This week I am returning to the theme of teaching Latino culture to medical professionals with a discussion of the value of familismo. According to Ayón et al (2010),
Familismo, a Latino cultural value, refers to the importance of strong family loyalty, closeness, and getting along with and contributing to the wellbeing of the nuclear family, extended family and kinship networks.
Although the value of familismo is typically associated with positive health outcomes, some negative effects have also been cited in various studies. In this post, I will describe what is the cultural value of familismo and look at its benefits on the health and wellness of the patients. Next week, I will explain some of the possible negative aspects regarding familismo that medical professionals should be aware of when working with Latino patients.
Familismo embodies the idea of family unity and support, a protective element against the struggles one confronts in life and also a source of identity and a sense of belonging. The needs of the family are always put over the individual´s needs, and decisions are made as a family unit. This includes not only the health decisions of a family member, but also their employment choices and even who they may date. It is often expected that the younger family members bring their significant others home for the family´s approval.
There is also a lot of pride that goes along with this idea of familismo: pride to be a part of the family and the pride of caring for and handling problems within the family. This is a sense of identity that can give personal strength and comfort, however, there can also at times be a rejection of this identity by more acculturated generations looking for a greater sense of independence. The desire to resolve problems within the family network is strong to the extent that the need to seek help outside of the family is often seen as a failure. This means that outsiders who intend to help (such as social workers or counselors) may not be readily welcomed.
It should be stated, however, that in this context family refers not only to nuclear family but also extended family as well as others who are so close that they are considered family, such as good friends or neighbors who “take care of them” or “are good to them”. Additionally, family members who do not live close-by ––for example, those living in the country of origin–– are usually excluded when discussing family in terms of familismo. Within this family unit, similar to machismo, the male leader (father or eldest son) is in charge and has the final say in decisions that are made. However, in contrast to machismo, the whole family is consulted and considered before the final decision is made.
In terms of acculturation, the studies I found seem to present differing views. Some statedthat familismo has been shown to remain strong despite acculturation, being preserved as an important value even after becoming more “americanized”. However, other studies affirm that this value is weakened as the members become further acculturated into American society.
So how does this cultural value benefit the health of Latino patients? In general, among patients who value familismo, we find higher rates of risk screenings and a more positive mental health status as well as decreased violence, drug abuse and child abuse. There also tends to be higher rates of support and empowerment for health changes or management of chronic diseases.
Regarding the risk screenings, the study by Suarez (1994) showed that women who score higher on valuing family (or familismo) are more likely to get a Pap smear or mammogram screening than those who hold to a more independent family structure (or, as it is described in the article, “more acculturated women”). It is possible that, as suggested in the article, these families offer the support ––either emotionally, financially or otherwise–– that helps women to follow through with the screenings. It is also possible that since the decision of whether or not to get preventative risk screenings is determined by the importance to the family, patients are oftentimes more likely to get them done since the decision is no longer centered around choosing between the negative sensations of the exam itself versus avoiding a possible disease to one of protecting the family from suffering the patient´s possible future illness. In terms of chronic disease management, it is possible that when families understand the importance of a treatment, they are likely to rally around that individual to help them stay on track. On the other hand, as we will see next week, the impact of the family in disease maintenance or treatment choices is not always positive.
However, in terms of mental health, violence and drug abuse, there are even more studies linking familismo to positive outcomes. For example, the one by Ayón et al. (2010) found that this cultural value may protect against symptoms of depression and that, similar to the findings of Harker (2001), familismo may “[…] protect and strengthen the psychological well-being […]” of the person in general. In terms of child maltreatment, Coohey 2001 investigated the effect of familismo on child abuse and concluded that non-abusive Latino have higher rates of familismo in comparison to those who are abusive. Additionally, Gil et al (2006) demonstrates that high levels of familismo correlate with lower levels of alcohol abuse. Finally, the study by Kennedy and Ceballo (2013) affirms the preventative nature of familismo in terms of violence among adolescents.
As you can see, there is a demonstrated benefit of familismo in terms of health and wellness (less substance abuse and violence, more preventative care and better chronic disease management). Medical professionals should not only be aware of this impact but should also be encouraged to utilize this value when connecting with patients as well as when motivating them to change their health behaviors or continue the ones they have. However, there is also a negative side to familismo that can affect the doctor-patient interaction as well as the health of some of the family members. We will look at this aspect more next week.
Ayón, C., F. Marsiglia & M. Bermudez-Parsai (2010). “Latino Family Mental Health: Exploring the Role of Discrimination and Familismo. Journal of Community Psychology 38(6): 742-756
Bleecker, A. (2011): “The effects of Familismo on First Generation Latino Adolescents”. URL: http://mblog.lib.umich.edu/~desolada/archives/2011/12/the_effects_of.html
Coohey, C. (2001). “The relationship between familism and child maltreatment in Latino and Anglo families”. Child Maltreatment 6(2): 130-42.URL: http://www.ncbi.nlm.nih.gov/pubmed/16705788
Carteret, M. (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]
Gil, A.G., E.F. Wagner & W.A. Vega (2000). Acculturation, familism, and alcohol use among Latino adolescent males: Longitudinal relations. Journal of Community Psychology 28:443-458.
Harker, K (2001). Immigrant generation, assimilation, and adolescent psychology well-being. Social Forces 79: 969-989.
Kennedy, T & R. Ceballo (2013). Latino Adolescent´s Community Violence Exposure: After-school Activities and Familismo as Risk and Protective Factors. Social Development 22(4): 663-682. URL: http://onlinelibrary.wiley.com/doi/10.1111/sode.12030/abstract
Peterson-Iyer, K. (2008). “Culturally Competent Care for Latino Patients: Introduction”. Markkula Center for Applied Ethics, Santa Clara University. URL: http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/hispanic.html
Ruiz, Mª E., E. Ransford (2012). Latino Elders Reframing Familismo Implications for Health and Caregiving Support. Journal of Cultural Diversity 19(2): 50-57.
Suarez, Lucina (1994). Pap Smear and Mammogram Screening in Mexican-American Women: The effects of Acculturation. American Journal of Public Health 84(5)