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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 ofcommunication and health beliefs/behaviors of patients. The most responsive providers explore

health within the full context of peoples lives, including the role of heritage consistency withinthe generations of a family.

What is Heritage Consistency?

The term heritage consistency is used to describe how much or how little a persons lifestyle

reflects his or her traditional culture. f one is very !consistent" with their heritage, then onemaintains more of the core values, beliefs, attitudes, and behaviors of ones cultural heritage. f

one is more !inconsistent," then he or she deviates from that cultural heritage. #sually, the more

one acculturates to $merican society, the less consistent they are with their original culture.$sking %uestions that reveal heritage consistency is an important means of &ooming in on the

individual patients experience which helps avoid stereotyping.

Three Key Factors Related to Heritage Consistency

'specially when working with immigrants and refugees, it is important to determine three key

factors related to heritage consistency( sociali&ation, acculturation, and assimilation into the

dominant #.). culture. Though close in meaning, the three are distinct.

)ociali&ation( The process of being raised within a culture and ac%uiring the characteristics ofthat group. *ormal +- education in the #.). is a key means of sociali&ing children in our

society.

$cculturation( This is the process of becoming a competent participant in the dominant culture.

$cculturation is necessary to survival so it is involuntary. The degree to which one becomesacculturated and the speed of the process are affected by an individuals circumstances and

choices. Children, who can easily avail themselves of socializationvia public schools, tend to

acculturate %uickly in the #.). They have an easier time learning a new language. randparents,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. *inally,literacy in ones native tongue as well as the language of the new country affects the

acculturation process.

$ssimilation 0ery much like acculturation, assimilation refers to the extent of identification

with the dominant culture. 1eyond becoming a competent participant in the dominant culture, anassimilated person chooses to identify with the members of the dominant culture. 1ehaviors that

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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 dominantcultural group." 23c4emore, 567, p. 89

3any 'uropean $mericans today rish $mericans, talian $mericans, *rench $mericans, etc. are disconnected from their cultural heritage. 'xploring the assimilation experience of ones

forebears can be very eye-opening. $mericas history is truly a history of immigration,acculturation and assimilation 2with notable exceptions/variations9.

Indications of Heritage Consistency

The following list of %uestions can help establish heritage consistency for a particular

patient/family. #sed skillfully, they reveal attitudes about health and illness as well as important

family dynamics. *or older children and adolescents, it can be especially stressful straddling twocultures. These %uestions can be especially helpful in facilitating discussion about acculturation

and assimilation with bi-cultural children struggling with identity confusion.

. :id the persons childhood development occur in the persons country of origin or in an

immigrant neighborhood in the #nited )tates;

. :o extended family members encourage participation in traditional religious or culturalactivities;

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Summary:

$long with the socio-economic factors of poverty, literacy, and health literacy, culturally

responsive care takes into account the heritage consistency of individual patients within thecontext of family dynamics. n an effort to avoid applying cultural generali&ations too rigidly,

providers explore the indicators of cultural consistency with their patients from different culturalbackgrounds to understand how closely each individual adheres to the traditional culture in

which they were raised. :eviations in attitudes and life experiences affect each persons health

beliefs and behaviors including their ability and/or willingness to comply with the treatment plantheir doctor recommends.

)ources(

The %uestions to use for indications of heritage consistency are adapted from the

Cultural :iversity in @ealth and llness by Bachel '. )pector. Ath 'dition,

@eritage consistency is a concept developed by 'stes and it&ow 25679 !The degree to

which ones lifestyle reflects his or her respective tribal culture."

This describes the degree to which ones lifestyles reect his or her respective tribal

culture (Spector, 1991). This denition helps in studying to what degree a persons

lifestyle reects the traditional culture. !eritage consistency is one way of e"ploring

whether people are #aintaining their traditional heritage and of deter#ining the

depth of a persons traditional heritage