Select and discuss the major subcultural ethnic group you know the least about.

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Select the major subcultural ethnic group you know the least about. Access the Purnell Model for Cultural Competence on the following site: Locate the diagram and research the health beliefs and cultural characteristics of that subculture regarding each of the cultural domains. Identify two components that would be important to consider when educating individuals in this subgroup, and indicate the reasons or rationale for your two choices.

Cultural Competence in Healthcare: Understanding and Educating the Hmong Subculture


In today’s diverse and multicultural society, healthcare providers must be culturally competent to ensure the delivery of effective and patient-centered care. Cultural competence involves understanding and respecting the values, beliefs, and practices of various subcultural ethnic groups, as these factors can significantly impact health outcomes. This essay explores the Hmong subculture, a major ethnic group that many may know relatively little about. We will utilize the Purnell Model for Cultural Competence to examine their health beliefs and cultural characteristics within each of the cultural domains. Furthermore, we will identify two critical components that healthcare professionals should consider when educating individuals in the Hmong subgroup, providing a rationale for their importance.

The Hmong Subculture

The Hmong people are an ethnic group originally from the mountainous regions of China, Vietnam, Laos, and Thailand. Due to historical and political factors, they have been dispersed around the world, with significant populations in the United States, France, and Australia. The Hmong have a rich cultural heritage, which includes distinct beliefs, practices, and traditions that influence their approach to healthcare.

The Purnell Model for Cultural Competence

To better understand the Hmong subculture and its healthcare-related cultural characteristics, we will utilize the Purnell Model for Cultural Competence. This model provides a comprehensive framework for assessing and enhancing cultural competence in healthcare settings. It consists of twelve domains, each of which represents a different aspect of an individual’s cultural identity and its potential impact on healthcare. The domains are as follows:

  1. Overview/heritage
  2. Communication
  3. Family roles and organization
  4. Workforce issues
  5. Biocultural ecology
  6. High-risk behaviors
  7. Nutrition
  8. Pregnancy and childbearing practices
  9. Death rituals
  10. Spirituality
  11. Healthcare practices
  12. Healthcare practitioners

In the following sections, we will examine the health beliefs and cultural characteristics of the Hmong subculture within each of these domains.

  1. Overview/Heritage

The Hmong people have a complex and rich cultural heritage that traces back thousands of years. They have a strong sense of identity and maintain their language and traditions despite migration and resettlement in various countries. Understanding the Hmong’s deep connection to their heritage is crucial for healthcare providers, as it shapes their worldview and influences their health-related decisions and practices (Purnell, 2002).

  1. Communication

Communication is a vital domain for cultural competence. Hmong culture places a significant emphasis on oral tradition, storytelling, and community-based information sharing. Traditional Hmong language skills are often limited, especially among older generations, which can create challenges in healthcare communication. Healthcare providers should be aware of potential language barriers and work with interpreters when necessary (Purnell, 2002).

  1. Family Roles and Organization

Hmong families are typically organized hierarchically, with the oldest male serving as the head of the family. Decision-making is often collective, involving input from various family members. This communal approach to decision-making can have a significant impact on healthcare choices, as family members may play a central role in medical decisions for a patient (Purnell, 2002).

  1. Workforce Issues

The Hmong population in the United States often faces socioeconomic challenges, including limited access to education and employment opportunities. Healthcare providers should be aware of these disparities and consider how they may affect healthcare access and utilization among the Hmong subculture (Purnell, 2002).

  1. Biocultural Ecology

The Hmong traditionally lived in mountainous regions, and their health beliefs are closely tied to their natural environment. They have a holistic view of health, considering physical, mental, and spiritual well-being as interconnected. Practices such as shamanism and herbal medicine play a significant role in their healthcare approach (Purnell, 2002).

  1. High-Risk Behaviors

Understanding high-risk behaviors within the Hmong community is essential for healthcare providers. These behaviors may include limited access to preventive care, reluctance to seek medical treatment, and the use of traditional healing practices. Healthcare providers should be aware of these factors to promote healthier behaviors (Purnell, 2002).

  1. Nutrition

Hmong cuisine is rich in vegetables, herbs, and rice, with meat typically reserved for special occasions. Traditional Hmong foods are nutritionally balanced and emphasize natural ingredients. Healthcare providers should consider these dietary preferences and practices when addressing nutritional concerns (Purnell, 2002).

  1. Pregnancy and Childbearing Practices

Hmong cultural beliefs surrounding pregnancy and childbirth are deeply rooted. Pregnant women are often cared for by female family members, and traditional rituals and practices are observed to ensure a safe pregnancy and childbirth. Healthcare providers should respect and accommodate these cultural practices when providing care to Hmong expectant mothers (Purnell, 2002).

  1. Death Rituals

Hmong death rituals are complex and involve various ceremonies and traditions. It is crucial for healthcare providers to be sensitive to these practices when caring for terminally ill Hmong patients or when assisting with end-of-life decisions (Purnell, 2002).

  1. Spirituality

Hmong spirituality is intertwined with nature and the spirit world. Shamanism plays a significant role in their spiritual beliefs and healing practices. Healthcare providers should be respectful of these beliefs and consider how they impact a patient’s approach to health and illness (Purnell, 2002).

  1. Healthcare Practices

The Hmong community often utilizes a combination of traditional healing methods and Western medicine. Healthcare providers should be open to discussing and integrating traditional practices when appropriate, as this can enhance patient trust and compliance (Purnell, 2002).

  1. Healthcare Practitioners

Cultural competence among healthcare practitioners is vital when caring for the Hmong subculture. Healthcare providers should be trained to recognize and address cultural differences, communicate effectively, and collaborate with interpreters when language barriers exist (Purnell, 2002).

Critical Components for Educating Individuals in the Hmong Subgroup

Having explored the health beliefs and cultural characteristics of the Hmong subculture within the twelve domains of the Purnell Model, it is evident that healthcare providers must consider several crucial components when educating individuals within this subgroup. Two components that stand out as particularly important are:

  1. Effective Cross-Cultural Communication:

    Effective communication is the cornerstone of culturally competent care, and it is especially critical when working with the Hmong subculture due to potential language barriers and differences in communication styles. Healthcare providers must invest in training and resources to ensure that they can communicate effectively with Hmong patients and their families. This includes:

    • Language Access: Healthcare facilities should have access to trained interpreters who are fluent in both English and Hmong. These interpreters can bridge the language gap and facilitate clear communication between healthcare providers and Hmong patients.
    • Culturally Sensitive Communication Skills: Healthcare providers should receive training in culturally sensitive communication. This involves understanding the importance of non-verbal cues, tone of voice, and active listening when working with Hmong patients. Respectful and patient-centered communication helps build trust and rapport.
    • Health Literacy Materials in Hmong: Providing health education materials in the Hmong language can empower patients to make informed decisions about their healthcare. These materials should be culturally tailored and accessible to Hmong individuals with varying levels of literacy.
    • Community Health Workers: Healthcare facilities can benefit from employing community health workers from the Hmong community. These individuals can serve as cultural liaisons, helping patients navigate the healthcare system and bridging cultural gaps between providers and patients.

    Effective cross-cultural communication ensures that Hmong patients fully understand their diagnoses, treatment options, and preventive measures, leading to better health outcomes and patient satisfaction.

  2. Respect for Traditional Healing Practices:

    As seen in the Purnell Model, traditional healing practices are deeply ingrained in Hmong culture. Healthcare providers must respect these practices and integrate them into the patient’s overall care plan when appropriate. This component involves:

    • Collaborative Care: Encouraging open dialogue between Western healthcare practitioners and Hmong traditional healers can lead to a more comprehensive and culturally sensitive approach to health. Providers should seek to understand the specific rituals and treatments used by Hmong shamans and incorporate them into the care plan if acceptable to the patient.
    • Education and Explanation: Healthcare providers should take the time to educate Hmong patients about the benefits and limitations of both Western medicine and traditional healing practices. Patients should be empowered to make informed decisions about their healthcare, taking into account their cultural beliefs.
    • Documentation and Coordination: When traditional healing practices are part of the care plan, healthcare providers should document these interventions and coordinate with traditional healers to ensure that they do not conflict with Western medical treatments. Collaboration between the two approaches can enhance patient well-being.
    • Respect for Privacy and Beliefs: Healthcare providers must respect the privacy and confidentiality of Hmong patients regarding their use of traditional healing methods. This includes refraining from judgment and ensuring that the patient feels safe discussing their practices and beliefs.

    By respecting and integrating traditional healing practices, healthcare providers can foster trust and cooperation with Hmong patients, ultimately improving health outcomes and patient satisfaction.

Rationale for the Selected Components

The choice of effective cross-cultural communication and respect for traditional healing practices as critical components for educating individuals in the Hmong subgroup is supported by several compelling reasons:

  1. Language and Communication Barriers: Hmong individuals in the United States often face language barriers, as English may not be their first language. Effective cross-cultural communication, including access to interpreters, helps ensure that Hmong patients can accurately convey their symptoms, understand their diagnoses, and make informed decisions about their healthcare.
  2. Building Trust and Rapport: Respectful and culturally sensitive communication is essential for building trust and rapport between healthcare providers and Hmong patients. Trust is a crucial element in patient-provider relationships, and it directly impacts a patient’s willingness to follow medical advice and adhere to treatment plans.
  3. Respect for Cultural Beliefs: The Hmong community places a high value on their cultural traditions and beliefs, including traditional healing practices. Disrespect or disregard for these practices can lead to cultural insensitivity and mistrust. By respecting and incorporating traditional healing practices into the care plan when appropriate, healthcare providers demonstrate cultural competence and respect for the patient’s autonomy.
  4. Enhanced Health Outcomes: Culturally tailored care that integrates both Western and traditional healing approaches can lead to improved health outcomes. Patients are more likely to engage with healthcare when they feel that their cultural beliefs and practices are respected and integrated into their care.
  5. Patient-Centered Care: The selected components align with the principles of patient-centered care, where the patient’s values, preferences, and cultural background are central to the decision-making process. Patient-centered care is associated with higher patient satisfaction and better adherence to treatment plans.


Cultural competence in healthcare is essential for providing high-quality, patient-centered care to individuals from diverse cultural backgrounds. The Hmong subculture, with its rich heritage and unique health beliefs, serves as an example of the importance of cultural competence. By utilizing the Purnell Model for Cultural Competence, healthcare providers can gain insights into the Hmong cultural characteristics within various domains and tailor their care accordingly.

Two critical components for educating individuals in the Hmong subgroup have been identified: effective cross-cultural communication and respect for traditional healing practices. These components are essential for overcoming language barriers, building trust, respecting cultural beliefs, enhancing health outcomes, and providing patient-centered care. Healthcare providers and institutions must prioritize these components to ensure equitable and culturally sensitive healthcare for the Hmong and other diverse subcultures within society.

As healthcare professionals continue to embrace cultural competence, they contribute to the broader goal of reducing health disparities and promoting health equity for all individuals, regardless of their cultural background. In doing so, they uphold the principles of ethical and equitable healthcare delivery, ensuring that every patient receives the care they deserve.


Purnell, L. D. (2002). The Purnell Model for Cultural Competence. Journal of Transcultural Nursing, 13(3), 193-196. doi:10.1177/104365960201300302

Purnell, L. D., & Paulanka, B. J. (2008). Transcultural health care: A culturally competent approach. F.A. Davis.

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