Last week, I described the cultural value of familismo and explained some of the positive benefits it can have in the field of health and wellness. Unfortunately, familismo does not always lead to some positive effects on health and care, but can also carry some negative consequences that the medical professional should be aware of when working with this population. In this post, I will specifically focus on four areas that can potentially be (but not always) negatively impacted by familismo: decision making and compliance, suppression of an individual´s problems, care for the elderly and acculturation.
An inherent characteristic of familismo is the required participation of the family in important decisions that affect each individual, including decisions on health behaviors and treatments. When families are large, this decision-making process can be quite time consuming. Given that some health measures are time-sensitive and need to be acted on more immediately, this delay in making important medical decisions is, at times, not only unhealthy, but also can cause conflict between the patient and the provider. Research has shown that this conflict can then lead to patient dissatisfaction and poor continuity of care. Also, if a decision is made before the family is consulted and, later, the family is found to be in disagreement, the patient may then fail to comply with the agreed upon plan. If the value of respeto is present as well, the patient is unlikely to inform his or her physician of the abandonment of the treatment plan, either choosing not to treat the problem, to treat it with home remedies, or to find another doctor.
Another aspect of familismo is the emphasis on putting the needs of the family above the needs of the individual. This means that if someone is seriously ill, the rest of the family gathers around them and offers their support. However, it can also mean that those who believe themselves to be “less ill”, or at least those that the family sees this way, may not take the necessary steps to seek care for themselves in order to, instead, put their energy into supporting another member of the family. In other cases, the individual may not want to put others members of the family out of the way or otherwise be a burden on them and, for that reason, will keep their problem hidden. The result is often the avoidance of seeking medical attention until the condition becomes more serious. This trait is most often seen in the elderly (as I will discuss further in a moment) and in women, especially when the woman also holds to the value of marianismo. In this case, women are more likely to focus on caring for their children and their husband, delaying their own care until they are no longer able to function.
Care of the elderly is typically viewed as one of the strong points of familismo; however, recent research shows that for Latinos living in the United States, the elderly are often not receiving the support that most physicians assume they are getting from their family. The study by Ruiz and Ransford (2012) demonstrates that, although familismo in theory would imply an excellent care of the elderly by the younger familial generations, this is not always what occurs in reality. They found that, though most elderly Latinos believed that the younger family members would come around “if they needed them”, they did not want to be a “burden or a bother” to these younger family members since they have their own problems and families to care for. Instead, many elderly Latinos advocate for their children to spend time with their own families and thus attempt to avoid imposing demands on them. This means that, despite having difficulties in activities of daily living, they are not likely to seek help from younger family members. This is confirmed in a study by Ruiz and Ransford which found that 44% of the elderly Latinos in the study rated their health as only “fair” or “poor” and …
“[…] 52% reported having some ADL [activities of daily living] limitations in lifting or carrying groceries, 62% in bending, kneeling or stooping and 40% in walking a block” For IADLs [instrumental activities of daily living], 44% reported some limitation in doing housework, 80% in grocery shopping, 48% in preparing meals, and 52% in getting to the doctor. Despite these significant health limitations, the majority of Latino elders (80%) reported very infrequent contact with their significant younger family members.” (2012)
This desire to not “be a bother” also results in the elderly Latinos tending to categorize illnesses as less serious than they are and trying to treat problems with home remedies or with time, rather than seeking medical help, so as to not have to ask a family member to take them to the clinic or cause them worry.
Another factor in the decreased support for the elderly is the fact that many do not live close to the younger family members, making it impossible to have constant support. To fill this gap, there is a tendency to “adopt” neighbors as family and look to their neighbors and friends for the support they need. This is not to say that the family members do not care. When family members can, or when they are informed, they do show their support. However, medical professionals should not take it as a given that these elderly patients are looked after by family due to familismo and should continue to offer the same support options as they offer to other, less connected patients.
Nevertheless, before moving away from the topic of elderly care, it should also be mentioned that sometimes familismo can have a negative impact on the mental health of caregivers. This sense of “duty” in caring for very ill family members inherent to familismo may prevent them from seeking help from a nursing home or assisted care program even when they are overburdened and can no longer maintain a healthy balance between their health and that of their family member (Rosenthal Gelman 2013).
Finally, although some studies have found familismo to be “immune” to the effects of acculturation, it has been shown that some Latinos do start to lose this value the longer they are in contact with the United States culture. Though the loss of familismo in and of itself is not necessarily a problem, it becomes an issue when one partner in a couple or one member of the family begins to lose it before the rest. This can be the source of stress and conflict within the family, having a negative effect on identity (since they no longer identify with the family unit but also do not yet fully identify with the American culture) and mental health in general. This is especially problematic when it is the woman who begins to lose this value before the man.
“Much dating violence between adolescent Latino couples occurs when the female begins to acculturate and achieve independence, because the male feels that this is an attack [on] machismo. […] Also, females who acculturate faster than others report feelings of hopelessness and suicide ideation because of the stress of adapting to an individualistic society when coming from a familismo upbringing and the stress of different rates of acculturation within the family.” (Bleecker 2011)
Although familismo has many positive effects in terms of health and wellbeing that can be taken advantage of when providing care, it also can carry some negative aspects that should be taken into consideration when treating Latinos who hold to this value. For this reason, it is important to include an explanation of familismo in courses for Spanish for healthcare professionals in a way that supports not only intercultural awareness but also a knowledge that will allow them to better care for this population. However, as always, care should be taken to not spread the idea that familismo is universal among Latinos or all who hold this value do so to the same extent.
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
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]
Gallardo, M. & Y. Paoliello (2008). “Familismo”. Encyclopedia of Counseling. Frederick Leong. http://knowledge.sagepub.com/view/counseling/n378.xml
Rosenthal Gelman, C. (2013). “Familismo and it´s impact on the family caregiving of Latinos with alzheimer´s disease: A complex Narrative”. Research on Aging 25(6). URL: http://roa.sagepub.com/content/early/2012/12/13/0164027512469213.abstract
Ruiz, Mª E., E. Ransford (2012). Latino Elders Reframing Familismo Implications for Health and Caregiving Support. Journal of Cultural Diversity 19(2): 50-57.