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A Study of Health Care Practices and Health Beliefs of Puerto Rican Women in Southeastern Pennsylvania Lorraine Martin-Plank

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A Study of Health Care Practices and Health Beliefs of Puerto Rican Women in Southeastern Pennsylvania Lorraine Martin-Plank Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 2008 A Study of Health Care Practices and Health Beliefs of Puerto Rican Women in Southeastern Pennsylvania Lorraine Martin-Plank Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Martin-Plank, L. (2008). A Study of Health Care Practices and Health Beliefs of Puerto Rican Women in Southeastern Pennsylvania (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/885 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. A STUDY OF HEALTH CARE PRACTICES AND HEALTH BELIEFS OF PUERTO RICAN WOMEN IN SOUTHEASTERN PENNSYLVANIA A Dissertation Submitted to the School of Nursing Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Lorraine Martin-Plank July 2008 Copyright by Lorraine Martin-Plank 2008 HEALTH CARE PRACTICES AND HEALTH BELIEFS OF PUERTO RICAN WOMEN IN SOUTHEASTERN PENNSYLVANIA By Lorraine M. Martin-Plank Approved July 9, 2008 ________________________________ ____________________________________ Joan Such Lockhart, RN, PhD, CORLN, Rick Zoucha, PhD, APRN, BC, CTN AOCN®, CNE, FAAN Associate Professor of Nursing Professor of Nursing (Committee Member) Associate Dean, Academic Affairs (Dissertation Director) ________________________________ ____________________________________ Eileen Zungolo, RN, EdD, CNE, FAAN Lauren Clark, RN, PhD, FAAN Dean, School of Nursing Professor, University of Utah Professor of Nursing (External Member) iii ABSTRACT A STUDY OF HEALTH CARE PRACTICES AND HEALTH BELIEFS OF PUERTO RICAN WOMEN IN SOUTHEASTERN PENNSYLVANIA By Lorraine (Lori) Martin-Plank, PhD August 2008 Dissertation Supervised by Joan Such Lockhart, PhD, RN, CORLN, AOCN®, CNE, FAAN The purpose of this focused ethnography was to discover the culturally based health care beliefs and practices of the Puerto Rican population in urban Southeastern Pennsylvania as related by Puerto Rican women. The study also sought to discern the influence of acculturation on the health beliefs and practices of this population. The study used a qualitative methodology to elicit the emic viewpoint of the informants through semi-structured interviews, participant observation, fieldnotes and memos. A quantitative measurement scale was used to measure psychological acculturation; most informants were bicultural although all self-identified Puerto Rico as home. A purposive sampling strategy with snowballing was used to identify 37 informants. Informants provided detailed data on home remedy use. Four themes were abstracted from the data analysis including (a) between two worlds: staying connected to our roots; (b) gardens as iv symbols of the motherland: creating the environment; (c) the holistic nature of health; (d) surviving the system: healthcare perspectives in Puerto Rico and Philadelphia. Findings have implications for health professions education and practice in the areas of safe integrative healthcare and health disparities. Policy implications include the need for interdisciplinary education of health professions students in social policy and health disparities and corresponding clinical practice in health disparities areas. Policy implications for third-party health insurers include the need to re-examine current primary care service mandates to reflect client input and needs. Further research is needed in the areas of safety and integrative medicine, health policy and health disparities, creation of healthcare delivery models that are culturally-based and focus on improving health outcomes, and the relationship of acculturation to health beliefs and practices, and ultimately to health outcomes. v DEDICATION I dedicate this dissertation to my wonderful family whose patience and encouragement has sustained me throughout this effort. To my husband Rick, who has used humor to weather the low times and has cheered me on in the high times; thanks for being you. To our daughter Erin thanks for the hugs, the cuddly stuffed animals, and the pictures. To my brother Frank, whose life in India first sparked my interest in culture, thank you—but please, don’t fall off any more mountains!! To my dear deceased parents who valued education; thanks for planting the seed. To my grandparents, Michael Martin and Mary Cullen, whose cultural journey to America landed them in the same place where my study occurred—I have a new insight into those difficult early days! And to my dear family in Ireland, my life has been enriched by knowing you all; thanks for your prayers and love. Finally, to my dear Aunt Madeleine, my first early childhood teacher—thanks for being with me for part of this journey; I miss you. vi ACKNOWLEDGEMENT A special thanks to my dissertation committee who has guided me along this journey. To Dr. Joan Such Lockhart, my chairperson, I thank you for your wisdom, expertise, and kindness throughout the development and process of this qualitative study—and for your patience. To Dr. Rick Zoucha who has been with me since the early days of the online qualitative research course and the Leininger theory, thank you. To Dr. Lauren Clark, thanks so much for being a part of my committee. I really appreciate your wealth of knowledge about culture and ethnography and your questions which challenge me to explore further. Thanks also to Dr. Ellen Olshansky for earlier guidance and encouragement and to Dr. Marta Rivera from Universidad de Puerto Rico for her mentorship and personalismo. To Dr. David Hufford whose class in Folk and Unorthodox Healing was fascinating and enlightening, thanks for getting me out “in the field”. To my dear friend, Dr. Priscilla O’Connor, thanks for your help and encouragement! To Dr. Karen Moore Schaefer, thanks for the backup support. Thanks to Dr. Rosemary Fliszar and my dear familia at the Hispanic Senior Center in Bethlehem. To Dr. Marian Highrighter, my first research mentor, I honor your memory. A special thanks to my dear friend, Wanda Wieckowski, for her persistent and loving encouragement. Thanks also to Joan Zieja, Nancy and Joe Capizzi, and Linda Hauns for your friendship and support. To Sylvia Metzler, CRNP, a nurse practitioner colleague par excellence, who lives in el barrio and walks the walk and talks the talk for health and economic equity for all; it is an honor and a privilege to know you. To my informants, my best teachers, how can I ever thank you?! Gracias por el viaje! A special thanks to Jen Ford at Temple for her patience and help with computer support. vii TABLE OF CONTENTS Abstract .............................................................................................................................. iv Dedication .......................................................................................................................... vi Acknowledgement ............................................................................................................ vii CHAPTER 1 ....................................................................................................................... 1 1.1. Need for the Study .................................................................................................. 2 1.2 Purpose of the Study ................................................................................................. 4 1.3 Research Questions ................................................................................................... 5 1.4 Significance for Nursing ........................................................................................... 7 1.5 Definition of Terms.................................................................................................. 8 1.6 Assumptions ............................................................................................................. 8 1.7 Limitations ................................................................................................................ 9 1.8 Summary ................................................................................................................. 10 Chapter 2 ........................................................................................................................... 11 2.1Ethnohistory and Culture of Puerto Rico ................................................................. 11 2.2 The Puerto Rican Community in Philadelphia ....................................................... 42 2.3 Puerto Rican Women .............................................................................................. 46 2.4 Puerto Rican Ethnomedical Beliefs and Practices ................................................. 66 2.5 Acculturation Research ........................................................................................... 79 2.6 Summary and Gaps in the Literature ...................................................................... 85 Chapter 3 ........................................................................................................................... 89 3.1 Introduction ............................................................................................................. 89 viii 3.2 Methodology ..........................................................................................................
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