 1981; Luckner, 1991; Ruscello, Lass, & Brown, 1988; Scheuerle, Guilford & Garcia, 1982). Three studies in the speech-language pathology and audiology literature (Bebout & Arthur, 1992; Erickson, Devlieger, & Song, 1999; Maestes & Erickson, 1992) and unpublished research by Saenz & Whitson (1994) reported on the cross– cultural attitudes toward the causes and treatment of communication disorders. Meyerson (1983, 1990) presents cultural considerations in working with Hispanic families with children who have craniofacial malformations and other birth defects. Several recent textbooks provide general information on Hispanic populations and communication disorders (Battle, 1998; Goldstein, 2000; Kayser, 1995, 1998; Langdon & Cheng, 1992).
Most cultures have been affected by science and technology and thus have incorporated medical information into their health belief systems (Applewhite, 1995; Keefe, 1981; Kleinman, 1980). Traditional folk beliefs, however, are still prevalent to varying degrees in all ethnic, racial, and cultural groups in this country and around the world (De la Cancela & Martinez, 1983; Garner, Lipsky, & Turnbull, 1991; Seligman & Darling, 1997). In order to provide quality treatment to individuals from cultures other than their own, healthcare professionals, including speech-language pathologists and audiologists, must understand cultural variations including folk beliefs about causes and treatments of disabilities. This concept is especially crucial given that in the next 20 years at least one-third of all clinical caseloads will consist of individuals from minority groups (Cole, 1989; Zuniga, 1992; Sue & Sue, 1990).
People of Spanish descent have been in the United States since their territories were annexed in the 1848 peace treaty with Mexico, which made them the ancestors of the current fourth and fifth generation of Hispanics of the Southwest (Marin & Marin, 1991; Novas, 1994). Others of Hispanic origin in the United States include individuals of Mexican, Puerto Rican, Cuban, and Central/South American origin. Hispanics’ are the fastest growing racial/ethnic minority group in the United States. The projected 2005 population based on 1990 census data (U. S. Bureau of the Census, 1996) indicates that there will be more than 38 million Hispanics in the United States which will represent approximately 13 percent of the total population, making it the largest minority group in the country. In 1996, the number of Hispanic children (12 million) in the country surpassed the number of African American children (11.4 million). The growth in numbers of Hispanic children has been attributed to fertility and legal immigration of this population.
Hispanics traditionally view the family as their most valued institution, with their religious and folk beliefs being essential aspects of the family system (Madsen, 1974; Samora, 1963; Zaldivar, 1994). Perceptions of health and illness are passed on from one generation to the next. Extended families are fundamental to the Hispanic people and can become the cornerstone of how the family members relate to the world. Home remedies are often described and information for their use is transmitted by women in the family (Trotter, 1981). The well-being of the group is more important than that of the individual, which highlights the value of interdependence in the Hispanic culture.
Because a disability is “owned” by the family members, it may be easier for the individual to adapt to his/her disability (Alvarez, 1998). In contrast, machismo (maleness, virility) may contribute to denial of a disability. For example, some males in the Hispanic culture may feel that participation in a rehabilitation program is a sign of weakness. Women also may deny the impact of a disability in order to meet cultural expectations to aguantar (endure) the hardship of the disability. Support and acceptance from others in the extended family, along with health care providers’ increased awareness of these gender roles, are crucial in order for the disabled person to benefit from rehabilitation (Zea, Quezada, & Belgrave, 1994).
Studies of attitudes of Hispanics toward illness– including disabilities-have been conducted primarily with Mexican-Americans (Arnold, 1983; Baer & Bustillo, 1993; Castro, Furth, & Karlow, 1984; Jay 1996; Kiev, 1968; Logan, 1993; Mardiros, 1989; Martinez & Martin, 1996; Mikhail, 1994; Smart & Smart, 1991; Trotter, 1982; White, 1977; Zea, Quezada, & Belgrave, 1994). It is necessary to recognize, however, that information regarding people of Hispanic descent frequently fails to specify the nationality or culture of the group. Therefore, results of studies are often generalized across all Hispanic groups rather than being presented from a specific ethnic/cultural perspective. With these limitations in mind, the above studies describe the following beliefs regarding illnesses: (a) an illness may be caused by an imbalance between hot and cold or by being improperly dressed for the weather; (b) diarrhea may result from the presence of flies in the home; (c) mal de ojo (evil eye) can cause conjunctivitis and other diseases; (d) susto (fright sickness) can result in the loss of appetite and weight as well as fatigue. Causes of childhood disabilities are believed to include: (a) premonitions (dreams during pregnancy); (b) past transgressions (prior sins); (c) genetic problems; (d) birth trauma; and (e) childhood accidents such as the baby being dropped. Mexican-American healing practices are a comfort to many families and include remedios caseros (home remedies) such as holy water, votive candles, eggs, rice water, and medicinal teas such as manzanilla (chamomile). Cures may involve a magical purification ritual performed by a curandero(a) (folk practitioner). Spirtualistic healers can also be a source of treatment through liturgical ceremonies that incorporate access to the spirit world, cleansing rituals, and herbal potions (Spires-Robin & McGarrahan, 1995).
Some Hispanic families may overprotect disabled family members as a result of the tightly knit family structure. Because members of the Hispanic culture often distinguish between the disability and what they describe as the normal child within, children with disabilities may be considered healthy and normal. Being healthy could simply refer to a lack of physical illness or disease, and being normal may be culturally defined as being able to attend to daily living at their present level of functioning (Mardiros, 1989). In addition, a close relationship exists between religion and illness. Therefore, a disability may be viewed as a divine punishment for sin, and the family may believe they should not interfere with God’s will. Because many of the studies on Hispanic health beliefs have focused on rural and/or low SES Mexican-Americans, caution must be exercised in generalizing the findings to all persons of Hispanic ethnicity. It is also important to separate the effects of culture from those of socioeconomic factors ( Zaldivar, 1994; Slesinger, 1981).
Folk beliefs specific to Hispanic families from New Mexico have been studied for many decades (Moya, 1940; Saunders, 1954; Samora, 1963). Moya (1940) stressed the need to document the folk beliefs of Spanish-American families in New Mexico because of the crucial role folklore had in molding their culture. As with all cultures, most health and illness folklore is handed down from generation to generation by word of mouth, although beliefs may be modified over time. For example, a 1983 study by Scheper-Hughes and Stewart investigated early data (e.g., Saunders, 1954) regarding the use of curanderismo (folk medical system) in rural Taos County of New Mexico. They reported that curanderismo in northern New Mexico continues to exist, albeit as an alternative treatment rather than a primary source of medical care.
There is a lack of research on Hispanic beliefs that focus primarily on disabilities, including communication disorders. Therefore, this study was designed to explore the attitudes of Hispanic individuals toward the causes and treatment of speech, language, and hearing problems and to determine the resources to which they turn for assistance. In addition, four generations of one Hispanic family provided the opportunity to investigate whether or not there were changes in belief systems over time and the effects of education, socioeconomic level, and language use.
Forty members of one Hispanic (Spanish-American) family from New Mexico–representing four generations– participated in this study (see Table 1). Thirty-four of the 40 participants were born in either Albuquerque, a large urban city, or Torreon, a rural mountain village approximately an hour’s drive southeast of Albuquerque. The remaining six were born in other cities in the Southwest. Thirty-four of the participants described their current place of residence as urban, five as rural, and one did not respond. In general this population traces its ancestry to Spain. Thirty-eight of the participants could understand Spanish and of those, 34 reported they spoke Spanish fluently. All participants could understand and speak at least some English. Religion was important or very important to all of the participants, with 34 (85%) describing themselves as Catholic and six (15%) as Christian. Twenty-four of the participants were married, seven widowed, five single, and four were divorced or separated. Twenty-four participants were employed, 13 were unemployed, and three were retired. The family was predominantly middle class and well educated (see Figure 1).
The interview protocol developed for this study was based on a literature review and the results from a pilot study conducted by the second author. The interview form was developed in English and then translated into Spanish. A reverse translation procedure was then used to ensure accuracy (Brislin, 1970). The interview instrument was evaluated by two cultural informants who provided information on content and lingusitic appropriateness. In addition, another cultural informant representative of the target population provided information regarding the appropriateness of the Spanish dialect used on the interview form.
The interview format began with six open-ended questions that explored beliefs regarding the causes (etiologies) and cures (treatment) of disabilities/handicaps in general, and those of speech and hearing problems in particular. The words “disability” and “handicap” were used synonymously with the participants because the general public does not differentiate between the two terms. The term “disability” will refer to both terms in the text. Similarly, because cultural informants suggested that the term “speech” be used to describe both speech and language, only the word “speech” was used to encompass both terms. Participants were asked to indicate disabilities with which they were familiar in order to further open the topic for discussion. The next four questions were closed-ended questions related to causes of disabilites and prevention or cures of hearing problems, stuttering, and other disabilities. Closed-ended questions included statements representing folk and medical beliefs that were based on information from the literature and a cultural informant. Participants were required to indicate if they agreed, disagreed, or did not know about the belief. Participants were also asked to respond on a four-point scale as to how frequently they would turn to various resources such as family, priest, or curandero(a). The final section requested demographic and personal information from each participant.
Interviewer and Site of Interviews
The interviewer was a bilingual family member who has a master’s degree in educational administration and has training and experience in interviewing techniques. The benefits of using a bilingual family member as the interviewer included providing comfort for the participants, allowing code switching when necessary, and inferring an acceptability of the belief systems of the participants. Although the interviewer may have contributed a cultural affirmation bias to the responses, the authors felt that the advantages of having a bilingual family member as the interviewer outweighed this disadvantage. All interviews were held in the participants’ homes and conducted in their language of choice. Culturally appropriate techniques also included an extended period of socialization prior to initiating the interview process. With the participants’ permission, the interviews were tape-recorded. Although early studies raise questions as to the validity of Hispanic responses to highly sensitive questions during interviews, Marin and Marin (1989) indicate that interviewing is appropriate for use with both genders and a variety of levels of acculturation of the Hispanic population.
Categorization of Responses
Two of the authors collaborated to categorize participant responses as being “medical” or “folk.” All nonfolk answers were categorized as medical, including responses that were educational or psychosocial in nature. Folk answers were nonmedical and related to cultural beliefs, including religion, curanderismo, and the use of home remedies.
Statistical analysis of the data for the closed-ended questions was performed. Responses were analyzed according to frequency of occurrence of both medical and folk beliefs. The chi square test was performed to analyze the relationship between folk beliefs according to age, education, and income and the following dependent measures: (a) 20 variables related to folk causes of disabilities, (b) 14 variables related to folk cures for ear problems, (c) five variables related to folk cures for disabilities, (d) four variables related to folk cures for stuttering, and (e) four variables related to folk resources turned to for advice. The strongest folk beliefs resulted in high positive numbers and the weakest folk beliefs resulted in high negative numbers. The chi square test was also conducted for age and gender and their relationship to six selected folk and medical variables. An alpha level of .05 was used for all statistical tests.
Frequency Analysis. According to Table 2, the two most frequently held beliefs regarding the causes of disabilities were catergorized as medical and included the use of alcohol or drugs by the mother when pregant (97.5%) and the lack of oxygen to a baby at birth (95%). The remaining causes were all categorized as folk beliefs, with responses ranging from “earthquake” (75%) to “mother made fun of a disabled person” (7.5%). The majority of participants agreed with the five religious (folk) beliefs listed for prevention or cure of disabilities. The most common folk belief was rezar una novena/prayers to a specific saint for favors (65%). The remaining beliefs that were held by more than half of the participants included: visiting El Santuariol visit a holy place (55%); cruzitas with holy water/sign of the cross (52.5%), promesas/promises to a saint (52.5%) and tierra bendita/blessed earth (52%).
The five most common beliefs regarding cures for hearing/ear problems were medical (see Table 3). The participants responded that they would turn to professionals, including ear doctor and audiologist (100%), and surgeon (97.5%). In addition, all participants believed in the use of a hearing aid, and 92.5% would used medicine to cure hearing problems. All other cures for hearing/ear problems were categorized as folk beliefs and varied from prayer (82.5%) to the use of urine in the ear (2.5%).
When participants were asked who they would turn to for help with stuttering, all but one of the participants would turn to a speech-language pathologist. Other types of treatment for stuttering included saying prayers (80%) and telling the person to slow down (75%). Only 5 participants (12.5%) indicated that scaring a person could be used to treat stuttering. None of the participants believed in two of the folk treatments for stuttering reported in the literature, which were putting a pencil in the mouth or placing the head under water.
Participants indicated a variety of resources they would turn to for advice with the most common being the medical doctor (87.5%) and the family (62%). Resources that participants would most likely not turn to include the bruja/witch (92.5%), curandero(a) (60%) and acupuncturist (62.5%). Although 38 (95%) of the participants indicated that religion was very important, 45% would sometimes turn to the priest for advice, and 27.5% would never turn to the priest for advice regarding disabilities.
Chi Square Analysis Related to Age, Education, and Income
Chi square analysis was used to examine the relationship between folk beliefs and the age, education, and income of the participants (see Table 4). Although none of the results were found to be statistically significant, clinically important information was found. Table 4 provides information on the percentage of participants in each group by age, education, and income who agreed with various folk beliefs according to the following categories: (a) causes of disabilities, (b) cures for ear problems, (c) cures for disabilities, and (d) cures for ear problems.
When the data was analyzed by age, education, and income the following patterns were apparent. The older participants held stronger folk beliefs than those in the other two age groups across all causes and cures of the four disability categories. The less-educated participants held stronger folk beliefs across all disability categories, particularly regarding cures for disabilities, where 80% held strong folk beliefs. Analyses by income showed variant patterns among the groups. For example, in the three cure categories, the middle income group had fewer folk beliefs than either the low or high income groups (see Table 4).
Chi Square Analysis Related to Age and Gender
The effect of age and gender on six variables regarding folk and medical beliefs for causes and cures of disabilities was assessed using the chi square test (see Tables 5 and 6). The variables analyzed included (a) two folk causes (mal de ojo and caida de molera), (b) two folk cures of disabilities (cotton with mentholatum and pray a novena), and (c) two medical causes (lack of oxygen at birth and drug or alcohol use by the mother). Table 5 shows that there were significant differences between the age groups and the four folk variables. For example, for the item mal de ojo/bad eye, nine of the participants in the youngest group (Age I), four in the middle group (Age II), and two in oldest age group (Age III), did not know that mal de ojo was a belief regarding a cause of disability. For the two medical items analyzed, lack of oxygen and alcohol/drugs, there were no significant differences between age groups. Indeed, nearly all participants agreed with these medical causes of disability.
Table 6 reveals that only one belief, praying a novena, was significantly different by gender. Twenty-one of 29 (73% ) females and 5 of 11 (45%) males believed in praying the novena as a cure for a disability. An evaluation of the remaining folk beliefs reveals that, although not significantly different, females as a group tended to have folk beliefs more frequently than males. For example, nearly all of the females, 22 of 29 (76%) believed in the use of mentholatum with cotton as a cure for hearing problems, compared to only 4 of 11 (36%) males. In general, males responded “did not know,” regarding folk beliefs more frequently than females did. Strong medical beliefs were shared by participants of both genders.
There were a variety of responses as to whom the participants would turn to for advice. Using a sample of a nonfolk (priest) versus folk (curandero[a]) belief, data was analyzed according to age (see Table 7) and gender (see Table 8). There were no significant differences by age or gender. An analysis of the data reveals that the majority of participants in all age groups and both genders either “sometimes” or “never” turned to a priest or curandero(a) for advice regarding causes or cures of disabilities. Thus, only small numbers from both age and gender groups turned to these resources for advice.
During the interview, participants were asked “Do you know anyone who has a disability or handicap?” and, if so, to describe it. Results indicated a broad spectrum of physical, cognitive, and communicative disabilities, with the largest numbers found in the physical category (see Appendix A).
The participants were also asked six open-ended questions related to causes (etiology) and cures (treatment) of disabilities in general, as well as those specific to speech and hearing disorders. Results revealed that participants reported more medical than folk beliefs overall.
In response to the first two questions “What do you think can cause people to have a disability or handicap?” and “What do you think can cure a disability or handicap?” participants reported a variety of medical and folk responses (see Appendix B). In response to the third question, “What do you think can cause people to have trouble with their speech?” the majority of the answers could be categorized as medical-stroke and paralysis, for example (see Table 9). The participants also reported what they would do or use to cure a speech problem (see Table 10), with the majority being such medical responses as seeing a speech therapist and receiving rehabilitation early in life.
There were a variety of responses to question four, “What do you think can cause people to have trouble with their hearing,” that were categorized as medical (see Table 11). These included disease, nerve damage, and old age as well as those suggesting noise induced hearing loss, such as “due to the job,” environmental noise, or loud music. Causes suggestive of conductive hearing loss included infection, having a bad cold, and putting things in the ear. Some of the responses-such as hemorrhage, toothache, and poor hygiene-had unclear relationships to a cause of hearing problems. No clearly discernible folk beliefs were reported.
In response to the fifth question “What would you do or use to cure a hearing problem?” participants provided less variety in their medical responses in comparison with the number and variety of folk responses (see Table 12). Medical answers included seeing an ear specialist or audiologist, having surgery, and using a hearing aid or ear drops. Therapeutic services included learning sign language and reading lips. A suggestion to “change the environment” may be related to noise-induced hearing loss. An extensive number of folk treatments were identified. Some were general such as the use of old remedies and some were more specific such as the use of warm olive and ocha (herb) on cotton. Procedures also included putting a warm cloth on the ear and clearing the ear out with a Q-tip. Praying and seeing a curandero(a) were also mentioned. Less clear were the suggestions to “get the air out,” and “use newspaper.” These suggested cures, however, may be related to the folk ear treatment called candling which uses newspaper to make a cone that is then burned in order for the heat and smoke to be funneled into the ear.
In this study we investigated the beliefs about disability held by four generations of one Hispanic family from New Mexico. The results support the general concept that
culture plays an important role in folk- and medical-belief systems regarding health and illness. Strong beliefs in medically based causes and cures of disabilities were apparent across the generations and showed little variation by gender, income, or education. In contrast, belief in folk causes and cures of disabilites varied according to age, income, education, and gender. Therefore, the results of this study both support and reject commonly held stereotypic views of the Hispanic population and their belief systems regarding health and illness. Some of our results support the stereotype that low income, less educated, and/ or older minority persons hold folk beliefs regarding causes and cures of disabilites. For example, older people tended to hold strong beliefs regarding the use of folk remedies for ear problems and agreed that being frightened (susto) could cause a disability. In contrast, well-educated young family members more frequently used medical care for curing disabilities, including ear problems. They also believed in medical causes of disabilites, such as a lack of oxygen to the brain. However, not all members within the various age groups had similar beliefs. This finding suggests that one should carefully evaluate commonly held stereotypes in order to avoid incorrect assumptions.
The direct-versus-indirect question format appeared to affect the participants’ responses. For example, when asked open-ended questions about causes or cures for disabilities, participants offered a wide variety of medical beliefs and few folk beliefs. In contrast, responses to close-ended questions revealed a strong folk belief system was in place. This was an unexpected finding. Perhaps by acknowledging or naming these folk beliefs in the close-ended questions the participants were free to respond more openly. The fact that little folk information was obtained from the open– ended questions in comparison with the closed-ended questions suggests that obtaining specific information about nontraditional beliefs should be explored through direct questioning with Hispanic families in a culturally sensitive manner (Capinha-Bacote, 1993).
It is commonly assumed that beliefs are changed over time as people live in a new culture. Thus, recent immigrants would be assumed to hold more folk beliefs than those who had lived in the US for longer periods of time. This study contradicted this concept, as folk beliefs were reported by individuals from all four generations, all of whom had lived in the US their entire lives. Therefore, both the generational influence as well as recency of immigration must be examined when considering the strength of folk beliefs held by individuals.
Historically, the use of the curandero(a) shows a strong generational and rural influence. The present study revealed that the youngest group did not often use curanderismo as a resource, although it appears to remain a viable altenative to mainstream health care for several members of the first three generations of this Hispanic family. Because nearly all of the participants lived in or near an urban setting, their access to a variety of medical information and resources may have decreased the strength of belief in or need for curanderismo.
The decreased importance of folk beliefs among many members of the youngest generation in this study may be related to such influences as level of education and access to the mainstream culture through work and social activities. Furthermore, access to television and other contemporary media may interfere with the transmission of folklore from the older to the younger generation, which is usually done by word of mouth. Although nearly all participants in this study were bilingual, the language of choice for the middle and younger generations was English. This language-use preference may contributed to a decrease in the transmission of cultural information from the oldest generation to the other two groups, because traditional folk beliefs could be more easily shared in Spanish.
Hispanic families have traditionally placed a high value on religion, including rituals such as visiting a holy place, crossing oneself with holy water, and making promises to a saint-all of which relate to folk beliefs regarding health and illness. However, half of the participants from the youngest generation were unfamiliar with the important cultural ritual of praying a novena. This may indicate a decrease in religious-based (i.e., folk) beliefs regarding causes and treatments of disabilities by this age group. This study shows that, in fact, there appears to be a shifting toward less belief-or awareness-of folklore, including religious aspects, by the youngest generation. However, one of the major beliefs across all generations was in the healing power of prayer.
Depending on the disability, family members varied in the number of folk beliefs regarding causes and treatment. For example, across all age groups there were few folk beliefs held about treatments for stuttering as compared with numerous reported uses of home remedies for hearing problems. All professionals who treat hearing problems, including speech-language pathologists and audiologists, should be aware of the implications of these findings when working with families from cultures who have similar beliefs.
The experiences and beliefs a professional holds may be in stark contrast to those held by the client. From an anthropological perspective (Loustaunau & Sobo, 1997), how one views the causes of disability and the healing process can be classisfied as either emic (an insider’s point of view) or etic (an outsider’s scientific point of view). From a clinical perspective, imposing an etic view and/or not respecting the emit view could interfere with the clinical relationship. For instance, the client/family may not return for services, may not be compliant, or may be reluctant to share crucial information as a result of the miscommunications.
An in-depth clinical model for developing culturally appropiate diagnostic and therapeutic clinical competence can he found in the field of transcultural nursing. Briefly, the four steps of this process include (a) developing cultural awareness, (b) increasing cultural knowledge, (c) enhancing cultural skills, and (d) engaging in cross-cultural encounters. In this final step, it is important to validate, negate, or modify existing cultural knowledge as well as develop culturally specific and individualized interventions (Capinha-Bacote, 1993). Although it was developed for the nursing profession, this clinical model can be effectively utilized by other helping professions, including speechlanguage pathology and audiology.
Developing clinical competence in issues related to linguistic and cultural diversity- including attitudes toward disability-is an ongoing learning process for students in training and for professionals in the field of communication disorders. Speech-language pathologists and audiologists must consider the beliefs and practices of members of culturally and linguistically diverse populations in order to provide appropriately sensitive diagnostic and treatment services. In this regard, cultural relativism (Kavanagh & Kennedy, 1992) is an important concept for our field, because it asks professionals to judge each culture on its own terms and accept the beliefs of others within a cultural context. Future research should continue to focus on increasing professional knowledge of the relationship between culture and management of communication disorders.
We wish to thank the students from St. Louis University, Southern Illinois University at Edwardsville, and the University of Illinois at Urbana-Champaign for their time and support with library work and data entry for this study. We also thank the family members who participated in this research, for without their enthusiastic commitment of time and their willingness to share information about their culture, this study would not have been possible.
Alvarez, L. L (1998). A short course in sensitivity training. Teaching Exceptional Children, 31, 74-77.
Arnold, B. R. (1983). Attitudinal research and the Hispanic disabilityped: A review of selected needs. Journal of Rehabilitation, 40(4), 36-38.
Applewhite, S. L. (1995). Curanderismo: Demystifying the health beliefs and practices of elderly Mexican-Americans. Health and Social Work, 20(4), 247-253.
Baca, J. E. (1969). Some health beliefs of the Spanish speaking. American Journal of Nursing, 69(10), 2172-2176.
Baer, R. D., & Bustillo, M. (1993). Susto and mal de ojo among Florida farmworkers: Emic and etic perspectives. Medical Anthropology Quarterly, 7, 90-100.
Battle, D. (Ed.). (1998). Communicaation disorders in multicultural populations (2nd ed.). Boston: ButterworthHeinemann.
Bebout, L., & Arthur B. (1992). Cross-cultural attitudes toward speech disorders. Journal of Speech and Hearing Research, 35, 45-52.
Brislin, R. W. (1970) . Back translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185-216.
Bullough, V. L., & Bullough, R. N. (1982). Health care for the other American. New York: Appleton-Century-Crofts.
Campinha-Bacote, J. (1993). Cultural competence in psychiatric-mental health nursing: A conceptual model. In J. Campinha-Bacote (Ed.), Readings in transcultural health care (4th ed., pp. 147-165). Wyoming, OH: Transcultural C.A.R.E., Associates.
Castro, F. G., Furth, P., & Karlow, 11 (1984). The health beliefs of Mexican, Mexican-American, and Anglo American women. Hispanic Journal of Behavioral Sciences, 6, 365-383.
Cheng, L.L., & Hammer, C. (1992). Cultural perceptions of disabilities. San Diego: Los Amigos Research Associates.
Cole, L. (1989). E pluribus pluribus: Multicultural imperatives for the 1990’s and beyond. Asha, 31, 66-70.
Cooper, E., & Cooper, C. (1985). Clinician attitudes toward stuttering: A decade of change (1973-1983). Journal of Fluency Disorders, 10, 19-33.
Crowe, T., & Walton, J. (1981). Teacher attitudes toward stuttering. Journal of Fluency Disorders, 6, 163-174.
Cuellar, I., & Arnold, B. RL (1988, July/August/September). Cultural considerations and rehabilitation of disabled MexicanAmericans. American Journal of Rehabilitation, 35-41.
De la Cancela, V, & Martinez, I. Z. (1983). An analysis of culturalism in Latino mental health: Folk medicine as a case in point. Hispanic Journal of Behavioral Sciences, 5(3), 251-274.
Erickson, J. G., Devlieger, P. & Song, J. M. (1999). Korean American female perspective on disabilities. American Journal of Speech-Language Pathology, 8(2), 99-108.
Edgerton, R. B. (1970). Mental retardation in non-western societies: Toward a cross-cultural perspective on incompetence. In H.C. Haywood (Ed.), Socio-cultural aspects of mental retardation (pp. 523-560). New York: AppletonCentury-Crofts.
Gartner, A., Libsky, D. K.. & Turnbull, A. P. (1991). Supporting families with a child with a disability: An international outlook. Baltimore: University Park Press.
Garro, L. C. (1986). Intracultural variation in folk medical knowledge: A comparison between curers and noncurers. American Anthropologist, 88, 351-370.
Goldstein, B. (2000). Cultural and linguistic resource guide for speech-language pathologists. San Diego: Singular.
Groce, N. E., & Zola, L. K. (1993). Multiculturalism, chronic illness, and disability. Pediatrics, 91, 1048-1055.
Helman, C. (1995). Culture, health & illness: An introduction for health professionals (3rd ed.). London: ButterworthHeinemann.
Jay, V. N. (1996). Mexican-American mothers’ beliefs regarding disability in children. Unpublished doctoral dissertation, University of Illinois at Urbana-Champaign.
Johnston, M. (1977). Folk beliefs and ethnocultural behavior in pediatrics. Nursing Clinics of North America, 12(1), 77-87.
Kavanagh, K. H. & Kennedy, P. H. (1992). Promoting cultural diversity: Strategies for health-care professionals. Newbury: Sage.
Kayser, H. (1995). Bilingual speech-language pathology: An Hispanic focus. San Diego: Singular.
Kayser, H. (1998). Assessment and intervention for Hispanic children: A resource guide. San Diego: Singular.
Keefe, S. E. (1981). Folk medicine among urban MexicanAmericans: Cultural persistence, change, and displacement. Hispanic Journal of Behavioral Sciences, 41, 41-57.
Kiev, A. (1968). Curanderismo, Mexican-American folk psychiatry. New York: The Free Press.
Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkley: University of California.
Langdon, H. W., & Cheng, L. R. (Eds.). (1992). Hispanic children and adults with communiction disorders: Assessment and intervention. Gaithersburg, MD: Aspen.
Leininger, M. M. (1970). Nursing and anthropology: Two worlds to blend. New York: John Wiley & Sons.
Logan, M. H. (1993). New lines of inquiry on the illness of susto. Medical Anthropology, 15(2), 189-200.
Loustaunau, M. 0. & Sobo, E. J. (1997). The cultural context of health, illness and medicine. Carvey, CT: Benin & Wesport.
Luckner, J. L. (1991). Mainstreaming hearing impaired students: Perceptions of regular educators. Language, Speech, and Hearing Services in Schools, 22, 302-307.
Lynch, E. W. & Hanson, M. J. (1998). Developing crosscultural competence: A guide for working with children (2nd ed.). Baltimore: Brookes.
Madsen, W. (1974). The Mexican-Americans of South Texas (2nd ed.). Fort Worth: Harcourt Brace.
Maestas, A. G., & Erickson, J. G. (1992). Mexican immigrant mothers’ beliefs about disabilities. American Journal of Speech Language Pathology, 1(4), 5-10.
Mardiros, M. (1989). Conception of childhood disability among Mexican-American parents. Medical Anthropology, 12, 55-68.
Marin, G., & Marin, B. (1989). A comparison of three interviewing approaches for studying sensitive topics with Hispanics. Hispanic Journal of Behavioral Sciences, 11, 330-340.
Marin, G., & Marin, B. (1991). Research with Hispanic populations. Newbury Park: Sage Publications.
Martinez, C., & Martin, H. W. (1996). Folk diseases among urban Mexican-Americans: Etiology, symptoms, and treatment. Journal of the American Medical Association, 196, 147-150.
Meyerson, M. D. (1983). Genetic counseling for families of Chicano children with birth defects. In Omark, D. & Erickson, J.G. (Eds.), The bilingual exceptional child (pp. 285-298). San Diego: College-Hill Press.
Meyerson, M. D. (1990). Cultural considerations in the treatment of Latinos with craniofacial malformations. Cleft Palate Journal, 27, 279-288.
Mikhail, B. (1994). Hispanic mothers’ beliefs and practices regarding selected children’s health problems. Western Journal of Nursing, 16, 623-637.
Moya, B. S. (1940). Superstitions and beliefs among the SpanishSpeaking people of New Mexico. Unpublished master’s thesis, University of New Mexico, Albuquerque.
Novas, H. (1994). Everything you need to know about Latino history. New York: Penguin Group.
Pachter, L. M. (1993). (Ed). Latino Folk Illness. Medical anthropology: Cross-cultural studies in health and illness. 15(2), 171-188.
Ruscello, D. M., Lass, N. J., & Brown, J. (1988). College students’ perceptions of stutterers. National Student Speech, Language, Hearing Association Journal, 16, 115-120.
Saenz, T. L, & Whitson, J. (1994, November). Latino parents’ understanding of speech-language disorders. Paper presented at the meeting of the American Speech-Language and Hearing Convention, New Orleans, LA.
Samora, J. (1963). Conceptions of health and disease among Spanish-Americans. American Catholic Review, 24, 314-323,
Saunders, L. (1954). Cultural difference and medical care: The case of the Spanish-speaking people of the southwest. New York: Russell Sage.
Scheper-Hughes, N., & Stewart, D. (1983). Curanderismo in Taos County, New Mexico: A possible case of anthropological romanticism? The Western Journal of Medicine, 139, 875-884.
Scheuerle, J., Guilford, A., & Garcia, S. (1982). Employee bias associated with cleft lip/palate. Journal of Applied Rehabilitation Counseling, 12, 6-8.
Seligman, M., & Darling, R. B. (1997). Ordinary families, special children: A systems approach to childhood disability (2nd ed.). New York: Guilford Publications.
Shorris, E. (1992). Latinos: A biography of the people. New York: W.W. Norton.
Slesinger, D. P. (1981). Folk and clinical medical utilization patterns among Mejicano migrant farmworkers. Hispanic Journal of Behavioral Sciences, 3(1), 59-73.
Smart, J. F., & Smart, D. W. (1991). Acceptance of disability and the Mexican-American culture. Rehabilitation Counseling Bulletin, 34, 357-367.
Spector, R. (1996). Cultural diversity in health and illness (4th ed.). Norwalk: Appleton & Lange.
Spires-Robin, R., & McGarrahan, P. (1995 ). The healing
practices of Mexican spiritualism. In L.L. Adler & B.R. Mukherji (Eds.), Spirit versus scalpel (pp. 121-135). Westport, CT: Bergin & Garvey.
Sue, D. W., & Sue, D. (1990). Counseling the culturally different: Theory and practice. New York: John Wiley.
Trevino, F. M. (1987). Standardized terminology for Hispanic populations. American Journal of Public Health, 77, 66-72.
Trotter, R. T. (1981). Remedios caseros: Mexican-American home remedies and community health problems. Social Science and Medicine, 15B, 107-114.
Trotter, R. T. (1982). Contrasting models of the healer’s role: South Texas case examples. Hispanic Journal of Behavioral Sciences, 4, 315-327.
U.S. Bureau of the Census Statistical Abstract of the United States 1996. (116th ed.). Washington, DC: Author.
White, E. H. (1977). Giving health care to minority patients. The Nursing Clinics of North America: Cultural & Biological Diversity and Health Care, 12, 27-40.
Zaldivar, A. (1994). Perceptions of the importance placed on religion and folk medicine by non-Mexican-American Hispanic adults with diabetes. The Diabetes Educator, 20, 303-306.
Zea, M. C., Quezada, T., & Belgrave, F. A. (1994). Latino cultural values: Their role in adjustment to disability. Journal of Social Behavior and Personality, 9, 185-200.
Zuniga, M. E. (1992). Families with Latino roots. In E. W. Lynch & M. J. Hanson (Eds.), Developing cross-cultural competence: A guide for working with young children and their families (pp. 151-177). Baltimore: Paul H. Brooks.
Received: July 13, 2000
Accepted: July 18, 2001
Marlene B. Salas-Provance
Southern Illinois University at Edwardsville
Joan Good Erickson
University of Ilinois at Urbana-Champaign
Educational Consultant, Albuquerque, NM
Contact author: Marlene B. Salas-Provance, PhD, Southern Illinois University Edwardsville, Department of Special Education and Communication Disorders, Box 1147, Edwardsville, IL 62027. E-mail: firstname.lastname@example.org
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