Full Answer Section

1. Emphasis on “Balance” and Symptom-Based Treatment in TCM:
   • Practice/Belief: TCM views health as a balance between opposing forces (Yin and Yang) and the harmonious flow of “Qi” (vital energy). Illness is seen as an imbalance. Hypertension, especially if asymptomatic, may not be considered a “disease” requiring Western medication but rather a temporary imbalance or a natural sign of aging. Patients might focus on restoring balance rather than directly lowering blood pressure numbers.
   • Problem Augmentation: If a client feels no symptoms, they might discontinue or refuse Western antihypertensive medication, believing it’s unnecessary or disrupts their body’s “balance” if they feel “normal.” They may seek herbal remedies, acupuncture, or dietary changes (e.g., “cooling” or “warming” foods) to restore balance, which they might not disclose to their Western physician. This can lead to uncontrolled hypertension and progression of the disease.
2. Use of Herbal Remedies and Dietary Practices:
   • Practice/Belief: Many Chinese Americans rely on herbal remedies, teas, and specific dietary patterns (e.g., high sodium in some traditional sauces and preserved foods, or special “medicinal” soups) passed down through generations, often without disclosing this to their Western medical provider. They may believe these natural remedies are safer, more holistic, or more effective than “chemical” Western drugs.
   • Problem Augmentation: Some herbal remedies can interact adversely with prescribed antihypertensive medications (e.g., potentiating or counteracting their effects). For instance, certain herbs can affect blood clotting or alter kidney function. Additionally, traditional diets can be high in sodium, directly counteracting the effects of blood pressure medication and dietary recommendations for hypertension management. The lack of disclosure prevents the Western physician from assessing potential interactions or providing comprehensive dietary advice.
3. Reluctance to Take Western Medication Long-Term or When Asymptomatic:
   • Practice/Belief: There can be a cultural skepticism towards long-term use of Western pharmaceuticals, often viewed as “strong” chemicals with significant side effects or as something only needed for acute illness. If a client’s blood pressure lowers and they feel well, they might stop medication, believing they are “cured” or no longer need the “chemicals.”
   • Problem Augmentation: Hypertension is a chronic condition that often requires lifelong medication. Discontinuing medication due to a feeling of wellness or fear of side effects, without medical consultation, leads to uncontrolled blood pressure fluctuations, increasing the risk of stroke, heart attack, and kidney damage.
4. Influence of Family and Community:
   • Practice/Belief: Family plays a central role in health decisions. Advice from elders or respected community members often carries significant weight, potentially overshadowing a Western physician’s recommendations if there’s a cultural conflict.
   • Problem Augmentation: Family influence, especially concerning traditional remedies or skepticism about Western medicine, can lead to non-adherence to prescribed treatments, seeking alternative, unproven therapies, or delaying follow-up appointments.

To mitigate these problems, healthcare providers need to engage in culturally sensitive communication, inquire about traditional practices and remedies without judgment, educate clients about the chronic nature of hypertension, and work collaboratively to integrate safe and effective aspects of both Western and traditional approaches.

Locus-of-Control Variable in Some Filipino Americans Influencing Health-Seeking Behavior

The concept of “fatalism” or a strong external locus of control is a significant cultural variable among some Filipino Americans that can influence their health-seeking behavior.

• Description: “Fatalism” refers to the belief that events, including health outcomes, are largely predetermined by fate, divine will (e.g., “Bahala Na” – “come what may” or “leave it to God’s will”), or other external, uncontrollable forces. This contrasts with an internal locus of control, where individuals believe they have significant personal agency over their health outcomes through their actions.
• Influence on Health-Seeking Behavior:
  1. Delayed Health Seeking: If an individual believes that an illness is destined or a punishment, they might delay seeking professional medical care, particularly for symptoms they consider minor or those that might indicate a serious condition. They may wait until symptoms become severe, believing that only then is it “God’s will” for them to seek intervention.
  2. Passive Acceptance of Illness: There can be a tendency to passively accept illness or disability as “God’s will” rather than actively engaging in preventative measures or rigorous treatment regimens. This might manifest as lower adherence to medication schedules, dietary restrictions, or exercise recommendations, especially if they are difficult or perceived as having limited impact on a predetermined outcome.
  3. Reliance on Prayer and Spiritual Healing: While faith can be a powerful coping mechanism, an extreme external locus of control might lead some to prioritize prayer and spiritual healing over scientific medical interventions, potentially delaying or even rejecting necessary treatments.
  4. Less Proactive Prevention: If health and illness are seen as beyond one’s control, there may be less motivation to engage in proactive health promotion behaviors (e.g., regular screenings, lifestyle changes) as these actions might be perceived as ineffective against fate.

It’s crucial to note that this is not universally true for all Filipino Americans, as acculturation and individual beliefs vary widely. However, understanding the potential influence of fatalism allows healthcare providers to frame their advice in a way that respects spiritual beliefs while still empowering clients to take active roles in their health, perhaps by emphasizing how God’s will can be enacted through human effort and medical science.