Abstract
PURPOSE: Not all patients share the values and perspectives of dominant society as currently reflected in Western medicine; therefore, development and provision of rehabilitation services on Native American reservations requires awareness of cultural uniquity. Patient adherence is enhanced when communication reflects understanding of the patient's belief system relative to health and the healing process. Although patient adherence is often integral in achieving successful therapeutic outcomes, specific assessment of patient health and cultural beliefs is frequently neglected by the therapist. Blame may even be assigned to patients for failure to adhere to professional advice. The purpose of this study is to identify cultural beliefs, particularly those influencing health status, specific to two Midwestern Native American tribes. SUBJECTS: Data were collected from a number of subjects including four physical and two occupational therapists involved in developing and providing services at two separate reservations across a two year time span. Other health professionals practicing at the sites, Native community leaders as well as Native patients and health education program participants also provided data. METHOD AND MATERIALS: Data Collection methods involved in-depth interviews with key community members including tribal historians, health professionals, community advisory panels and patients. Personal reflections and focus group data from therapists were also collected. ANALYSES: Data were analyzed using qualitative analysis techniques including transcription and coding of interviews using Ethnograph 4.0; thematic analysis was also performed. RESULTS: Using the data, we identified several cultural beliefs affecting successful delivery of PT/OT services at the reservations. These include: emphasis on community over individual, noninterference, importance of sensitivity to community historical events, importance of alternative medical techniques and the value of our visibility within the Native community. CONCLUSION: This study demonstrates our gradual acceptance of deficiencies related to traditional methods of implementing PT/OT services in these Native American cultures. In addition, the study identifies specific cultural health beliefs which, if ignored, may be misinterpreted as barriers to communication and adherence; however, when identified, may enhance and facilitate successful rehabilitation outcomes.