Chronic Illness and Hmong Shamans

Abstract

Among the challenges health care personnel in California's central valley face has been finding ways to help Hmong Americans manage chronic illness. Interviews were conducted with 11 Hmong shamans diagnosed with diabetes or hypertension and were qualitatively analyzed to ascertain respondents' understanding and management of their illnesses. Hmong shamans are influential individuals within their communities and are often the resource persons to whom patients turn for information on health. Understanding the shamans' perspective on chronic illness was seen as a gateway to understanding how the broader Hmong American community perceived these conditions. The concept of chronic illness was not well understood, resulting in sporadic medication and dietary regimens, limited awareness of potential complications, and a persistent impression that these illnesses could be cured rather than managed. Suggestions for patient educators include family and community involvement in care regimens and the use of descriptive terminology to identify the disease.

Lay beliefs about hypertension: An interpretive synthesis of the qualitative research

“…Directions were described as “indirect or hard to follow” (Horowitz et al, 2004, p. 639); some participants expressed the belief that doctors would prefer to prescribe medications because they were not trained to teach about diet. While the Hmong shaman in Helsel et al’s (2005) study did not specifically criticize healthcare provider teaching, one told of being taught to eat fish at every meal and another of being taught to eat three turkey sandwiches each day. One might question how effective the communication had been; both language and cultural barriers may have played a role.…”

“…It was implied in Ogedegbe, Harrison, et al’s (2004) study that found people questioned the accuracy of the diagnosis if they did not have a family history of high blood pressure. Other less frequently mentioned etiologies included evil spirits (Wilson et al) and seasonal changes or pollen (Helsel et al, 2005).…”

“…Of further interest, the Hmong shamans in Helsel et al’s (2005) study described some difficulty in conceptualizing high blood pressure. Their own language did not have a word for it, and the notion of a chronic illness was not part of their culture.…”

“…An interesting exception to the involvement of family members was among the Hmong shaman. Although family members were typically involved in healthcare issues in this culture, they were not regarding blood pressure (Helsel et al, 2005). The disjoint between the conceptualization of hypertension and cultural expectations may have contributed to this.…”

“…The populations investigated in these studies were not broadly distributed. One study investigated the beliefs of Hmong shamans (Helsel et al, 2005), one looked at the beliefs of older adults specifically about blood pressure monitoring (Viverais‐Dresler & Bakker, 2004), one focused on urban African Americans and Latinos (Horowitz et al, 2004), and the remaining eight studied African Americans. Of the African American samples, three focused on rural poor (Boutain, 2001a, 2001b; Schoenberg & Drew, 2002), two on urban poor (Lukoschek, 2003; Rose et al, 2000), two on urban with mixed economic status but the majority were poor (Ogedegbe, Harrison, et al, 2004; Ogedegbe, Mancuso, et al, 2004), and one on urban without reporting economic status (Wilson et al, 2002).…”