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Developing a Research Agenda for Cultural Competence in Health Care:
Integration of Traditional Healers/Practices into Conventional Medical Encounters
Draft research agenda--version 1.0

Resources for Cross Cultural Health Care
and the U.S. Department of Health and Human Services
Office of Minority Health and the Agency for Healthcare Research and Quality

We invite public input on our draft research agendas. Please read the following document and send your comments to rcchc@aol.com. We are especially looking for recommendations for additional research questions and methodological/policy considerations. We are also seeking additional bibliographic references for the literature review abstracts. Comments received by December 10 will be incorporated into the final report–comments will also be posted online.

Definition

In many ethnic communities, health status, disease causality and health care treatment may be defined or explained through traditional or folk models. These models may differ from conventional explanations in that illness could be caused by injuries, environmental factors, interpersonal conflicts, witchcraft, sorcery, spirits, or the result of violating cultural, religious, spiritual or traditional norms. Responses may differ in approach from that of conventional medicine, requiring the use of traditional practices/remedies and employ the use of traditional healers. In some cultures the use of traditional practices/healers may be the first and only approach to dealing with health related concerns, while some individuals may feel that an integration of both traditional and conventional approaches is beneficial. Understanding these alternative models may be useful to uncover potential barriers to service delivery while providing the opportunity to integrate specific components into conventional practice.

Literature Findings

An extensive amount of literature was identified that describes alternative diagnostic/prevention methods, traditional healing practices utilized by individuals, and the use of traditional healers. Descriptive findings validate the need to integrate components of alternative systems and practices into conventional approaches to care if the delivery of culturally competent care is to be achieved.

The majority of literature examining the impact of traditional practices/healers is process related; very little scientific evidence was identified that measured the impact of the interventions on outcomes. Several common themes were found among these studies: utilization of alternative practices, integration into conventional systems of care, impact on service utilization and conflict with conventional methods. Several studies examined issues such as motivation for seeking care, frequency of use, whether traditional practices with used in conjunction with conventional services, and level of awareness and knowledge regarding alternative methods. Findings from these studies suggest:

• Traditional healers are consulted for common medical conditions.
• Using alternative methods in conjunction with conventional methods can be an effective
approach.
• Patients are reluctant to inform physicians and other members of their community about the use of traditional practices/healers for fear of judgement and stigmatization.

Key Words

Traditional healers, traditional healers/programs, healing practices, medicine men, traditional medicine, folk medicine/western medicine, folk illnesses, cross cultural medicine, healers, shaman, traditional medicine integration, traditional health practices, alternative medicine, providers

Research Questions

• Can traditional healers/practices be integrated with conventional medicine? If so, what models might be appropriate for implementation (e.g., programs for certain conditions v. others; programs that integrate both types of practitioners at one site v. services coordinated remotely)? What preparation is needed by clinicians and health care organizations to make integration successful?
• What are the processes (decision-making, behavioral) by which patients integrate traditional practices with conventional medicine? Do patients prefer one approach to another? How do patients decide whether to share their participation in traditional treatment with conventional clinicians, and how can this sharing be encouraged? Do patients show improvements in certain outcomes (satisfaction, adherence to treatment, return for follow-up visits) when participating in integrated care v. conventional care alone?
• What types of conflicts arise when attempting to integrate traditional and conventional treatments or to be supportive of dual but separate treatment-seeking by patients? What are the most effective resolution processes to mediate conflicts that arise as a result of the use of traditional and conventional practices?

Research Considerations

The questions formulated by the RAC were purposely process-oriented. Members did not propose questions that would further examine the impact of traditional healers or practices on health outcomes, strongly suggesting that it would not be appropriate to examine the impact or effectiveness of traditional healers or practices within targeted communities. These concerns appeared to be related primarily to comparing outcomes of traditional treatments with conventional treatments. Further arguments supporting the integration of alternative practices as a component of the culturally competent health care process were offered, and research questions related to the effectiveness of such integrated approaches have been proposed.

Researchers should be alert to the need to actively involve ethnic community representatives and/or traditional healers in study design and execution, and be sensitive to concerns about testing the "efficacy" of traditional treatments or healers.

literature review abstracts >

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