1 An Analysis of African American Culture in the Health and Human Services Setting Introduction
Communication has often been defined by scholar as the process by which people send messages and generate meanings across various contexts, cultures, and media. The process of communicating does not stop; it occurs cycle after cycle. Whether through verbal or non-verbal messages, the transaction takes place and is inevitable, named by scholars as The Principle of Communication Inevitability. Recognizing that communication will exist, whether intentional or not, it is important to understand the various areas of our life where communication may be vital to the success of the structure. One important area is focused on human welfare—medical, physical, emotionally, mentally, and financially—of children and adults. The method in which health and human service workers communicate with the people whom they serve is one that must be studied, implemented, and constantly improved. Health and human service workers are focused on the quality of life for an individual. They are not present to meet the wants out of life. The ultimate focus is rendering services that are conducive to one’s ability to live. Whether communicating good or bad news, professionals, patients, and clients have mutual responsibility for effective sending and receiving messages.
People belong to certain demographics that shape who they are, how they feel, how they learn, their exposure to certain aspects of life, their privileges, and the inequalities that they may face. A person may be young or old, first class or second class, or a member of a particular culture. All of these demographics affect our communication patterns, both within the demographic to those who are on the outside. While people communicate about a variety of topics, it is important to understand the importance of the communication surrounding health care and human services. This communication affects one’s growth and development and the ability to understand health issues. Recognizing the history of African- Americans in the United States, health care professionals, must take some level of responsibility in communicating with these individuals. Acknowledging levels of patient responsibility, it is conducive that health care professionals display a sense of cultural awareness when communicating with African-American patients because there are limited educational opportunities, access to healthcare, affordability, and a history of negative perceptions of health providers. The importance of understanding culture’s effect on health and human services worker can be identifying that various cultures do exist, understanding the development of cultural competence, and recognition that groups like African-Americans have health disparities because of low health literacy.
Studying the effect of culture on health communication is not a new research area. It is has been researched by medical professionals and communication scholars alike. However, there is a need for continued research because, history never stops. The African- American experience continues to move forward each day. Access to health care is changing. Technology development affects the educational opportunities. There have been communities who have placed focus on health education and advocacy. Professionals are starting to address the perceptions of doctors. The positive communication patterns are being implemented at earlier ages.
Culture and Communication
Van Servellen (2009) defines culture as referring to “values, beliefs, knowledge, art, morals, laws, and customs acquired by individuals and groups”. It is the way in which humans are programmed to think and in a particular way. Our experiences shape our expectations from the doctor-patient role. Those experiences define how we are able to relate. A patient and doctor who share a common experience like immigration or in a similar socioeconomic group will communicate differently from those who are unable to define the common link. In order to understand how one cultural group in particular may be affected, it is important to identify the terms minority and majority. Majority groups are those that have emerged as mainstream, while minorities are identified as the subgroup. Recognition of inequities in health outcomes between different racial and ethnic groups is one step to the battle. Kreps (2006) writes that “minority groups, especial African Americans, experience significantly more serious health problems, such as higher rates of morbidity and mortality, than member of the racial majority, White (non-Hispanic) American health care consumers”.
In order to understand that dyadic relationship of health and human service professionals and their patients, imagine the following scenario:
James is a 66 year old African-American male. He works a blue collar job. He has a wife of 42 years, 4 children, 8 grandchildren. He has not consistently seen a medical provider for concerns. Over the last 10 years, his grandchildren have worked to make sure that he is having routine exams and check-ups to ensure that he lives a healthy life. James visits his doctor at mid-year. The physician’s name is Bryan, a 41 year old white male. Bryan has a wife and recently received the news of the birth of his first born son.
James arrives to the doctor for his yearly tests results. He is nervous, He is afraid to speak. The worst thing that he could imagine is getting some news about being ill. Bryan, the doctor, has some test results to provide that are not exactly good.
In the previous scenario, James may have been calmed, or provided some sense of relief if the doctor was able to come out of the physician role and become comforting and gentle, yet firm and knowledgeable. In contrast, the doctor may have a greater ability to deliver the messages if there had been a previous rapport building phase in which doctor and patient found a common link in their backgrounds. Failure to acknowledge that racial and ethnic disparities do exist leads to a lack of progress in the establishment of the doctor-patient dyad.
Development of Cultural Competence
As time progresses, more health care and human service workers are recognizing the culture plays a role in the jobs that they do. Van Servellen (2006) provides a continuum of ideologies about culture. Using this spectrum, health care and human service workers should identify their position and set goals to move forward. On the negative end of the spectrum is the idea of cultural destructiveness, defined as “attitudes, practices, and communications that are destructive to cultures and, therefore, to the individuals who come from these cultures” (van Servellen, 73). At this extreme end, individuals under this category may be participating in large scale or subtle cultural genocide. They take on the attitude that the majority race is superior, while all others are inferior. In the health and human services arena, there may be forcing of the English language. The next level on the spectrum is Cultural Incapacity, defined as “beliefs of supremacy of one group, but… is not characterized by intentional behaviors to eradicate minority cultures” (van Servellen, 73). Next, is the level of cultural blindness, where individuals take pride in the fact that there are no biases present. Although the individual does not have any misconceptions about others, but they are “blind to their own cultural influences and do not perceive the influence of culture in others’ responses” (van Servellen, 73). Moving through the spectrum, “culturally precompetent persons realize the limitation they have in providing culturally sensitive responses, while attempting to improve their services to one or more subgroups” (van Servellen, 75). One could identify with this role if they are making a conscious effort to educate themselves on various cultural experiences. One may learn a new language, partake in diversity training and seminars, interview and immerse in cultural settings, and serve on minority boards. Through continued growth and development, “self-assessment, careful attention to the dynamics of differences, and continuous expansion of cultural knowledge”, one may have cultural competence (van Servellen, 75).
Trust and mistrust Literacy as a Concern
Weekes (2012) defines health literacy as “a patient’s ability to obtain, process, and understand basic health information and series needed to make appropriate health decisions” (76). The discrepancies in health literacy impact one’s concerns about issues and understand the issues involved in treatment. If a person, or patient, does not have the ability to read, write, and articulate, there is a greater chance that s/he will not be receptive of information that is be provided. Van Servellen (2009) writes that “low literacy has been associated with poor knowledge of disease, poor adherence to treatment regimen, problems in sef-management, and even clinical outcomes” (205). Weekes (2012) found that “communication is also affected by provider perception of the client’s literacy level” (77). Literacy in the health and human services is conducive to fulfilling the intent of maintain the welfare of the people. When literacy levels are high, patients are empowered and form alliances, simply because there is an understanding of basic medical terminology. Those patients who are adequately informed take an active role in self-management and participate health-promoting behaviors. Finally, the inability to understand medical providers increases the likelihood that instructions are fulfilled, impacting the quality of health care. (van Servellen, 2009, 206-207)
Attempting bridge the gap in communication of health and human service workers and patients, it is important to recognize the attributes the may prevent functional health literacy. While both patients and providers have some responsibility, individual characteristics such as age, language, education, culture, health status, illness experience, and prior exposure are the building blocks of the platform. Proper identification allows both doctors and patients an opportunity to understand and adapt. Weekes (2012) found that “physicians overestimated the literacy level of 54% of the African American clients” (78). Although literacy is a current issue, overcoming such an obstacle is not difficult.
Conclusion
So often, people like to put on the cultural blinders and pretend that there are no cultural barriers. Thomas, Temple, Perez, and Rupp (2011) write that “in order to increase needed service use among hard-to-reach populations, we must move beyond financial factors and address ethnic differences in the stigma associated with and access” to health care (102). Studying the effect of culture on health communication is not a new research area. It is has been researched by medical professionals and communication scholars alike. However, there is a need for continued research because, history never stops. The African- American experience continues to move forward each day. Access to health care is changing. Technology development affects the educational opportunities. There is an opportunity for instructional videos and aides. There has been a development of web based materials. Some doctor offices have implemented a process in which they develop a questionnaire that would reveal more about a patient that required of a medical chart. There have been communities who have placed focus on health education and advocacy. There are organizations that have place particular health issues as a platform. Government leaders have started education campaigns. In order to improve, there must be a constant effort to educate and advocate for the improvement of health literacy, especially for those groups who have been identified as being at risk.

Works Cited
Hood, K. B., Hart Jr., A., Belgrave, F. Z., Tademy, R. H., & Jones, R. A. (2012, August). The Role of Trust in Health Decision Making Among African American Men Recruited From Urban Barbershops. Journal of teh National Medical Association, 104(7), 351-359.
Noar, S. M., Crosby, R., Benac, C., Snow, G., & Troutman, A. (2011). Application of the Attitude-Social Influence-Efficacy Model to Condom Use Among African-American STD Clinic Patients: Implications for Tailored Health Communication. AIDS Behavior, 15, 1045-1057.
Perry, R. C., Chien, M., Walker, W. J., Fisher, T. L., & Johnson, W. E. (2010, April). African American Adolescent Males' Views on Doctors and the Health Care System. Journal of the National Medical Association, 102(4), 312-320.
Thomas, J. T. (2011). Ethnic and Gender Disparities in Needed Adolescent Mental Health Care. Journal of Health Care for the Poor and Underserved, 22, 101-110.
Weekes, C. V. (2012). African Americans and Health Literacy: A Systematic Review. ABNF Journal, 23(4), 76-80.