Intercultural Competence and Patient-Centered Care _ _____________________________________________
no founder or central figure. It teaches that all things in the world are imbued with a spirit (kami). Therefore, Shinto fol- lowers revere nature in all forms [138]. Most of the deities associated with Shinto are related to nature, such as the sky, earth, heavenly bodies, and storms [136]. How- ever, deities are not different from humans, because everything is imbued with spirit. Everything is connected, including rocks, trees, dust, water, animals, and humans [138]. Shinto has no fixed doctrine and no scripture or sacred text. However, ancient prayers are passed down via oral tradition. Shinto followers worship primarily individually rather than in groups, and followers engage in purification rituals (e.g., handwashing) [138]. Worship occurs outside the shrine, and worshipers usually bring offerings of food or coins for the spirit ( kami ). These offerings are not given as sacrifices but as signs of gratitude [138]. Some followers write prayers on slips of paper and leave them nearby. New Age Spirituality The New Age movement became popular in Western society in the 1970s [142]. The precise definition of the term differs among scholars largely due to its highly eclectic range of spiri- tual beliefs and practices [142; 143]. The movement takes many shapes and is continually changing. However, there are some common features that distinguish it from other religions, such as followers who [136]: • Look forward to a society that reunites the wisdom of both science and religion • Adopt holistic and alternative healing methods • Embrace a wide array of traditional and nontraditional spiritual beliefs and practices • Accept the existence of a universal energy that under- girds and permeates all of existence Adherents believe healing can occur when individuals connect with this universal energy and learn to use it. This energy has been called by many names by different cultures, including chi (Chinese), ki (Japanese), prana (Sanskrit), mana (Pacific Islander), or the use of self as a final authority [136]. GENDER Gender identity is a vital aspect of a person’s experience of the world and of themselves. It also impacts the ways in which the world perceives and treats individuals, with a clear effect on the effective provision of health and mental health care. This section will focus on persons presenting as cisgender male or female; special considerations for those who are transgender, non-binary, or gender nonconforming will be explored in the next section.
An increasing amount of research is supporting a relationship between men’s risk for disease and death and male gender identity, and the traditional male role has been shown to conflict with the fostering of healthy behaviors [62; 63]. Male gender identity is related to a tendency to take risks, and the predilection for risky behavior begins in boyhood [63; 64; 65]. In addition, boys are taught that they should be self-reliant and independent and should control their emotions, and societal norms for both boys and men dictate that they maintain a strong image by denying pain and weakness [62; 64; 65]. Issues related to male gender identity have several important implications for health. First, risky behavior is associated with increased morbidity and mortality. Second, the concept of masculinity leads to inadequate help- and information-seeking behavior and a reduced likelihood to engage in behavior to promote health [62; 64; 65]. These behaviors appear to be rooted in a decreased likelihood for men to perceive themselves as being ill or at risk for illness, injury, or death [62]. Third, male gender identity, coupled with lower rates of health lit- eracy, creates special challenges for effectively communicating health messages to men [66; 67; 68]. Gender differences in health-related behaviors are consistent across racial/ethnic populations, although specific behaviors vary according to race/ethnicity [63]. Men’s beliefs about masculinity and traditional male roles affect health communication, and healthcare practitioners should consider male-specific beliefs and perceptions when communicating with male patients. For example, because men tend to focus on present rather than future health, concepts of fear, wellness, and longevity often do not work well in health messages [69]. Instead, healthcare practitioners should focus more on “masculine” concepts, such as strength, safety, and performance, all of which tie into men’s perceptions of their roles as providers and protectors. Although men are more likely than women to lack a regular healthcare provider and to avoid seeking help or information, women are more likely to have a chronic condition requiring regular monitoring and are more likely to have forgone neces- sary health care due to the cost [70]. In general, women are disproportionately affected by stresses related to caregiving, and this can be a barrier to help-seeking. Caregiving has been social- ized as a feminine role, and two out of every three caregivers in the United States are women, meaning they provide daily or regular support to children, adults, or people with chronic illnesses or disabilities [145]. Women who are caregivers have a greater risk for poor physical and mental health, including depression and anxiety. Women are more likely than men to be diagnosed with a mental health disorder, and more than 20% of women in the United States experienced a mental health condition in the past year [146]. In addition to being disproportionately affected, mental health conditions, such as depression and bipolar disorder, can manifest differently in or have different impacts
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