This week I am going to continue the discussion of Latino culture by presenting the cultural value of respeto. Before beginning, I would like to remind you that not all Latinos hold the cultural value of respeto and that the information presented here should not be generalized across the whole population.
At first glance it may seem surprising that the value called “respect” could negatively alter the doctor-patient interaction or even affect a patient’s compliance. However, a closer look will reveal how it can affect both the advice given during pediatric appointments and the medical interview with adults with regard to both general communication and compliance. However, since my posts have slowly been growing to the length of articles, I will break up the discussion of respeto into three posts. This first post will be the shortest as I will just give an overview of the cultural value of respeto. Next week I will explain the effect it can have in the healthcare setting. Lastly, for those who like to plan ahead, I will offer a few recommendations for communicating with Latino patients in light of this information and how these skills can be taught and practiced in the Spanish for healthcare professionals classroom.
Although respeto can easily be translated into its English equivalent, “respect”, the English word fails to capture the nuances of the cultural value. So, what is respeto as a cultural value? According to Perez (2009), respeto “implies deference to authority or a more hierarchical relationship orientation. Respeto emphasizes the importance of setting clear boundaries and knowing one´s place […] ”. Harwood, Miller and Irizarry (1995: 98) puts it another way, stating that respeto is related to “knowing the level of courtesy and decorum required in a given situation in relation to other people of a particular age, sex and social status”.
In a recent study published in the American Psychological Association, Calzada, Fernández and Cortés (2010) go one step further in defining respeto by breaking it down into four categories: 1) obedience, 2) deference, 3) decorum, and 4) public behavior. Since they have done an excellent job explaining each category, though in relation to children´s behavior, I offer you their explanation:
Obedience, or conformity to authority, refers to the importance of following commands and accepting rules without question. Deference refers to the courtesy owed to elders and reflects the hierarchical aspect of respeto. […] Decorum dictates the appropriate behaviors for social interactions, particularly in more formalized situations. Children are expected to, “Say good morning, say please, […], greet others formally.” Finally, public behavior refers to the set of boundaries imposed on the behavioral expression of children in public situations. Children must present well to others, […], perhaps because children are seen as a reflection of the entire family.
In general, in Western society, especially in the United States, we teach our children from early on to be independent (Calzada, Fernández and Cortés, 2010). The ability to question authority as “free-thinkers” is valued. In the study by Calzada, Fernández and Cortés (2010), Latina mothers noted that in their culture the children can also question authority figures, but it must be done in a respectful manner with consideration for the hierarchy. From my limited travels within the United States, with the exception of certain parts of the South, the use of Sir, Ma´am and expressions of decorum (for example, an extended use of “please” or “good morning”) and deference (for example, opening the door for someone), though present, are not considered a must nor are they terribly common. However, when I first returned to the U.S. from Spain, I was surprised by the contrast between the Spanish (who are more similar to the United States in the amount of decorum, independence, etc.) and the Latinos I was working with. The Latinos were much more likely to use the formal form when speaking with me as well as terms such as “Señora”, “por favor”, “gracias”, “muy amable”, etc. Little did I know at the time that these are just a few of the more obvious, external signs of respeto but that there is so much more going on that is important to be aware of due to its impact on healthcare and doctor-patient communication. Next week, I will look at some of those factors.
Calzada, Esther J.; Fernández, Yenny and Cortés, Dharma E. (2010): “Incorporating the Cultural Value of Respeto Into a Framework of Latino Parenting”. Cultural Diversity and Ethnic Minority Psychology. 16(1): 77-86.
Calzada, Esther J.; Huang, Keng-Yen; Anicama, Catherine; Fernandez, Yenny and Miller Brotman, Laurie (2012): “Test of a Cultural Framework of Parenting with Latino Families of Young Children.” Cultural Diversity and Ethnic Minority Psychology (en línea). Recuperado de <http://www.academia.edu/1788855/Test_of_a_Cultural_Framework_of_Parenting_with_Latino_Families_of_Young_Children>.
Carteret, Marcia (2011): “Cultural Values of Latino Patients and Families”. Dimensions of Cultural: Cross-Cultural Communications for Healthcare Professionals. Recuperado de <http://www.dimensionsofculture.com/2011/03/cultural-values-of-latino-patients-and-families/>.
Perez, Magdalena (2009): “Latino Adaptation Guidelines: Cultural Values”. Chadwick Center for Children and Families. Recuperado de <http://www.chadwickcenter.org/Documents/WALS/Adaptation%20Guidelines%20-%20Cultural%20Values%20Priority%20Area.pdf>.
Peterson-Iyer, Karen (2008): “ Culturally Competent Care for Latino Patients: Introduction”. Ethics Articles, Santa Clara University. Recuperado de <http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/hispanic.html>.