Southwest Educational Development Laboratory
Disability, Diversity and Dissemination: A Review of the Literature on Topics Related to Increasing the Utilization of Rehabilitation Research Outcomes among Diverse Consumer Groups
Cultural and other considerations that can influence effectiveness within the rehabilitation system
Considerations of culture within the broad category of African American are extremely complex. Most African Americans have a long ancestry in the U.S. (Takaki, 1995). For many, however, their position in U.S. society is marginal to that of the mainstream. At the same time, links to their cultures of origin have been attenuated (McLemore, 1994). In addition, African Americans are diverse in terms of education, economic status, religious belief, degree of urbanization, and other characteristics (Tatum, 1997). Lubiano (1992) observes that:
In our attention to the history of racism in the United States, African Americans have learned to keep in our memory the unrelenting attacks on our existence as a group… But blackness is simply too large and unelaborated a category to carry the weight of analysis. (p. 346)
While it is inaccurate to speak of "Black culture&" in monolithic terms, African Americans tend to remain in touch with what Lubiano (1992) describes as "a conscious awareness of being part of a group… with a particular place in history and a political relationship to other groups within the… United States&" (p. 330). In addition, some African Americans share affiliations and world views that are grounded in elements of traditional African cultures, Protestantism, and adaptations to the experiences of indenturehood, slavery, and subordination in U.S. society (Takaki, 1995; Harry, 1992). Cross (1995), in discussing racial identity development, observes that not all African Americans develop a Black identity. For those who do, however,
Having a Black identity means that the reference group functions of one's identity are grounded in one's Blackness… One's values, cultural preferences, artistic tastes, leisure activities, cooking styles and food choices, secular and religious musical tastes, church affiliation, organizational memberships, and social network or intimate friends are all influenced by one's perceived connection to Black people. In brief, some or a great deal of the meaning and hope one has for living a purposeful life is linked to one's perception of oneself as an African American… Whether it is mingled with other identities or singular, being Black plays an important reference group function in the daily life of the person. (p. 119)
Jackson and Sears (1992, cited in Leung, 1993) describe an "Africentric&" world view as characterized by a "group orientation, collective responsibility, cooperation, and interdependence&" (Leung, p. 96). Similarly, Harry notes that Protestantism within Black culture "emphasizes group solidarity and collectivity&" (p. 48). McLemore (1994) cites a number of sources that emphasize the importance of extended families, noting that "accumulating evidence supports that the extended family, rather than the nuclear family, is the proper unit of analysis&" for studies of African American families (p. 328). He reports that "regardless of income level, African Americans are significantly more likely than white Americans to have extended family members living in the household&" (p. 330).
In terms of attitudes regarding disability, studies suggest that many African Americans attribute "significantly more importance to spirituality in causing and treating&" developmental and other disabilities. Instead of, or in addition to, seeking help through medical or rehabilitation systems, many African Americans rely heavily on community supports, particularly the church (Leong, Wagner, & Tata, 1995, p. 423). Harry, Allen, and McLaughlin (1995, cited in Schaller, Parker, & García, 1998) also point out that African American parents "may hold broader perceptions of normalcy and have a wider range of expectations for developmental milestones of children's behavior&" than do many educational professionals (p. 41).
Soriano (1995), discussing culturally appropriate rehabilitation counseling for Latino populations, observes that "Latinos are highly diverse… in terms of culture, ethnicity, and geographic origin, as well as in terms of education and economic levels&" (p. 67). However, within this diversity, many scholars find a number of commonalties in customs, beliefs, and world views. Harry (1992), for example, lists characteristics common to traditional Hispanic world views. She characterizes traditional Hispanic culture as "based on Catholic ideology, with an inextricable interweaving of the ideologies of native Central and South American views of the universe&" (p. 26). In Caribbean territories, however, "it is mainly African religious beliefs that have been added to a Catholic base&" (p. 26). Other characteristics cited by Harry and others include:
As is described for other non-mainstream groups, perspectives on disability among members of traditional Hispanic cultures are influenced by beliefs in the intersection of the physical and the spiritual (Smart & Smart, 1992). Families, which act as a powerful support system (Leong, Wagner, & Tata, 1995) consider some conditions as merely a reflection of individual differences rather than disability, and adapt family and work roles to accommodate those differences. However, severe disability, especially developmental disability, is a stigma for the traditional Hispanic family (Harry, 1992).
Many traditional Hispanic families, though they may seek assistance from mainstream health systems, also may seek help from folk healers and members of the clergy. Leong, Wagner, and Tata (1995), in discussing mental health services, cite findings that "utilization of folk healers is not common, particularly among urbanized, acculturated Hispanics&" (p. 427). However, they also cite a study by Martinez and Martin (1966), which found "that approximately 97% of the 75 Mexican American housewives they surveyed were familiar with folk remedies and more than 50% had been treated by a folk healer&" (p. 427). Trevino (1991) concludes that:
To many Mexican Americans both traditional health services and folk healing are important, each addressing different needs in different ways… Rehabilitation counselors who serve many Mexican Americans should seriously consider building relations with folk healers. After all, they may be viewed as simply another allied health professional offering rehabilitation services from a different cultural perspective. (p. 24)
Leung (1993) notes that "no ethnic group in the U.S. is as difficult to describe as Asian Americans&" (p. 95). Harry (1992) also describes "vast racial differences&" among groups in this category, as well as differences in religion, language, and culture, but identifies "certain commonalties&" (p. 35). She observes that "the essence of Eastern cultures is collectivism and harmony&" (p. 35). Quoting Chan (1986), she summarizes the common features in Eastern cultures as
harmony, social order, rules of propriety, filial piety, benevolence, loyalty, cooperation, reciprocity, and obligation, all of which exist within a system of "prescribed roles and relationships which emphasize subordination and interdependence&" … A belief in "the supremacy of the universal order over oneself is further manifested in reverence for the past.&" (p. 35)
In discussing Americans of Chinese descent, Chan, Lam, Wong, Leung, and Fung (1988) contrast the individualistic orientation of U.S. mainstream culture with "the Chinese preoccupation with social order (collectivist orientation). This concern of the Chinese people for harmony-within-hierarchy is strongly influenced by Confucian philosophy and often continues to be an influence on Americans of Chinese descent&" (p. 21). They observe that the emphasis in traditional Chinese society on "functioning within well-defined and structured social relationships&" may lead some Chinese Americans to "expect the same well-defined structure and role in a [rehabilitation] counseling relationship. The client-centered approach used by many rehabilitation counselors in the United States may be viewed as too ambiguous and wishy-washy' by Chinese-American clients&" (Chan et al. 1988, p. 22).
In a similar vein, McFarlane, Farley, Guerrero, and Galea'i (1996), discussing Pacific cultures in areas served by the Rehabilitation Research and Training Center of the Pacific, describe how these differences influence concepts related to independent living: "The concept of independent living when described by such terms as empowerment, advocacy, personal choice, and living independently, goes against Pacific Island cultural practices of respect, being humble, … family choice and involvement, and living and being with the family&" (p. 24).
As do other authors (see for example, Harry, 1992; Hong, 1995), McFarlane et al. stress the importance in traditional Asian Pacific cultures of family life and the preservation of family honor. They explain that, in traditional Samoan culture, for example, "a person has an identity only so far as that person can demonstrate his/her connections to the aiga (extended family). Personal needs, goals, and eccentricities must be downplayed for the good of the family group&" (p. 25). They further observe that, "in Samoa and throughout most of the Pacific, there remain strong inhibitions against airing family problems to outsiders&" (p. 25).
Yamashiro and Matsuoka (1997), discussing the underutilization of mental health services among Asian and Pacific Americans, note the concept of "face,&" which is reinforced by Confucian philosophy. They conclude that traditionally oriented Asian and Pacific Americans "may perceive that losing face because of mental illness in the family would subject the individual or family to a religious or spiritual crisis&" (p. 182).
In terms of attitudes about disabilities, Leung (1996) cites Paris (1993), who "found that Asians generally had the least positive attitudes [toward people with disabilities], even when healthcare professionals are the subjects of research&" (p. 5). As Hong (1995) explains,
There are many [Asian Americans] who believe in supernatural or metaphysical forces which could play a role in health and disease, and in fortune and misfortune. Such beliefs have strong implications in the perception of the causes of disability, in the treatment of disability, and in the feelings of guilt, responsibility or shame associated with having a person with a disability in the family. (p. 61)
Traditional Asian Pacific Americans often seek help through sources other than, or in addition to, the western medical or rehabilitation system. Hong observes that "a family will often want to pursue traditional Asian cures, such as herbal medicine, or take certain actions to restore the balance of nature&" (p. 61). Liu (1995) notes that "Asian Americans rely more heavily on informal social networks&" than do most other minority groups (p. 125).
Quoting Trimble (1990), Leung (1993) explains that "the term American Indian can be viewed as an imposed social and political ethnic category with little relevant meaning,' and represents a range of cultural orientations'&" (p. 95). Leung notes the existence of more than 500 tribal groups that have been recognized by the U.S. government. Harry (1992) points out the dangers of ignoring the diversity inherent within these groups as well as other factors. She concludes:
To the extent that there can be said to exist a Native American culture in the United States, it must be seen as the product of three centuries of contact with U.S. mainstream culture and the imposition of alien forms of government, philosophy, and social organization on varying traditional cultures of Native American peoples… Contemporary Native American groups hold certain features in common, which may be, to varying extents, a combination of traditional features, adaptive strategies, and varying levels of acculturation to the dominant culture. These features include an enduring sense of pride in cultural heritage, a belief in the interrelatedness of body and spirit, culturally distinctive communication styles, and a reliance on extended community and kinship networks. (p. 40)
Harry notes among Native American groups "a style of communication that is consistently described in the literature as less verbal and direct than that of mainstream U.S. culture&" (p. 44). This indirect style, along with standards of courtesy and appropriate interaction, lead Locust and Lang (1996) to conclude that, "if a [rehabilitation] counselor wished to observe courteous behaviors with an [American] Indian client, the time spent with that one client would double or triple what might be necessary for other clients&" (p. 5).
Regarding concepts of disability among American Indians, Locust (1988, cited in Harry, 1992) observes "that most traditional Indian languages do not have words for retarded, disabled, or handicapped and, rather than using such categories, may assign names of individuals that are descriptive of the disability, such as One-Arm, or One-Who-Walks-with-a-Limp&" (p. 46). The belief in the interrelatedness of body and spirit described by Harry and others contrasts with the beliefs inherent in the mainstream medical model. As is true in other traditional cultures, American Indians with strong roots in traditional tribal culture may seek help from "folk healers&" as well as the mainstream medical and rehabilitation systems.
This ends Part 1, which offers a discussion of the theoretical framework describing the relationship of constructs such as race, ethnicity, culture, disability, and power. Influences within the rehabilitation system were presented, as well as descriptions of "mainstream" and "ethnic" cultures in the United States.
Volume 4, Number 2 will focus on the characteristics of effective systems and how to build relationships within "culturally competent" organizations. The concepts about culture and diversity that were presented in Part 1 will be related to issues in conducting research and issues in dissemination and utilization. The conclusion will offer organizational, research, and D & U recommendations.
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