title: The effects of the cultural context of health care on treatment of and response to chronic pain and illness.
abstract: Qualitative data from two studies in Puerto Rico and New England are used to show how cultural values, standards and beliefs in different health care contexts affect (1) health care professionals' responses to patients' problems, (2) the relationships between providers and patients, and (3) the patients' responses to chronic pain and illness. Influencing elements in the care setting include the world view of the relationship of mind and body in illness processes, the dominant values and standards regarding pain and illness behaviors and the degree of cooperation between the providers and other agencies the patient depends on for compensation, rehabilitation and health insurance. In the New England study, the biomedical world view of mind-body dualism was shared by providers and most patients, but this shared belief often contributed to substantial patient stress and alienation. In contrast, in the Puerto Rican study providers and patients often shared a view of mind-body integration in illness and valued treatments which addressed chronic pain as a biopsychosocial experience. In this setting, shared views and values contributed to more supportive patient-provider relationships, and patients thus experienced less treatment-related stress.
authors.affiliation: Division of Human Development, School of Education & Human Development, State University of New York at Binghamton 13902-6000, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Bates
authors.forename: L
authors.initials: L
authors.lastname: Rankin-Hill
authors.forename: M
authors.initials: M
authors.lastname: Sanchez-Ayendez
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology / Q000534:rehabilitation*; D003431:Cross-Cultural Comparison; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009511:New England; D010146:Pain / Q000523:psychology / Q000534:rehabilitation*; D010348:Patient Care Team; D010817:Physician-Patient Relations; D011647:Puerto Rico; D012803:Sick Role; D012941:Social Responsibility; D012945:Social Values; D016896:Treatment Outcome