Indian Immigrants Culture Through Cultural Competence

Paper Info
Page count 7
Word count 2091
Read time 8 min
Topic Culture
Type Case Study
Language 🇺🇸 US


As the world becomes increasingly multicultural due to effects of globalization and migration of labor (Wexler, 2012), health professionals are now, more than ever before, aware of the heightened challenges they face when meeting the healthcare needs of a culturally diverse population (Bhui et al., 2007). As suggested by these authors, it is becoming increasingly obvious that for health professionals to provide culturally competent care, they must have in-depth prior knowledge of cultural beliefs, values and practices of the cultural group in question or else fall prey to a multiplicity of undesirable health-related outcomes such as errors of diagnosis, inappropriate illness management and poor compliance. The present paper is an attempt to employ the cultural competence model and the cultural self-efficacy scale (CSES) to evaluate the health and illness beliefs, needs and management of typical Indian immigrants to the U.S., as well as their dominant healthcare practices.

Cultural Competence & Cultural Self-Efficacy Scale

In general, cultural competence takes the consideration of agencies, programs, and services that are critically responsive to the socio-cultural, racial, and ethnic variations of the people and communities they service. In this context, a culturally competent nursing professional would be one exhibiting the capacity to not only serve individuals and communities of diverse backgrounds, but also understand how culture modifies illness perceptions and illness behavior of these people and communities, and how the concerned accepts specific interventions as prescribed by professionals (Bhui et al., 2007).

Developed by Bernal and Froman, the Cultural Self-Efficacy Scale (CSES) addresses “…a nurse’s knowledge about cultural concepts, cultural patterns and skills in performing transcultural nursing functions” (Wexler, 2012; p. 24). The assessment tool has a total of 26 questions divided in three sections. While the first section requests nurses to rate their confidence in knowledge of general cultural concepts, the second requests them to rate their confidence with diverse features of the lifestyles “…of each of four different racial/ethnic groups (African American, Hispanic, Asian, and Native American)” (Gozu et al., 2007, p. 184). The last section, according to these authors, requests the professionals to rate their confidence in some nursing proficiencies associated with cross-cultural care.

Description of Indian Immigrants

Going by the 2000 and 2005 Census data, an estimated 1.7 people residing in the U.S. identified themselves as Asian Indians or Indian Americans (Shapiro, 2001), and that Asian Americans comprise the third largest ethnic group with non-white background, after Hispanic/Latinos and African-American (Wexler, 2012). Indian immigrants to the U.S. are not highly visible as a culturally diverse group not only because of member’s ability to speak English and to achieve high levels of education, but also due to non-concentration in distinct neighborhoods. Their high education background ensures most immigrants work in well paying professions and businesses. However, Indian immigrants are not a monolithic society as they have 16 languages recognized in the Constitution in addition to many other tribal languages which lack written scripts (Ramakrishna & Weiss, 1992).

From the interview with an Indian immigrant family, it was clear that health practices of Indian immigrants “…are learned through early childhood socialization and derive from the traditional ayurvedic (ayur = longevity, veda = science) principles” (Ramakrishna & Weiss, 1992, p. 266). Unlike popular belief that all Indians, at least all Hindus, are vegetarian, the interview demonstrated that many Indians eat meat but not usually beef, and that meat does not form a core component of their diet. Indian immigrants maintain unique customs, traditions, and values acquired in their homeland, such as arranged marriages, strict caste relations, kinship obligations, dependence on the family group, responsibility for others, and absolute obedience to parental authority (Gallant et al., 2010). An estimated 8 in every ten Indian immigrants subscribe to the Hindu religion (Shapiro, 2001). Additionally, it was realized that the nuclear family is the core unit of family organization in most immigrant families due to economic hardships.

Health Beliefs of Indian Immigrants

The dominant heath belief among Indian immigrants, it seems, entails the development of ayurveda, implying a positive attitude towards health. The interrelationship between the universe (system) and the body (organism) is of immense importance in ayurveda as any disequilibrium causes sickness. According to the group’s mainstream belief, “…the universe contains five elements (pancabhuta): water, fire, earth, wind, and ether. Three of these universal elements, tridosa, have analogues in the body as humors: fire (as bile), water (as phlegm), and wind (as wind)” (Ramakrishna & Weiss, 1992, p. 267). It is assumed that an individual is healthy when a delicate balance between these humors is attained, while an interruption of this homeostatic relationship occasions illness.

The immigrants also believe that blood plays a noteworthy function in the maintenance of health due to the ayurvedic assertion’s that the potency or limitation of dhatu (elements) is inversely related to the richness or poverty of blood. Lastly, and in line with the ayurvedic theory of health, most Indian immigrants are in agreement that a healthy digestive system is critical in determining the health status of an individual since “…it is here that the crucial transformation of food into humors and body constituents occurs” (Ramakrishna & Weiss, 1992, p. 267). Consequently, it is believed that the answer to good health lies in adopting an orderly daily life (dinacharya) where by personal hygiene, diet, habits and behaviors, work roles, and sleep and rest patterns are synchronized to achieve maximal health outcomes (Nadimpalli & Hutchinson, 2012).

Specific Health & Illness Needs/Health problems of Indian Immigrants

As is the case with other immigrants groups, Indian Americans are increasingly faced with a myriad of health and illness challenges, some of which are triggered by traditional beliefs and practices. For instance, research has demonstrated that infant mortality rates among Indian immigrants in the U.S. is high than in the general average (Nadimpalli & Hutchinson, 2012). This problem can be widely attributed to age-old belief among Indian women that colostrum is unsuited to infants. The problem can also be associated with the belief among Indian women of childbearing age that “…milk does not descend to the breast until their ritual bath on the third day, so newborns are fed sugar water or milk expressed from a lactating mother (Ramakrishna & Weiss, 1992, p. 266). Such milk may be contaminated, leading to diarrhea, dehydration, and death of the infant. Additionally, the prevalence of hypertension among Indian American older adults is higher when compared to other cultural groups such as Latinos and Whites (Gallant et al., 2010).

Management of Health and Illness Needs

Available literature demonstrates that cultural attitudes and beliefs facilitate self-care, self-management, and home-based management of health and illness-related needs among Indian Americans (Gallant et al., 2010; Ramakrishna & Weiss, 1992). From the interview with the family, it was demonstrated that traditional emphasis on self-discipline, in addition to a self-directed attention to dietary behaviors, exercise, rest, and exposure to the elements, contributes to the desirable effect of self-management interventions in the management of health and illness needs among Indian Americans.

Due to a fairy good understanding of illness and health needs among Indian immigrants, perceptions about chronic illness tend to correspond to mainstream Western biomedical views (Gallant et al., 2010), but older Indian people, who are obviously less literate, tend to view traditional medicine as more effective than Western medicine in the treatment of chronic illness. Consequently, it is safe to suggest that Indian Americans rely on self-care and home-based care first before consulting health professionals when situations get worse. However, the major imperative is to prevent illness through the culturally enshrined ayurvedic view of health, which not only entails living an orderly and well sustained daily life (dinacharya), but also determining carefully which dietary and lifestyle habits best suits their health (ritucharya) (Ramakrishna & Weiss, 1992).

Dominant Healthcare Practices, Areas of conflict & Implications

There exists a relatively high use of complementary and alternative medical remedies among members of this cultural group, with particular reference to older Indian Americans. Indeed, “…data from the National Health Interview Survey for White, African-American, Hispanic, and Asian adults illustrate that Asian older adults are the most frequent users of complementary and alternative medicine, with 49% reporting their use, compared to an average of 28% overall” (Gallant et al., 2010, p. 29). From the interview with the family, it was demonstrated that most people use herbal medicine as well as Western medicine to manage health and illness needs, but use of herbal remedies is higher in older adults than in younger generations.

In line with the ayurvedic theory, a daily health management schedule “…has to be established for each person, depending on his or her constitution, and changed according to the season (ritucharya)” (Ramakrishna & Weiss, 1992, p. 267). In the interview, the family head argued that it was imperative for women to be vigilant on what they feed the children and the effects of such food on the children’s bodies. Lastly, another dominant healthcare practice among this group revolves around the conception that “…the mind, body, and soul are interconnected components of a system in which malfunctioning in one component, or an upset in the relationship between the components, disturbs the harmony of the whole system” (Ramakrishna & Weiss, 1992, p. 267). To avoid illness, therefore, members always strive to avoid situations which can cause disequilibrium to the system, such as poor diet and exercise.

There have been noted conflicts between some of the healthcare practices of Indian immigrants and the conventional American healthcare system. Due to ayurvedic perspective, for instance, “…Indian patients may eagerly recount their diets, relate symptoms to changes in weather conditions, and provide other information that American health professionals may consider unnecessary” (Ramakrishna & Weiss, 1992, p. 268). Indians immigrants presenting with various health needs are also likely to be accompanied by family members and friends when seeking care. The accompanying individual participates in making decisions about treatment strategies, thus posing a dilemma for American health professionals whose training and expertise emphasizes independence and privacy (Gallant et al., 2010).

The implications for nurses and healthcare delivery system is to be at the forefront in developing and adopting culturally-competent strategies to enable effective and efficient provision of care to culturally diverse groups (Friedman et al., 2003). Over time, cultural attributes of such immigrant groups will continue to be different from the nursing professional providing care to them, thus the need for culturally effective healthcare not only to increase the utilization of medical services among minorities, but also ensure acceptance of interventions by caregivers (Committee on Pediatric Workforce, 2004). Consequently, nursing professionals must engage in continuous education and learning to be effective in provision of care to these groups. The healthcare delivery system must avail the structure and resources required to evaluate and successfully meet the cultural and language needs and expectations of its diverse clients (Douglas et al., 2009; Friedman et al., 2003).

Usefulness of the Cultural Assessment Theory and Tool

The cultural competence model is useful in providing care to diverse groups as it promotes social justice, encourages critical reflection among nursing professionals, and endows them with transcultural nursing knowledge, cross-cultural communication strategies, cross-cultural leadership and policy development, and cross-cultural practice (Douglas et al., 2009). Additionally, it reduces biases and stereotypes in the provision of care among culturally diverse groups (Bhui et al., 2007; Friedman et al., 2003). In terms of weaknesses, “…repeated failures and negative psychological outcomes decrease self-efficacy for learning and performing the necessary tasks for becoming a culturally competent registered nurse, thereby lowering persistence and commitment behaviors overall” (Jeffreys, 2010, p. 98).

Among the advantages of the CSES, Gozu et al (2007) report that it has content and construct validity and notably high internal consistency, while Jeffreys (2010) presupposes that that the model assist nursing students to become more confident about their attitudes while practicing in a dynamic but diverse cultural environment. However, trainee learners using the self-assessment tool develop lower self-efficacy perceptions than experienced learners, probably due to inherent weaknesses in variable construction.


From the discussion, it is evident how nursing professionals can utilize cultural competence to effectively evaluate the healthcare needs of Indian immigrants, and how the can use the CSES to evaluate their skills and education in transcultural nursing. The discussion, more than anything else, demonstrates that culturally effective healthcare aimed at the management of health and illness needs of diverse cultural groups necessitates the acquisition of knowledge, development and internalization of skills, and subtle demonstration of behaviors, values and attitudes that are in sync to the provision of care for patients, families, and communities with a wide allay of cultural attributes (Committee on Pediatric Workforce, 2004).

Reference List

Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhugra, D. (2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7(15), 1-10.

Committee on Pediatric Workforce. (2004). Ensuring culturally effective pediatric care: Implications for education and health policy. Pediatrics, 114(6), 1677-1685. Web.

Douglas, M.K., Pierce, J.U., Rosenkoetter, M., Callister, L.C., Hattar-Pollara, M., Lauderdale, J…Pacquiau, D. (2009). Standards of practice for culturally competent nursing care: A request for comments. Journal of Transactional Nursing, 20(3), 257-269. Web.

Friedman, M.M., Bonden, V.R., & Jones, E.G. (2003). Family nursing research: Theory & Practice (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Gallant, M.P., Spitze, G., & Glove, J.G. (2010). Chronic illness self-care and the family lives of older adults: A synthetic review across four ethnic groups. Journal of Cross-Cultural Gerontology, 25(1), 21-43.

Gozu, A., Beach, M.C., Price, E.G., Gary, T.L., Robinson, K., Palacio, A…Cooper, L.A. (2007). Self-administered instruments to measure cultural competence of health professionals: A systematic review. Teaching & Learning in Medicine, 19(2), 180-190. Web.

Jeffreys, M.R. (2010). Teaching cultural competence in nursing and healthcare (2nd ed.). New York, NY: Springer Publishing Company, LLC.

Nadimpalli, S.B., & Hutchinson, M.K. (2012). An integrative review of relationship between discrimination and Asian American health. Journal of Nursing Scholarship, 44(2), 127-135.

Ramakrishna, J., & Weiss, M.G. (1992). Cross-cultural medicine – A decade later: Health, illness, and immigration – East Indians in the United States. Western Journal of Medicine, 157(4), 265-270.

Shapiro, M.E. (2001). Asian culture brief: India. In P.E. Pinto & N. Sahu (Eds.), Working with persons with disabilities: An Indian perspective (pp. 1-4). Buffalo, NY: Center for International Rehabilitation Research Information and Exchange.

Wexler, L.M., & Gone, J.P. (2012). Culturally responsive suicide in indigenous communities: Unexplained assumptions and new possibilities. American Journal of Public Health, 102(5), 800-806.

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EssaysInCollege. (2022, May 24). Indian Immigrants Culture Through Cultural Competence. Retrieved from


EssaysInCollege. (2022, May 24). Indian Immigrants Culture Through Cultural Competence.

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EssaysInCollege. "Indian Immigrants Culture Through Cultural Competence." May 24, 2022.