Short Answer/Essay Questions (2 Questions Total)

Mrs. Begay (not her real name) has come to a clinic for evaluation of a large mass in her right breast. She is 60 years old, and monolingual in her Navajo Indian language. The health care provider notices that she has worn her traditional velvet dress and beautiful turquoise jewelry, and has brought her adult daughter to translate. This is the health care provider’s initial interview with Mrs. Begay.

What are some strategies for appropriate communication that the health care provider may want to consider in the interview session?

Answers should include, but not be limited to:

1. Communication of respect for the elder.
2. Eye contact levels of comfort
3. Use of “indirect” questions, rather than “direct” —may use the example of a third party under similar circumstances.
4. Conversational pace and space for silence
5. Appropriateness of the family member as translator
6. Avoidance of the “invisible elder” method of interview (directing questions only to the translator)
7. Avoidance of listing of negative outcomes
8. Translatability of medical terms, probability statements, and concepts.
9. Modesty and touching during physical examination
10. Literacy level and individual learning style for printed or educational materials.

Discuss why it is important to illicit information concerning beliefs about the causes and treatment of illness (explanatory models) from American Indian elders in the health care setting.

Answers should include the following:

1. Health and illness beliefs are culturally mediated.
2. Health and illness beliefs are extremely diverse among American Indian groups and tribes.
3. Appropriate questioning about causes and treatments of illness can convey respect for the elder and his/her world view.
4. Understanding and acceptance of American Indian elder’s health beliefs is required in order to plan culturally congruent intervention and treatment strategies.
5. Acculturation influences should be assessed along with cultural influences.
6. Spiritual and religious beliefs are often not separated from healing practices, and healing is considered sacred work.
7. Combinations of biomedical and traditional Indian therapies may be used concurrently by the older American Indian.
8. Modesty and touching during physical examination
9. Literacy level and individual learning style for printed or educational materials.