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Bicultural, Youth Development Program for At-Risk Latino Families Enhances Overall Health, Teen Birth Control Use, and Family Communication


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Innovative Use of Cultural Tailoring Helps Reduce Disparities Among Latino Youth

By Thomas A. LaVeist, PhD
Director, Center for Health Disparities Solutions
Johns Hopkins Bloomberg School of Public Health
Former Member, Innovations Exchange Editorial Board


Cultural competence, cultural tailoring, patient-centered care, and community-based participatory research entered the health care lexicon less than two decades ago, as we began to notice that the nation was undergoing a demographic transition to a “minority-majority.” Cultural tailoring refers to integrating aspects of the culture of the target population into a public health intervention so that the intervention is more readily accepted. Since then, researchers and public health practitioners have struggled to operationalize these concepts with relatively little success.

The Aqui Para Ti (“Here for you”) program has successfully incorporated elements of these concepts to address the mental and physical health needs of Latino teens and young adults in Minneapolis. This is a population with well-documented health concerns, which help drive health disparities.1

The staff at Hennepin Family Care–East Lake Clinic has developed a program that is innovative in that it effectively tailors cultural aspects of patient-centered care to the target population of patients. Cultural tailoring can be tricky because cultures are constantly changing and people vary in their adherence to the cultural tenets of their ethnic group. Cultural tailoring can easily descend into stereotyping, which is not a patient-centered approach.

Perhaps the most innovative aspect of this program is also the greatest source of concern. Culturally tailoring programs along ethnic lines can be highly effective or highly negative. The dividing line between these two possibilities is painfully thin. A truly culturally competent team will be able to accurately interpret patient behaviors and recognize problems even if the patient has not articulated them. But in less skillful hands, attempts at cultural tailoring can lead to misinterpreting patient behaviors and result in a loss of patient trust and reduced efficacy.

The description of the Aqui Para Ti program does not explain how staff determined the criteria for “culturally appropriate” resources. It is also unclear whether the Latino teens were originally from Mexico or from another Latin American country. This is important because the label “Latino” represents different cultures and countries. What is culturally appropriate in one country may not be in another. When my Dominican mother moved to Arizona and lived in a predominantly Mexican-American community, she experienced a difficult cultural adjustment to the food, Spanish dialect, and other norms. She had felt more at home culturally when she lived in the largely Puerto Rican Latino community in New York.

Judging by the success of the program, the Hennepin Family Care team members were sufficiently culturally competent to implement a culturally tailored program. But, it would seem cultural competence is a key requirement for attempting to implement Aqui Para Ti elsewhere.

Reference

Centers for Disease Control and Prevention. Health risks and disparities experienced by Hispanic youth. 2009.

Disclosure Statement: Dr. LaVeist reported having no financial interests or business/professional affiliations relevant to the work described in this commentary.

Original publication: April 28, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: June 04, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: June 12, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.