Population Health for Nurses · Cultural Influences on Health Beliefs and Practices
The Role of Culture in Shaping Health Beliefs and Practices
On this page 9 sections
In 30 seconds
Every person answers three questions about illness, aloud or silently: What is wrong with me? Why did this happen? What should be done about it? Culture supplies the answers — beliefs about cause, symptoms, and the proper response (home remedies, prayer, emergency care) are learned from the cultural groups a person belongs to.
Health beliefs are not exotic customs to memorize; they are the everyday logic people use to make health decisions. A person who believes illness comes from an imbalance of hot and cold may treat a fever with cooling foods; one who believes illness is a test of faith may combine prayer with medication; one who believes symptoms are caused by spirits may consult a Traditional healer A practitioner of culturally based healing (herbalist, curandero, faith healer) Full entry → alongside a physician. None of these frameworks is inherently wrong — and patients often use several at once. The nurse's task is to understand the framework well enough to help the patient make safe, informed decisions in partnership.
Why this matters
- Explains health-seeking behavior: Culture shapes whether, when, and from whom people seek care.
- Improves communication: Teaching built on the patient's own explanation works; teaching that ignores it talks past the patient.
- Prevents judgment and conflict: Providers who dismiss patients' beliefs as "superstition" damage trust; providers who explore them find common ground.
- Reveals hidden practices: Many patients use traditional remedies alongside prescribed care without telling clinicians — often because they were never asked.
- Supports adherence: Plans that respect the patient's beliefs, family roles, and daily practices are more likely to be followed safely.
The college version
Core Concepts
Explanatory models: the patient's story of illness
An Explanatory model The patient's own story of an illness: name, cause, fears, expected treatment Full entry → is a person's own understanding of an illness episode: what they call it, what caused it, what they fear, and what they think will help. Clinicians carry explanatory models too — the biomedical one taught in school. The two often differ, and the gap is where miscommunication happens: a patient who explains diabetes as "bad blood from eating the wrong things" and a clinician who explains it as a metabolic condition are speaking two health languages. The practical skill is eliciting the patient's model — asking "What do you think caused this? What do you think would help?" — and connecting it to the biomedical plan.
Beliefs about cause
Cultures offer varied explanations for why illness occurs, and most people hold several at once:
- Natural or physical causes: germs, weather, food, imbalance, wear and tear.
- Personal behavior: what a person did or failed to do — diet, rest, exposure.
- Social causes: stress, grief, family conflict, envy.
- Spiritual causes: punishment, a test of faith, evil eye, spirits.
These beliefs are not mutually exclusive: a person may accept a viral explanation for a cold while also believing work stress made them vulnerable. The clinical implication: when the patient's explanation of cause differs from the biomedical one, the treatment plan may seem irrational to them even if it is medically sound — so address causal beliefs directly and respectfully.
The sick role and proper behavior
Culture defines the Sick role Culturally expected behavior of a sick person Full entry → — what a sick person is allowed and expected to do. In some frames, illness excuses a person from duties and entitles them to rest; in others, it must be endured silently; in still others, illness is a family event and the whole household carries the decisions. These expectations shape when symptoms are reported and how pain is described. Pain expression is a classic example: some norms encourage vocal expression, others value stoicism.
Who decides: family, elders, and healers
Health decisions are rarely made alone. Culture determines the decision-making structure: individual autonomy (common in much of Western biomedicine), family-centered decisions (common in many collectivist traditions, where elders or the head of household decide), and community or faith-based consultation. U.S. health care defaults to individual informed consent, which can clash with Family-centered decision-making Health decisions made by family or elders rather than the individual alone Full entry →. The responsive approach is to ask early, "Who would you like involved in decisions about your care?" and honor the answer within legal and institutional limits.
Traditional healing and complementary practices
Much of the world's health care happens outside hospitals, in the form of traditional and complementary practices: herbal remedies, dietary regimens, massage, spiritual healing, and the advice of traditional healers — herbalists, curanderos, faith healers. Many patients combine these with biomedicine, a practice called Medical pluralism Using several healing systems at once Full entry →. Because herbal remedies can interact with prescription drugs, nurses should ask about all treatments the patient uses, nonjudgmentally, and verify interaction concerns against current drug-information resources.
Beliefs are not static
Health beliefs respond to experience. A family with good results from modern medicine adopts it; a community harmed by research abuses becomes cautious; a second-generation immigrant may hold few of their grandparents' beliefs. Beliefs also vary within any group by age, education, religion, and personal history. The most reliable guide is the patient — assessment beats assumption.
Common Confusions
| Do Not Confuse | With | Difference |
|---|---|---|
| Health beliefs | Health behaviors | Beliefs are what people think; behaviors are what they do — cost, access, and fear also shape action |
| Cultural pattern | Individual preference | A group pattern describes tendencies, not any given patient; always assess the individual |
| Traditional practice | Unsafe practice | Many traditional practices are safe and valued; only specific practices in specific contexts pose risks — evaluate, don't dismiss |
| "Nonadherence" | Mismatched explanatory models | Apparent nonadherence is often a clash between the patient's model and the plan, not willful refusal |
| Asking once | Ongoing assessment | Beliefs change with experience and illness course; revisit the patient's model over time |
| Explaining more | Listening more | A lecture without eliciting the patient's beliefs is a monologue, not communication |
Eli explains
The same idea, in plain words
Explain it like I’m 10
Imagine two kids with a stomachache. One family says it's from eating too many sweets; another says a cold settled in the belly; another says you should pray and drink warm tea. All three families love their kids and are trying to help — they just have different ideas about why the belly hurts and what fixes it. A good nurse doesn't laugh at anyone's idea. She asks what the family thinks is going on, then helps them understand what the doctor thinks — so everyone works together.
Worked example
Mr. Adjei, 58, is diagnosed with type 2 diabetes at a community clinic. The nurse explains glucose metabolism, diet, and medication; Mr. Adjei nods but stops coming, and his control worsens. The clinic labels him "nonadherent." A second nurse, Ms. Ruiz, opens differently: "Tell me what you think is going on with your health, and what you think would help." Mr. Adjei explains that in his family "sugar sickness" comes from worry and heavy foods, the proper response is rest, bitter herbal tea, and avoiding "cold" foods, and he fears the medication will weaken his kidneys. Nothing he believes is hostile to medicine — but no one ever connected the two worlds. Ms. Ruiz does not argue with the tea. She checks it against a current drug-interaction resource, negotiates a plan that keeps the tea while adjusting meals and medication timing, and arranges a call with his brother, the family's health decision-maker. Mr. Adjei returns to care. The diagnosis never changed; the explanation did — and with it, the plan became his plan.
Key takeaways
- Culture shapes the explanatory model: what illness is called, why it happened, what will help.
- People often hold several causal beliefs at once — natural, behavioral, social, and spiritual.
- The sick role varies culturally: expectations about symptom reporting, pain expression, and duties differ across groups.
- Decision-making may be individual or family-centered; ask who the patient wants involved rather than assuming.
- Medical pluralism is common: patients combine traditional and biomedical care, often without disclosing it — ask nonjudgmentally.
- Herbal remedies can interact with medications; verify interactions against current evidence before advising.
- Never stereotype: beliefs vary within every group; ask the patient.
- Elicit the patient's model before teaching.
Check yourself
5 review questions from the chapter. Try each one, then open the answer.
What is an explanatory model, and why does it matter in patient education?
Show answer
An explanatory model is the patient's own understanding of an illness — what it is, what caused it, what they fear, and what they think will help. Teaching that ignores it talks past the patient; eliciting it allows the plan to be built on the patient's framework.
Name three types of causal beliefs people may hold about illness.
Show answer
Any three: natural/physical causes (germs, imbalance, weather); personal behavior (diet, rest); social causes (stress, grief, conflict); spiritual causes (punishment, evil eye, spirits). People often hold several.
How can family-centered decision-making conflict with U.S. informed-consent practices, and what should the nurse do?
Show answer
U.S. health care defaults to individual informed consent, while some cultural traditions expect family or elders to decide. The nurse should ask early who the patient wants involved and honor that preference within legal and institutional limits.
Why is medical pluralism important for medication safety?
Show answer
Because many patients combine traditional remedies with prescribed medications without disclosing it, and herbal products can interact with drugs. Nonjudgmental asking enables checking for interactions with current evidence.
Why is "nonadherence" often the wrong label for a patient who stops following a treatment plan?
Show answer
Because apparent nonadherence is frequently a mismatch between the patient's explanatory model and the prescribed plan — different causal beliefs, fear of treatment, family decision-making, or hidden traditional practices. The response is to bridge the patient's model, not blame.
Study tools & related lessonsKey vocabulary · Related
Key vocabulary
- Health belief
- A person's understanding of what causes illness and what should be done about it
- Explanatory model
- The patient's own story of an illness: name, cause, fears, expected treatment
- Sick role
- Culturally expected behavior of a sick person
- Medical pluralism
- Using several healing systems at once
- Traditional healer
- A practitioner of culturally based healing (herbalist, curandero, faith healer)
- Family-centered decision-making
- Health decisions made by family or elders rather than the individual alone
- Causal belief
- A person's explanation of why an illness happened
Sources & references
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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