The 'good' family syndrome: social and cultural issues in community and family health.

Abstract

Many nurses would openly admit to classifying families into two groups, the good families and the 'problem' family. Generally the good family is one that complies with all medical treatments, and behaves appropriately according to frequently unarticulated parameters set by health professionals. Conversely the problem family is one that fails to adhere to prescribed treatment plans, challenges health professionals, is over involved or too detached and oversteps the boundaries of their expected role. Unfortunately too many times families from different cultures end up being labelled as difficult or problematic because of perceived non-conformity to social norms and desired behaviours. They end up in the 'problem' family category due to biased attitudes towards their cultural backgrounds and/or socioeconomic status, despite only trying to cope with the situation from their own frame of reference and understanding. Families from different cultures may lack knowledge of what is appropriate behaviour in healthcare interactions which can result in misunderstandings and conflict. Learning to negotiate in a culture that has different norms and values is not easy when you are feeling vulnerable and ill. Labelling families is discriminatory. Many health professionals are prone to making generalisations about cultures which ignores heterogeneity and leads to erroneous assumptions and stereotypes. This leads to poor understanding which potentially leads to inadequate care.The statistics on cultural groups' health status makes for sobering reading as these families usually have higher rates of illnesses but yet receive little if any preventive healthcare, inadequate health maintenance, and have limited access to health services. Research from the Netherlands suggests that cultural factors and poor living conditions seem to contribute to the poor health of immigrants, besides an adverse socio-economic position (Stronks et al. 2001). Migrant families in particular generally suffer more illnesses, both acute and chronic, than do the general population because of unhealthy living environments, poverty and insufficient medical care. Lack of funds or inaccessibility to health services inhibits some families from seeking treatment for any but severe illness or injury. Alternatively cultural beliefs that value stoicism and self-reliance will prohibit many families from seeking advice or treatment for healthcare concerns. Consequently they only access healthcare services when symptoms have become acute or unbearable. Language barriers and the perception of services as being for the majority population prohibit cultural groups, in particular the elderly, from accessing many statutory and voluntary services.The generally negative view of cultural groups ignores the fact that many such families show tremendous resilience when faced with illness, trauma and unexpected crises. Many families can usually rely on a wide informal network of support such as extended family members, friends and social networks that may not be so evident in other westernised cultures. Families bring patterns of functioning that is unique to each individual family and often families develop their own way of problem solving that facilitates their coping and adaptation. The social capital of extended families and community networks is now being recognised as a significant factor that contributes to families overall functioning and well being. Therefore a theoretical reframing of families from different cultures is required to acknowledge healthy family functioning and provide culturally competent care. Viewing families from a positive perspective rather than a deficit approach would encourage recognition of families' resilience, hardiness and adaptation. Although research is proliferating in this area, there remains a deficit of knowledge about cultural minority families' successful coping strategies and patterns of functioning. Intergenerational communication and support contributes to families' social capital and hence should be respected and valued by health professionals. …