Abstract
Health concerns for Latinos, the largest ethnic minority in the United States, merit attention by policy makers. Given the importance of the Latino population to the economic well-being of the United States, ensuring good health for this group is crucial. Lack of access to health care is the most obvious barrier to maintaining good health for Latinos, but it is not the only important factor. Sociocultural factors, including acculturation, culturally competent health professionals, immigration status, income, and education are also influential to health concerns. Recommendations to decrease health disparities among Latino men include theoretically based health interventions, better integration of research findings, working with local communities, and incorporating Latino masculine values into both health care and health education. Given the importance of the sociocultural factors, the discussion that follows emphasizes these and the interaction of these factors with Latino cultural values.
Latinos are now the largest ethnic minority in the United States 1 and that means concerns that affect the Latino population cannot be ignored. Of particular importance is anything related to health—health care, access to health care and health insurance, health literacy, barriers to health care, and, of course, health disparities. Latinos are also more likely to be found in the lower socioeconomic categories, which means higher rates of poverty, unemployment and underemployment, undereducated, and a greater likelihood of being uninsured—all factors that are implicated in limited access to health care and a higher risk for negative health outcomes. 2 Maintaining good health for the Latino population is essential as Latinos are increasingly represented throughout the U.S. economic and political system, and their ability to be productive members of society is essential to the American economy. 2
Maintaining good health for the Latino population is essential . . ., and their ability to be productive members of society is essential to the American economy.
The health issues that disproportionally affect Latino men in the United States are many. For example, of the top 10 leading causes of death for all ages of Latino men in 2006, unintentional injuries accounted for 12.3% of deaths whereas for white men it was 6.5%. The Latino death rate for diabetes was 4.2% as compared with 2.8% for non-Latino white men. Homicide did not make the top 10 list of causes of death for non-Latino white men but ranked sixth for Latino male deaths at 4%. It should be noted that although heart disease and cancer are the top 2 leading causes of death for both groups, Latino men fare better in both categories (ie, for heart disease, 20.9% vs 26.6%, and for cancer 18.7% vs 24.5%) as compared with non-Latino white men. 3 Researchers have examined various causes of health disparities, including access to care, the role of acculturation, culture beliefs, lack of health education, use of health services, health care decision making, and cultural competence of health care providers.
Although lack of access to health care is the most frequently mentioned barrier to good health for Latinos, it is not the only influential factor, nor is it the only determinant of good health. 4 The current status of Latino men’s health is strongly affected by other important and interconnected sociocultural factors—Latino cultural values, citizenship status, income, education—as well as by structural factors such as the lack of culturally and linguistically competent health programs and services. Health outcomes, both positive and negative, are influenced by sociocultural factors 2 perhaps as much as, if not more so, than by structural factors such as health insurance status; however, all play critical and related roles. All these factors contribute to the health disparities we see in Latino men. The discussion that follows emphasizes where these factors interact with Latino cultural values.
Acculturation and Health
Acculturation is often noted as an important factor that impacts the health behaviors, health status, and health disparities of Latinos. Acculturation has been defined as “the degree to which a majority culture is adopted by a minority culture.” 5 The research in this area has been criticized for lack of clear definition of the term acculturation and inconsistencies in how it is measured. In addition, theoretical perspectives of acculturation have evolved beyond the historical view of acculturation as linear and one dimensional. In other words, once acculturation—as defined by acquisition of a new language, length of stay in United States, and/or nativity—occurs, it is likely that loss of original culture also occurs. 6 More recent perspectives, however, indicate that acculturation is actually multidimensional and that one can adopt characteristics of the new culture without loss of the old ways. There may also be a reciprocal process in which the minority culture impacts or changes the majority culture, as has been observed in border towns in the United States 6 and wherever cultural borders intersect. As the Latino population grows, it will be important to evaluate this reciprocal process and its impact on the health of Latinos.
The Latino paradox is a frequently noted aspect of acculturation that states that less acculturated Latinos have fewer chronic health problems, lower all-cause mortality, and higher life expectancy, as compared with both non-Latino whites 7 and to more acculturated Latinos, despite the fact that less acculturated Latinos have less access to health care and tend to be lower on the socioeconomic status (SES) scale. Surprisingly, it appears that an increase in acculturation brings an increase in less healthy behaviors, hence the paradox. There does seem to be a gender effect, however, with higher acculturation in Latinas leading to more unhealthy behaviors as compared with Latino men. 7 For example, Castro et al 8 found that among Latino men, smoking cessation increased with years in the United States and with English as the preferred language. This same pattern was not observed among Latinas trying to quit smoking. Past research has found a strong link to the adoption of smoking and higher levels of acculturation in Latinas but not with Latinos. 8
Acculturation can bring positive benefits such as greater use of and access to health care as well as an increase in leisure time physical activity. 9 In addition, Fitzgerald 9 argues that for Latinos who are lower on the SES spectrum, acculturation may be a protective factor as they avoid the adoption of the expensive risky behaviors associated with increased acculturation (eg, increased alcohol use, smoking, and unhealthy fast food diet). Again, a gendered pattern is seen; in Latinas, smoking and alcohol consumption rates increase with acculturation whereas the same pattern is not found in men.8-10 A study on gender differences between Latinas and Latinos and physical activity found that, overall, men engaged in greater physical activity than did women 11 and that acculturation was correlated with less overall physical activity in both genders. Other research has found increased acculturation to be associated with increased leisure time physical activity for Latinos. 12
Culture and Latino Health Decision Making
Many cultural factors affect Latinos when it comes to health care decision making and health-related behaviors. One that is specific to men is the concept of machismo, which is defined as the cultural value that Latino men are expected to behave in a masculine way and is an influential factor in their decision-making processes.13,14 Expectations of men consistent with machismo affect how Latino men interpret and react to symptoms even if they are acculturated to an American way of life. 14 The machismo value can have a positive effect on health care usage—from this perspective, a Latino male who considers himself a good provider and caretaker of his family, will want to be in good enough health to be able to work.13,15 In addition, as head of the family, he will likely participate in major decisions for his family, including those related to health care.15,16 However, if a Latino man is not provided with health education about the health needs of women and children, machismo can create a barrier to seeking care for family members. 16
Machismo is a multidimensional concept consisting of 2 distinct components—caballerismo, characterized by positive family relations and participation along with courage and egalitarian beliefs,16,17 and the second component, macho, which encompasses the generally more negative aspects of machismo. Behaviors associated with macho include dominance, dogmatism, and aggression. To date, no research has examined how these 2 concepts affect health behaviors in Latino men. One study 18 has explored how marianiso, the cultural concept of Latinas adhering to feminine behavior, such as being the family caregiver and provider of support and nurturing to family members, was affected by a cancer diagnosis. Women in the study who were unable to fulfill these role expectations due to illness showed considerable emotional distress. It is interesting to note that, despite their debilitating cancer treatments, women neither expected nor wanted husbands to take on their household duties. The researchers concluded that it was important for women (and men) to maintain their expected gender roles in the family, even during a health crisis.
Fatalismo, or fatalism, the belief that an individual’s fate is beyond his control, is another cultural value that can have health consequences. 13 Fatalism can act as a barrier to preventive health actions (eg, participation in health screenings or making behavioral changes), but this cultural value may also mask a lack of access to health prevention services. 13 Some researchers have questioned the validity of the concept of fatalismo as a cultural value and suggest that it can also be viewed as a reaction to the inaccessibility of health care resources of a disadvantaged group. Since Latinos perceive more negative experiences within health care settings, fatalismo can be interpreted as an appropriate response to these health system barriers and not simply a passive cultural trait. 19
A cultural value associated with positive impact on health is religiosity. Although not specific to Latino cultures, the vast majority of Latinos do report strong religious affiliation and religious beliefs and attendance at religious services is associated with better health behaviors and attitudes such as lower rates of smoking and alcohol use, seeking treatment for substance abuse problems, and the improved ability to cope with adverse health outcomes. 13
Importance of Culturally Competent Health Education
Another factor that increases health disparities among groups is lack of access to effective health education. Although health education has the potential to save lives and improve quality of life, it is generally accepted that men’s poor health attitudes and behaviors, as well as the lack of effective health education that specifically targets men, contributes to men’s negative health outcomes.20-22 Cultural values that affect health behaviors may be a reason that Latino males are even more unlikely than men in general to attend to personal health or respond to efforts to improve their health status. 7 In addition, Latino males’ lack of access to culturally appropriate health education also contributes to their negative health consequences.15,21,23 In contrast, many researchers believe that one reason women in general and Latinas in particular have better health outcomes is because women and Latinas are better consumers of health information and more likely to turn that information into beneficial health behaviors.20,21,24
One way to improve the effectiveness of health education and health care for Latino men is to target those services appropriately to them and then to evaluate whether associated health outcomes improve. Unfavorable health outcomes can be seen in health disparities, “persistent differences in health conditions and illness rates that cut across many illness categories and demographic groups” 25 and are an acknowledged problem in health care and the target of many investigative efforts to understand the problem and try to solve it. Whereas there is wide agreement that health disparities result in negative health outcomes for specific groups, there is not as wide agreement as to the causes or effective solutions.
A first step to finding a solution is to come to agreement on the contributors to health disparities, in particular those related to cultural competence. Betancourt et al 26 combine social and cultural contributors into the catchall term sociocultural barriers to care. This comprehensive term includes organizational (leadership and workforce), structural (lack of trained interpreters, confusing and unhelpful bureaucratic procedures, and other access issues), and clinical (culturally competent health interventions) barriers. Cultural competence can include all or some of the three sociocultural barrier types. For example, a culturally competent approach that addresses organizational barriers might mean finding ways to recruit a diverse workforce. A culturally competent approach that addresses structural barriers might include ways to ensure that all health education materials are linguistically and culturally appropriate. Similarly, a culturally competent approach that addresses clinical barriers could include opportunities for health care providers to learn culturally specific information or how to enhance patient–provider communication or the active recruitment of minorities into health care professions. 26
The definition of health disparities can be expanded to include social capital, influential social assets such as power, status, wealth, and opportunities that are frequently distributed unequally depending on group affiliation. 27 As long as health care remains a commodity that is distributed unequally, health outcomes for Latinos, who are overly represented as members of an economically disadvantaged group, will continue to suffer. One aspect of social capital that is not as vulnerable to unequal distribution is that of social support networks. Members of ethnic minority groups may compensate for other social capital deficits with enhanced social networks. Social networks can provide tangible resources as well as information and linkages to others who might provide information or assistance; these components would be especially useful if language is a barrier to help seeking in the wider community. 27
Many chronic health problems that affect Latinos, especially diabetes and high blood pressure, can be moderated or reduced if individuals are aware of appropriate prevention and health management options. But Latino men are not expected to take an active interest in their health unless their ability to provide for their families is involved. 28 In addition, men’s lack of attention to their health may promote early death from cancers and other diseases that could be delayed or prevented.20,21 Similarly, the trajectory of heart disease and diabetes in men could be affected by education about diet and exercise and reduction in the effects of stress. Typically, most men are unlikely to show concern for their diet or focus on stress reduction techniques20-22,24 or consider the dangers of risky behaviors, such as sexually transmitted diseases, and the importance of decreasing unintentional injuries. The public health intervention could be to educate men to participate in their own health care and to have access to effective health education. For Latino men this means culturally appropriate and linguistically acceptable methods of delivery.
Latino Use of Health Care Services
The growing diversity of the United States has made solving the problem of disparities in health care utilization a social policy goal. It is well accepted that health disparities exist, even when insurance status, income, age, and access to health education are held constant.29,30 In addition, the Latino population appears to use health care services differently than other ethnic groups. Studies have shown that Latinos do not use physicians as often as non-Hispanic whites31,32 and that Latinos make less use of all health care services than do those of other ethnicities. 33 In addition, Latinos will seek health care that meets their cultural and physical needs which may include holistic healers, herbal remedies, over-the-counter options, and folk medicine. 34
Another area of health care utilization that has shown culturally based differences is in hospice services. Despite similar or even greater levels of need, Latinos are less likely than non-Latino whites to access hospice care 35 and the reason for that appears to be related to differences in cultural values. Non-Latino populations value autonomy when making health care decisions and prefer accurate information that will help them make informed decisions. Conversely, Latinos avoid open talk about disease and illness with others and consider that hearing accurate prognoses might be damaging for the patient as well as painful for family members.30,36
Of the many possible explanations for differences in health care usage, not having health insurance is recognized as a significant barrier that affects access to care. 37 Latinos have the lowest rate of health insurance among all ethnic groups and Mexicans/Mexican Americans have the lowest (40%) among the Latino grouping. 3 According to the US Census Bureau, 1 almost 31% (30.7%) of Latinos lacked health insurance in 2008. Gary et al 38 also found that Latinos were less likely than either non-Latino whites or African Americans to have health insurance as did Becker 39 who reports that as many as 1 in 3 Latinos does not have health insurance. Having health insurance affects both the health services used and the extent of usage especially for immigrants—who comprise more than half of the Latino population in the United States and who are less likely to be eligible for publicly funded health insurance. 3 Citizenship status is a related barrier to health care access since, even if individuals are in the United States legally, they cannot access government-provided health insurance (eg, Medicaid) until they have been in the United States for 5 years. People who do not have health insurance are less likely to have a regular source of care and tend to use emergency departments, free clinics, or community health clinics to meet their health care needs. 22
A second barrier is lack of cultural competence among health care practitioners. Beyond not speaking Spanish, this includes physicians not understanding patients who are different from themselves, as well as lack of interest on the part of practitioners to incorporate patients’ health beliefs into treatment options.30,40 Language and culture both affect health care choices and treatment responses. Thus it is possible that enhancing cultural competence might result in better health outcomes for ethnic minority patients. 40
Acculturation is another variable that affects health care utilization—and is discussed at greater length above. Acculturation can be thought of as the “psychological and social changes that groups and individuals experience when they enter a new and different cultural context.” 41 The effects of acculturation can vary along a continuum of response from positive to negative. On some measures (eg, adult and infant mortality) less acculturated Latinos are healthier—see the discussion on the Latino paradox above—but more acculturated Latinos are more likely to access preventive services and to have consistent access to health care. 42 In addition, less acculturated Latinos are more likely to eat a healthy diet 10 whereas those who are more acculturated are more likely to address chronic health needs. 37
Other contributors to differences in health care usage include a sense of exclusion that results from lack of understanding of the health care system, a fear of poor functional outcomes, 43 and a negative perception of the quality of physician–patient interactions, particularly if the physician does not speak Spanish.28,44 Related to the sense of exclusion is the perception of discrimination. Many Latinos believe that they are not treated respectfully by health care providers, as compared with the treatment non-Latino whites receive, and that perception of discrimination is associated with going without needed care. 45
Another possible explanation for low usage is that Latinos may attempt self-care initially and only interact with the standard health care system when self-care fails. 46 Factors associated with higher health care usage for Latinos include older age, having health insurance, an established medical condition 47 or chronic disease, 45 persistent symptoms that interfere with ability to work, and access to a free health clinic.28,39
The Role of Women and Family in Health Decision Making
Research has consistently found that married men have better overall health and increased life expectancy when compared with divorced, widowed, and never married men. Other research has suggested that men may engage in very different health-related behaviors when compared with their nonmarried counterparts. 48 These behaviors are affected by having a spouse who encourages health-promoting activities and discourages health-harming ones. Women also encourage social integration and provide social and emotional support that men living alone may lack. For example, a man’s health status before marriage does not show the same health benefits found in married men. 48 Markey et al 48 found that for men, being married positively affected their beliefs about the importance of their health. In a qualitative study with young African American men and women, women were found to be important health promotion agents. 49 This role is demonstrated in a number of ways: women can demystify the health care experience for men as women are frequent users of health care for themselves (eg, contraception, pregnancy) and facilitators for others (eg, children, older family members, and spouses). In fact, Norcross et al 50 found that men were 2.7 times more likely to seek health care after being influenced by a woman. Also, in a study with family physicians, men were found to seek support from women for health-related concerns and rarely did so from other males. 51 Clearly, women have a role to play in the health beliefs, health behaviors, and health care seeking of men.
Most of the research on the role of women and men’s health has not specifically examined the role of ethnicity although preliminary research showed that for Latino men, women can play an important role in health-related decision making. A focus group study with Latino men noted that women were looked to for advice and help about health problems. 28 Other research has found that Latino women exert a significant influence on who the man decides to rely for health care.14,15 Family involvement, also known as familism, may continue throughout the decision-making process, including utilization of problem-solving skills or providing information or support as Latino families often make health decisions together.15,30 As was seen in a couples study in Guatemala, when women are educated and work for pay, both partners report they were more likely to share decision making related to health. 52 The researchers 52 noted that better outcomes may result from joint decision making because that promotes the exploration of more options. In addition, joint decision making may help solidify the plan of action chosen. Interestingly, past research has found that familism does not seem to decline with acculturation. 34
Cultural Competence Among Health Care Providers
Cultural competence among health care providers probably has its biggest impact in its absence. The lack of cultural competence is implicated as a root cause of many health disparities that involve minority populations. 30 Cultural competence in health care has evolved beyond merely speaking the same language as the patient to the more complicated bridging of cultural differences between provider and patient. The need for cultural competence on the part of health care providers can be seen in explanations of cultural variations in causes of illness, in diverse patient belief systems, in cultural influences about how and when patients access care, and in whom they ask to provide that care.30,53 Key features of cultural competence include trying to provide a diverse workforce that reflects the local community, locating health care facilities in accessible locations in communities, providing trained interpreters for all who need that service, and in-service staff education and training about the delivery of culturally acceptable and linguistically appropriate services.30,54 Another necessary component of culturally competent health care is to include representatives of local communities in both the planning and in evaluating services provided. It is also important to evaluate the quality of care provided specifically in terms of its cultural competency—otherwise there would be no way to know if any improvements in health care outcomes result from the efforts to enhance the cultural competence of the health care providers. 55
Language differences between patient and health care provider can also cause confusion and miscommunication and result in poor health outcomes. 30 Language communication difficulties can occur within as well as between Spanish-speaking groups. Regional differences, unique dialects and idioms, and/or low literacy levels, can all contribute to unexpected communication barriers. 53 If hiring more bicultural staff is not a realistic solution, adding trained medical interpreters is also a good option, as is language training for existing staff. 53 Specific training in medical terminology and procedures is an important component of interpreter training programs. It is not enough to use professional interpreters (as opposed to family members or convenient staff), trained interpreters means training in the language and concepts necessary to transmit specific medical information accurately and clearly. 30
Recommendations
Recommendations for Clinical Interventions
The health education needs of Latino men are many. Although it is recognized that Latinos are a diverse group with different health needs, beliefs, and attitudes, the use of culturally appropriate research and interventions can reduce health disparities among Latino men. The PEN-3 model 56 has been successfully used with Latino groups for both needs assessments and intervention development.17,57,58 Central to the model is the suggestion that culture interacts with health behavior in 3 ways—first, that within a specific cultural group there may be positive cultural qualities that promote health that should be encouraged; second, there are negative cultural qualities that should be changed because of their negative impact on health behavior; and third, there are exotic qualities that should be understood but ignored since they do not influence health behavior. As an example of how the model might be used to change the impact of a cultural quality from negative to positive, Erwin et al 17 recommend that, given the role of machismo in much of Latino culture, interventions that encourage men taking care of their wives should include messages that capitalize on Latino cultural norms rather than trying to change Latino men to fit the norms of the dominant culture.
Nuestros Hombres 59 is another example of using culturally appropriate health education to address the health needs of Latino men. In this case, health educators targeted the machismo-related position to take it like a man when it comes to men’s health concerns. A Texas-based health consortium used promotoras, bilingual health education, and a network of community providers to provide a nonthreatening health environment for Latino men. The goal of Nuestros Hombres was to change the negative impact that cultural attitudes can have on Latino men’s health and to encourage them to make their health a priority. 59
Another model that holds promise in improving Latino men’s health behaviors is the “reverse capacity model.” This model 13 looks at how culturally specific resiliency factors (eg, social networks or religiosity) act as buffers within the context of health outcomes. Adverse social conditions (eg, low SES or ethnic minority status) can have inconsistent effects on health outcomes, and it has been suggested that resiliency factors may play a protective role in some cases. When and how that protective role comes into play and what other factors may be involved are still being explored but interventions that capitalize on the resiliency factors can include acculturation and stress as culturally appropriate variables. As noted above, the avoidance of acculturation among some Latinos is an example of a protective factor, especially if it serves as a barrier to culturally acceptable health alternatives such as curanderos. 60
Successful health interventions should respect and use cultural norms, including machismo and marianiso. Health education geared toward Latino men can encourage men to take care of themselves using the “be a good provider” message since providing for one’s family is culturally acceptable whereas self-interest is not. In order to remove barriers to seeking health care and to encourage healthy behaviors for Latino men, interventions need to work within existing cultural beliefs systems. Use of culturally focused models can help improve the outcomes of health education and decrease health disparities for Latino men.
Recommendation to Use Culturally Appropriate Sources of Health Education for Latinos
Cultural values appear to be key factors in determining where Latino men turn for health information and education as well as how they use it. As noted above, familism, is a central concept in the Latino culture; all family members are considered reliable information sources, including for health care advice. In addition, familism can promote better health behaviors when those behaviors are associated with improving the well-being of the family. 13 In a Texas study, 32 friends and family were found to be the main sources of information regarding medical and health care needs. Similarly, in the study by Hsia, 32 63% of respondents reported seeking health information from relatives and friends, compared with only 5% who reported using television as a source of health information. Other research46,61 confirms that Latino men are most comfortable consulting family members and friends for health advice and information.
Recommendations for Health Promotion and Health Care
For immigrant Latinos in particular, Matthews et al 62 call attention to information poverty, which is defined as a group consistently lacking needed information that may result in the inability to access information sources, which, in turn, leads to a cycle of failure or unwillingness to seek out information. They recommend the use of a framework for cultural competency in communication originally proposed by Kreuter et al. 63 This framework suggests that health education and promotion programs should (a) use the target audience’s native language, (b) involve members of the target population in program planning and delivery, (c) take into account cultural beliefs and traditions, (d) use design elements that appeals to the target population when creating published materials, (e) focus on data that the target population will find most relevant when presenting health data, and (f) be aware that some members of the target population may lack literacy in any language and that alternative ways to present information may be needed (eg, use of the Internet, photonovelas, and oral presentations).
In light of these recommendations, Gast and Peak 64 propose using novelas for Latino men with embedded health education messages that have been validated using a community-based participatory approach 65 as a remedy for culturally inappropriate health education barriers. This proposed intervention will incorporate models, including the PEN-3 described above, social cognitive theory, 66 and diffusion of innovation theory. 67 Social cognitive theory concepts, vicarious learning, and modeling, are used to help understand culturally based health behaviors and guide the novela development, whereas diffusion of innovation theory helps identify which formal and information-sharing channels are used within a Latino community. In addition, Latinas would be used as valuable change agents for improving health behaviors among Latino men. The goal of this proposed intervention is to evaluate whether Latino men can avert health disparities using an accessible, culturally appropriate, and linguistically acceptable method.
Another approach to decreasing health disparities and increasing health care use among Latinos is the use of promotoras. Promotoras are members of the target population’s own community who are trained to provide accurate health information in a culturally acceptable way. Research has shown the use of lay health advisers has been successful in changing health behavior and attitudes with Latinas. 68 The success is because of the fact that promotoras come from within their own communities and bring an insider’s view of the needs and assets of their communities. In addition, promotoras can overcome language and cultural barriers as would not be possible for an outsider. The HoMBRes program 69 used promotoras in a HIV/STD prevention program in North Carolina. Afterward, the researchers evaluated the promotoras’ experiences as lay health advisers and found that the partnership between researchers and promotoras increased insights for all concerning the health beliefs and behaviors of Latino men related to HIV and STDs. The promotoras reported an increased awareness of sexual risk taking among the men, increased public-speaking skills, and that their increased knowledge and reputation continued after implementation of the program had ended. These results suggest that health promotion programs might do well to include Latino men within Latino communities as health educators for other men.
Health education programs geared toward Latino men also need to reflect the cultural values and norms of the target population. Since Latinos are a diverse group, it s critical to make sure health messages directed to them are culturally effective and linguistically appropriate. For example, focus group research on heart disease education programs for Latinos found that for many low-income Latinos, disease prevention activities were not a high priority compared with what participants felt were more pressing matters, such as paying rent and purchasing food. 70 In fact, our previous research 7 confirms this prioritization. Therefore, any health education program for Latinos must consider that economic reality and incorporate both how to eat healthy on a budget and how to include being physically active within normal, daily activities.
Another important issue to take into consideration in health promotion programming is the role played by masculinity and machismo. Past research has found that masculinity, as expressed in masculine gender scripts, can be a barrier to accessing health education and health care. 71 For example, men who score higher on masculinity scales tend to engage in riskier health behaviors. 72 Masculine gender scripts may encourage men in general and Latino men in particular to view health care settings as unwelcoming. Latino men may see themselves as vulnerable in health care settings and have difficulty asking for help and taking direction as these behaviors are incompatible with machismo. In the machismo role, Latino men are expected to be in charge and in control of decision making, thus, it is not surprising that even when Latino men have access to health care, they may not use it. In addition, cultural and language barriers may further complicate seeking health care. Through the Community Voices initiative from the WK Kellogg Foundation, several men’s health clinics have opened in underserved areas. 73 Just as women’s health clinics are commonplace, it would be ideal to see such a network of men’s health clinics. As recommended by Whitley et al, 73 such clinics could include culturally appropriate outreach such as promotoras along with links to relevant social services.
Taking into account the important role women play in the Latino family, health care providers and planners would do well to include both women and men in health decision making for Latino men. Past research has found that Latino men are open to sharing this decision making with their partners, 28 although less acculturated men may be less willing to do so. 17 Holland et al 74 found that when female significant others were sent “spouse cards” concerning health screenings for prostate or cholesterol for their partners, this technique increased the number of men who received the screenings. More research is needed to see if involving Latinas in their partners’ health decisions would improve Latino men’s health care use and improve their health behaviors.
Conclusion
Sociocultural factors that are unique to Latino men need to be addressed if health disparities in this population are to decrease. A culturally competent health care system requires that health care providers and health promotion planners understand how culture and gender influence the health behaviors of Latino men. The current method of delivery of health care and health education are often barriers for many Latino men when it comes to seeking both care and information. Health professionals who work with cultural values and gender scripts of Latino men are more likely to have success if they incorporate these suggestions.