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Medicine, Culture & Faith

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“Respecting culture and faith is crucial to delivering patient-centered care.”

DISPROPORTIONATELY BURDENED by chronic diseases such as asthma, cancer and diabetes, foreign-born Latinos in Southern California highly value culture and faith when making decisions about their health. That’s according to the research of Rosana Leos Bravo, who has found that elder Latinos experience, on average, 7-13 chronic conditions compared to the 4-5 average of other ethnicities. This health disparity is at the root of her work to understand how elders in the community in which she grew up make medical decisions at the end of life.

“I wanted to understand how people in such critical stages of life make decisions – do they include family? What factors do they take into account?” says Bravo, a doctoral student in the Department of Community Health Sciences and researcher at the Fielding School’s Center for Health Policy Research.

For years, Bravo has served her community in East Los Angeles while volunteering at her church, Our Lady of Guadalupe, where members offer end-of-life care and bereavement services to Latinos struggling with multiple chronic conditions. But Bravo’s research interests also stem from a more personal experience, the painful memory of how her grandfather died fighting multiple diseases. Born in Mexico and later faced with critical medical decisions as he neared the end of his life in Southern California, his experience is all too similar to millions of other people in the community in which Bravo was raised.

Through interviews with foreign-born Latinos living in Southern California trying to manage the burden of multiple chronic diseases, Bravo has found some answers. In addition to doctor interactions, she has found, culture and faith are integral to making such decisions.

While older foreign-born Latinos tend to trust their doctors as experts, for many the trust is also based on the belief that physicians are instruments of God, Bravo has found in her research. People across many cultures use faith as a supplement — praying after going to the doctor, for example.

But Bravo notes that faith and culture can also affect the way people make decisions about their health — such as deciding not to go to a doctor for mental health services, preferring instead the support systems offered through the church and community. Bravo is quick to point out that the influence of culture and faith does not necessarily conflict with doctor recommendations, especially in treating chronic conditions. Rather, Bravo believes these values are avenues of hope and resilience, helping people manage multiple diseases and the end of life. Ultimately, she hopes her research will help physicians understand and respect these perspectives, improving their ability to provide culturally relevant care to this growing population of Southern California.

“Respecting culture and faith is crucial to delivering patient-centered care,” Bravo says. “Doing so doesn’t interfere with doctors’ work and ultimately benefits the health care experiences of all populations.”