Last week I presented the cultural aspect of fatalismo as the belief that fate is predetermined and inevitable. I mentioned that despite this belief, many patients who hold to fatalismo are still willing to make healthy changes to their behaviors. Also, though some evidence shows that relatively few Latino patients hold to fatalismo in such a way as it would affect their health and health behavior, it is still an important concept to present in Spanish for healthcare courses due to the impact it can have when it is present.
When fatalismo does have a negative impact, it typically causes passivity, an avoidance of information or even an increase in high risk behaviors, particularly among adolescents. With an increased passivity, behaviors such as not participating in preventative screenings (such as for cancer), not complying with treatment plans and not adhering to a healthy lifestyle, in terms of diet and exercise. They are also more likely to experience anxiety and psychological distress regarding an illness or diagnosis due to this lack of perceived control. The key is in this being passivity based on the belief that they cannot change the outcome rather than a passivity based on laziness or not wanting to take the time.
Another characteristic is the avoidance of information regarding their health status. While working in a clinic in Western North Carolina, it took me months to convince a mother of the benefit of having her son (who was believed to be deaf by the medical staff) undergo a hearing test. She did not understand that early detection could help with his healthy development and instead insisted that what would happen would happen and the outcome would be the same no matter the results of a hearing test. Villagran, Collins and Garcia (:216) in their paper on Latina Communication and Cancer quote a patient undergoing chemotherapy: “I haven´t asked my doctor what comes next. And my husband doesn´t ask me what is happening either. We are just praying that everything will be alright.” If the outcome cannot be controlled, what use is it knowing the information.
Finally, a study conducted by Borowsky at the University of Minnesota revealed that adolescents who hold to fatalismo believe that they are invincible or will live longer. On the other hand, if they are meant to die young, they will die no matter what. For this reason, they are more likely to take higher risks with drugs, sex, fights, etc. than their non-fatalistic counterparts.
Though fatalismo may also lead to other behaviors (e.g. decreased use in contraceptive methods, decreased use of a seatbelt, fewer annual check ups), I will not discuss each one but leave you with the three main areas I have mentioned. In general, the most important aspect to teaching about fatalismo in Spanish for healthcare courses is presenting the belief itself: a description of it as well as its roots and history. The professor should then point out a couple of common ways it can impact the health or the actions of the patient (based on research). Finally, there should be time for the professionals to reflect on and discuss other possible effects. If time allows, they can be given excerpts from some of the research articles to discuss their thoughts on the validity of the study or even further implications of the results. Finally, there should be time for the professionals to discuss and practice ways to interact with patients who hold to fatalismo. For example: how can we encourage patients with this belief to undergo preventative screenings?
Abraído-Lanza, Ana; Anahí Viladrich, Karen Flórez, Amarilis Céspedes, Alejandra Aquirre & Ana Alicia de La Cruz (2007). “Commentary: Fatalismo Reconsidered: A Cautionary Note for Health-Related Research and Practice with Latino Populations”. Ethn Dis 17(1): 153-158. URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617551/ [9/13/2013]
Boyles, Salynn (2009). “Asocian el fatalismo adolescente con comportamientos de alto riesgo”. WebMD en español. URL: http://www.webmd.com/news/20090706/teen-fatalism-linked-to-risky-behavior [9/13/2013]
Braselton, Karen (2007). “Intercultural Encounters between United States Health Care Providers and Hispanic Immigrant Health Care Seekers: A Critical Ethnography.” Doctoral Dissertation. Southern Illinois University, Carbondale. URL: http://books.google.es/books?id=V8IrJNsGtTAC&printsec=frontcover#v=onepage&q&f=false [9/13/2013]
Carteret, Marcia (2011): “Cultural Values of Latino Patients and Families.” Dimensions of culture. URL: http://www.dimensionsofculture.com/2011/03/cultural-values-of-latino-patients-and-families/ [9/13/2013]
Edberg, Mark (2013). Health, culture and diversity. Jones and Bartlett Learning: Burlington, MA
Esparza Del Villar, Óscar Armando; Juan Quiñones Soto & Irene Concepción Carrillo Saucedo (2013). Propiedades psicométricas de la escala multidimensional de fatalismo y su relación con comportamientos de salud. Universidad de Ciudad de Juárez. URL: http://www.uacj.mx/difusion/publicaciones/Documents/Reportes/ICSA/Propiedades%20psicometricas%20RTI-SF-27.pdf
Hovey, Joseph & Lori Morales (2006). “Religious / Spiritual Beliefs: Fatalismo”. Yo Jackson (dir) Encyclopedia of Multicultural Psychology.
Loach, Barbara (2010). “Las Creencias”. Spanish for Professionals, Cedarville. URL: http://ctl.cedarville.edu/span/professionals/content/u3-Conocimientos.pdf [9/13/2013]
Villagran, M.; D. Collins & S. Garcia (2008). “Latina communication and cancer”. Emerging perspectives in health communication: Meaning, Culture and Power. Heather Zoller and Mohan Dutta (ed.). Routledge: New York.