Part of being a competent health practitioner is knowing how culture influences the delivery and access of health care services. More often than not, nurses and other medical professionals find themselves struggling when providing care services to a culturally diverse population. For instance, Asian Indians are among the minority communities in the United States. Such status deems them vulnerable to poor access to healthcare services, alongside other outcomes. However, a deeper understanding of the community in question is warranted with a focus on the application of the Purnell model.
Community Overview
The National Council of Asian Pacific Physicians (NCAPIP) (2015) noted that there are 3.4 million Asian Indians in the U.S., and that they make up the largest subgroup across 23 states. They are mostly concentrated in the Northeast, South, and Midwest regions. Another important finding is that most of them did not participate in expansion for Medicaid. Apart from that, more than two-thirds of the community in question are foreign-born live in the most populous states, cities, or counties. While the rate of uninsurance is low nationally, at 10.4%, it is higher in the city and county levels, for instance, 16.7% in Chicago, 14.6% in Queens and 15.1% in New York City (NCAPIP, 2015). The data in question demonstrates that Asian Indians do not have as much access to healthcare services which explains their lack of participation in Medicaid expansion.
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Application of Purnell’s Model
The Purnell model is based on an ethnographic exploration of a target community. It allows cultural understanding of a community when it comes to protecting and promoting health when dealing with diseases (Dogu, Coskun, Uzen & Ulay, 2016). Further the Purnell model includes various domains such as heritage and overview; family roles and organization; communication; bio-cultural ecology; healthcare practices; pregnancy and childbearing practices; nutrition; workforce issues; spirituality; death rituals; as well as healthcare practitioners (Marzilli, 2017). The said factors are related to all facets of culture. One should note that the outermost factors, global society, community, family and family, have a considerable effect on the innermost factors hence shaping cultural competence (Marzilli, 2017). Therefore, before discussing how a community is affected, it is important to determine what factors determine provision of culturally competent healthcare services.
Based on the data acquired about Asian Indians, the Purnell model could be used to assess the community’s psychological, spiritual and social needs. Being largely composed of foreign-born individuals, the Asian-Indian community is likely to suffer from limited access to healthcare services. For instance, Asian-Indians did not participate in Medicaid expansion making them ineligible for insurance (NCAPIP, 2015). Using the Purnell model, one could focus on the psychological effect that such kind of limitation has had on the community’s wellbeing. The idea would be to explore the community’s social factors such as access to basic amenities, rate and nature of employment, among others. It could be that most Asian-Indians have job stress because they are enrolled in industries that they do no fit in culturally. Thus, the Purnell model would be helpful in, further, determining the interplay of spirituality and, for instance, choice of industry where one wishes to work. Notably, a culturally competent approach involves one having cultural knowledge about the target population or community (Cai, 2016). The Purnell model is likely to support acquisition of culturally-specific information about the Asian-Indian community thereby allowing a deeper understanding of the target group in question.
A study was conducted focusing on food behaviors and dietary acculturation of Asian Indians. The authors found that Asian Indians modified their traditional behaviors due to social independence alongside effects of social networking (Venkatesh & Weatherspoon, 2016). However, they experienced a high cost of their traditional foods alongside time constraints and convenience (Vinkatesh & Weatherspoon, 2016). The findings demonstrate that for Asian Indians, getting access to traditional foods is not only difficult, but they are costly. Using the Purnell model, one could use such data to determine the interplay between physiological, environmental and epidemiological outcomes for Asian Indians. For instance, it could be that some of the health problems they face are due to the change in diet. Further, the Purnell model could also help in determining the influence of geographical setting in determining the prevalence of certain illness among Asian Indians. Nutrition, for instance, is considered as one of the elements in the Purnell model (Marzilli, 2017). In this case, using the research that Vinkatesh and Weatherspoon (2016) conducted, one could focus on how changes in diet have affected Asian Indians’ physiological wellbeing and whether there have been notable trends in terms of their vulnerability to various types of diseases.
Conclusion
As mentioned, Asian Indians are mostly foreign born which makes some of them ineligible for Medicaid. Thus, with no access to insurance as is the case with other individuals, they become increasingly vulnerable to healthcare challenges. Data gathered demonstrates that Asian Indians have undergone a major cultural shift in various sectors of their lives. They are forced to change their diet as buying Asian Indian foods is costly. For that reason, they have no option but to conform to America’s dietary culture. Being foreign to them, they suffer the likelihood of experiencing health complications. The Purnell model is reliable as it considers how the wide range of factors such as community and family influence health outcomes for the community in question.
References
Cai, D. (2016). A concept analysis of cultural competence. International Journal of Nursing Sciences,3 (3), 268-273. doi:10.1016/j.ijnss.2016.08.002
Dogu, O., Coskun, E., Uzen, S. & Ulay, G. (2016). Purnell model for cultural competence: Nursing care of an Afghan patient. Journal of Nursing and Health Science, 5 (5), 44-48.
Marzilli, C. (2017). A review of the theoretical framework of culture and value applied to nursing. Journal of Nursing and Health Science, 6(6), 32-34.
The National Council of Asian Pacific Islander Physicians. (2015). The Impact of the Affordable Care Act on Asian Indian, Chinese, Filipino, Korean, Pakistani, & Vietnamese Americans . Retrieved from http://www.searac.org/wp-content/uploads/2018/04/2015_ACA_policy_brief_v13_final.pdf
Venkatesh, S., & Weatherspoon, L. J. (2018). Food Behaviors and Dietary Acculturation of Asian Indians in the US. Journal of Nutrition Education and Behavior,50 (6), 529-535. doi:10.1016/j.jneb.2017.10.014
