Meaning of Culture in Pediatric Rehabilitation and Health Care.

Campbell SK, Wilhelm IJ, eds. Binghamton, NY 13904-1580, The Haworth Press Inc, 1992, paperback, 65 pp, illus, $17.95.

This slender volume covers various issues associated with cultural diversity and their application to the practices of occupational therapy and physical therapy. Dr Suzann Campbell states in her preface that pediatric rehabilitation services will improve as therapists become better at understanding and addressing the needs of patients from cultures other than their own. The book contains three articles; six book reviews; a list of suggested readings; samples of public service announcements; and the names, telephone numbers, and addresses of the Americans with Disabilities Act hotline and national services information centers.

The three articles presented were originally part of a symposium sponsored by the maternal and child health programs at the University of Illinois at Chicago and the University of North Carolina at Chapel Hill during the spring of 1991. Published versions of these presentations first appeared in Physical and Occupational Therapy in Pediatrics.

The first article, written by Laura Krefting, defines culture as a system of learned patterns of behavior and shows how this socialization process can operate on multiple levels. At the level of the individual, each person makes choices that represent a unique interpretation of that individual's culture. Acknowledgment of individuality within groups helps therapists avoid racial and ethnic stereotyping, Krefting shows that the concept of culture is not synonymous with ethnicity, geographical region, or issues related to immigrant health. Culturally sensitive therapists should not generate lists of cultural traits for any given group but should evaluate the cultural identity of each patient on an individual basis. With the goal of improving patient-therapist rapport and communication, Krefting presents strategies for helping therapists develop a more culturally sensitive practice.

The second article, written by Joyce Sparling, describes the cultural dimensions of the contemporary American family. Sparling defines the family as "a unique cultural unit" and cites studies involving ethnic groups, battered women, and new reproductive technologies to illustrate diversity within the contemporary American family. The social role of a child caretaker gets defined differently from one family to the next. Despite variation in membership or definition, Sparling stresses the key role the family plays in pediatric rehabilitation. Sparling urges therapists to adopt a broader definition of family and provides eight guidelines to assist therapists in improving their interaction with these important cultural units.

Johnette Meadows, director of the Department of Minority International Affairs of the American Physical Therapy Association, wrote the third article. Meadows presents demographic data to show a changing American population. Increases in immigration and birth rates in ethnic minority groups have resulted in increased percentages of these groups within the US population. These changing demographics pose a special challenge for health care professionals. Meadows shows the influence of culture on health beliefs and discusses the effects of these beliefs on the provision and acceptance of health care. Therapists, educated in the health care culture, may have difficulties establishing rapport with patients from diverse cultural backgrounds. Meadows stresses the need for good communication skills in overcoming cross-cultural barriers. She presents suggestions for reducing problems arising from linguistic and cultural diversity.

The strength of this book rests on its well-written articles. The authors know their topics and have the literary skills to engage the reader in their material. They document their points with references and provide convincing arguments. The need for increased cultural sensitivity, especially in health care, cannot be overstated.

One problem with the book is its cost. Seventeen dollars and ninety-five cents for a 65-page paperback book is quite high. A more economical presentation would make the book more attractive to pediatric therapists and other health care workers who are on limited budgets.

Few of the concepts in the book are new. Definitions of culture, applications of cultural anthropology to clinical settings, and many of the specific strategies for promoting cross-cultural communication have been explored by therapists over the years. Katherine Parry, Ann Goerdt, Patricia King, and Patricia Yarborough represent some of the physical therapists who addressed these issues in the past. The authors cite few of these earlier researchers and do not build on their works.

Cross-cultural health care does have inherent problems, but these issues were not discussed in the book. For example, how can there be informed consent for treatment if the therapist and the patient disagree on basic health beliefs? How should therapists approach culturally accepted behaviors that result in developmental disabilities (eg, Native American drinking behaviors resulting in fetal alcohol syndrome)? In merely replicating previous research and skirting tough questions, the authors have missed an opportunity to advance the body of cross-cultural rehabilitation knowledge.

Clinicians need to consider issues of culture if they endeavor to provide the best rehabilitation possible in a culturally diverse and changing American population. This book, despite its price and shortcomings, does provide assistance in that endeavor.