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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Community health representative: The first tribally contracted program, since 1968 - American indian paraprofessional healthcare providers

Program Management and Guidance

Culturally Sensitive Care

“A fish only discovers its need for water when it is no longer in it. Our own culture is like water for the fish. It sustains us. We live and breathe through it.” – Unknown

Culture Card - A guide to build cultural awareness.  American Indian and Alaska NativeThe tools included in this section can be used by anyone to build cultural awareness, particularly for self-awareness of the American Indian/Alaska Native broad culture.

Cultural Awareness is the foundation of communication, acceptance and success of providers to AI/AN communities. “Let’s say you’re a social worker or psychologist doing an assessment of an Indian person who talks very quietly and keeps their eyes on the ground,” suggested R. Andrew Hunt, M.S.W., L.I.C.S.W., a public health advisor in Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Mental Health Services (CMHS). “That can easily be misinterpreted as low self-esteem, depression, or some other problem, when in actuality that person is just showing respect.” Now CAPT Hunt and a team of U.S. Public Health Service officers and American Indian professionals and community members have created a tool to give disaster responders and health professionals a head start on understanding American Indian and Alaska Native cultures. To order, call SAMHSA’s Health Information Network at 1-877-SAMHSA-7. Ask for publication number SMA08-4354, or download the PDF.

These are basic tips for beginning CHRs, they are not specific but important to remember:

  1. Be warm and friendly-make the patient feel that you genuinely care about them.
  2. The first meeting is extremely important, it sets the basis of your relationship.
  3. Make the patient feel welcome.
  4. Use language the patient can understand (medical terminology may be confusing.) If a patient speaks a different language do your best to explain yourself and refer them to a CHR who can speak their language.
  5. With the patient’s consent involve the family (may include extended family as well.) The family plays crucial role in the patient’s outcome, the support of family will help speed recovery and raise social wellbeing.
  6. Treat them how you or how you would like your family to be treated.
  7. Do not rush the patient.
  8. Advocate for the best of the patient.

It is important for the health care provider to note that each People have their own cultural preferences of relationships and roles. Native People have their own social norms; however some of these are stereotypes and may not be as common and many of the CHRs are familiar with those of their people.

  1. Silence is valued and is not necessarily a negative behavior. Sometimes the patient may require time to think and respond to a comment.
  2. Time is viewed more passively and the people are more task conscious as opposed to time conscious.
  3. Eye contact is used in varying degrees and should be limited.
  4. Respect tribal healing ways and the diagnosis, work to accommodate their beliefs. CHR’s can give their support to traditional healing by respecting the people’s ways and not degrading the beliefs of other peoples.
  5. Show great respect to the elderly. In many cases the elders are not accustomed to the modern healthcare facilities, the new atmosphere, the noises, the caregivers and types treatment; for many of them it may be their first trip to a medical facility, it is important to ease their mind and explain procedures thoroughly.

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