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Background

China is a country located in Asia and covers nearly the entirety of the East Asian landmass. Having the largest population in the world, China encompasses a variety of ethnic and linguistic groups [1]. China’s most common dialect is Mandarin,  which is their official dialect; other common dialects include Cantonese, Hunanese, Min dialect, and Kejia dialect [2]. Even with more than half the population being unaffiliated with a religion, many religious practices such as  Buddhism, Christianity, Muslim,  and folk religion are still observed within China [3]. 


Many Chinese immigrated to the U.S. in the early 19th century for the gold rush in California. Around the same time, some of this population later moved to Saint Louis from New York and San Francisco in search of mining and factory jobs [4].

Health Beliefs

  • In general, most Chinese embrace the duality between Western medicine and Chinese traditional medicine. 

  • A major concept that encompasses traditional Chinese medicine is “Qi” or the harmony in energy and matter in the human body. Thus, it is hypothesized that the imbalance and the disruption in “Qi” lead to illnesses [5]. This concept also parallels the idea of Yin and Yang, where health is found when harmony is achieved within [5].

    • Notably, traditional Chinese remedies are integral to the maintenance of health and energy balance. 

    • Another popular treatment utilized by Chinese patients is acupuncture, which also adjusts the imbalances in the flow of “Qi”.

Social Traits

  • Age hierarchy 

  • Gender roles

  • Filial piety

  • Stoicism

  • Collectivist

  • Confucianism

  • Concept of face 

Implications for Health Practitioners/Health Questions

Greeting: Handshakes are preferable when greeting a Chinese patient. Deference should be shown to the elderly, along with the expectations of bowing one’s head slightly and speaking softly [3]. The head is considered to be an important part of the body. Thus, it would be helpful to inform the patient before you touch their head.

 

Many Chinese rely on indirect communication. They may understate their point or rarely give a direct negative response given their inclination to maintain harmony. Therefore, one should pay careful attention to signs of hesitation and ask for clarification when needed [3].  

 

Mental Health: Discourses on mental health may often be stigmatized, leading to the dismissal and neglect of mental health symptoms. Most Asian Americans have difficulty seeking mental health resources/treatment due to language barrier [6]; therefore, it is highly encouraged to utilize interpretation services as well as psychiatrists/mental health care workers that speak the same language and share a similar cultural experience as the patient. It is also important to consider the impact of mental health on the overall health of these patients due to racial and cultural discrimination experienced in workplaces and schools [6].  

 

Diet: Diet includes grains, vegetables, fruits, and meat. Often, there is a heavy emphasis on meats and vegetables being cooked fresh, while canned or frozen foods are rarely eaten [5]. The high salt and oil consumption in Chinese dietary patterns are often associated with a higher risk of hypertension and cardiovascular disease [7,8].

Questions/Education

  • Healthcare Challenges:

    • Describe the importance of completing the full course of medicinal treatment. 

      • Some patients may believe that western medicine is too strong and would halt the course of treatment midway regardless of their physical status [2]. Some patients may also expect medicine to work instantaneously.

    • Ask patients about additional treatments that they might be using.

      • At home, in addition to the treatment we are giving right now, is there another treatment that you are planning to follow? 

      • For example, are you planning to use herbal remedies/oil or acupuncture?

      • Many Chinese patients may supplement with herbal medicine or alternative medicine as an approach to healing. This is important to ensure that none of the ingredients they utilize would interact with prescribed medications.

      • Pay attention to the geriatric population as they are most likely to utilize alternative medicine [8].

  • Social History:

    • What are your thoughts about smoking?

      •  In the elderly population, asking a patient to stop smoking may be difficult due to strong cultural habits. Moreover, smoking is often seen as a social activity that is practiced among men.

    • In one day, how often do you smoke? If not, how about the people around you?

    • Have others expressed concern about your smoking habits?

  • Women’s Health: 

    • Be mindful of patients’ sexual history and sexual health education.

      • Risk factors associated with stroke, cardiovascular disease, and cancer.

    • The incorporation of social support may allow for more effective health interventions.

      • The traditional gender roles that place emphasis on avoiding familial burdens may make it difficult for women to express their health needs [9]. Providing interpreter service, community resources, and mental health services may help alleviate a woman's distress over family cultural conflict [9].

      • Couple-based interventions may lead to improved communication and management of chronic diseases.

Health Challenges

  • Smoking is considered a social activity practiced among adults and elderly, specifically in the male population. This normalization of smoking may create difficulties in reducing the smoking rates of Chinese patients [7].

  • Patients may be hesitant about the potency and effectiveness of the prescribed medication [2]. Education and thorough communication about taking the full course of medication may be useful in assisting patients.

  • Some of the most common causes of death in China are stroke, ischemic heart disease, and chronic obstructive pulmonary disease [10]. Individuals from China are also likely to be affected by infectious diseases such as Tuberculosis, and Hepatitis B [11].

    • In the case of TB, most individuals are vaccinated with BCG vaccine at birth [12].

Women's Health

  • In some cases, Chinese women in the U.S. may not seek medical attention unless they experience physical symptoms [9].  Therefore, education on preventive care like breast and cervical cancer screening can be extremely beneficial to their health management.

  • Breast disease may often go undetected in Chinese patients due to the lack of attention in breast health [13].

  • Chinese women may be victims to domestic violence involving abuse from an intimate partner. However, these incidents may not qbe reported given the cultural stigma of speaking ill of one’s family [14].

  • Chinese women are susceptible to hypertension, heart diseases, heart attacks, chronic lung diseases, and asthma [15].

Family Structure

  • The Chinese family unit was traditionally strongly aligned with Confucian thought - the most important relationships for individuals and forms the foundations of all social organization [16].

    • While not strictly adhered to anymore, the idea of ‘filial piety’ is still prevalent in many Chinese families: children are expected to take care of elders and turn toward them for decisions.

  • The collective identity and reputation of the family unit is integral - the idea of ‘face’ that a single individual’s actions or behavior can impact perception of the entire family [16].

    • Interests of the collective supersede the individual.

    • Family members can expect preferential treatment from other members in return for such strong loyalty. 

Conclusion

  • Although many Chinese patients are comfortable with the duality of Western and Chinese traditional medicine, it is still important to consider their health beliefs and preferences.

  • Many patients may expect medicine to work immediately or question the potency of the medications. Therefore, it is crucial to stress the importance of medication and the benefits of staying consistent with the prescribed duration. 

  • The high sodium diet in a Chinese diet may increase the risk of hypertension and cardiovascular disease.

  • Given the stigmatization of mental health discussions in Chinese culture, checking up on patients about their mental well-being can reduce the likelihood of patients neglecting their mental health needs.

Resources for Patients

  • Chinese Culture and Education Services

    • An organization that works to foster an increased awareness of Chinese culture.

    • To contact, view the website and fill out the corresponding form.

    • Link: https://www.stlcces.org/

  • Asian American Pacific Islander (AAPI) Mental Health St. Louis

    • Mental health resources for the AAPI community including educational resources and resources for connecting with mental health professionals.

    • Link: https://aapimentalhealthstl.org/

  • Chinese Education and Culture Center in St. Louis

  • International Institute of St. Louis

This information was collected and organized by our team. As of this time, we have not yet been able to connect with any individuals in this community that could review this article. If you are interested in reviewing this article, please contact kaitlynn.borik@health.slu.edu

References

(1) Zürcher, E. et al. (2024, March 27). China. Encyclopedia Britannica. https://www.britannica.com/place/China 

(2) Do, H. (2014). China. EthnoMed: Chinese. Retrieved March 27, 2024, from EthnoMed.

(3) Scroope, C. (2017). Chinese Culture. Cultural Atlas. Retrieved March 27, 2024, from https://culturalatlas.sbs.com.au/chinese-culture/chinese-culture-religion#chinese-culture-religion Chara Scroope, 2017

(4) Ling, H. (2005). Reconceptualizing Chinese American Community in St. Louis: from Chinatown to Cultural Community. Journal of American Ethnic History, 24(2), 65–101. http://www.jstor.org/stable/27501563

(5) Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Chinese. (2020, November 2). Mass Chan Medical School. Retrieved March 27, 2024, from Lamar Soutter Library.

(6) Nishi, K. (2012). Mental Health Among Asian-Americans. American Psychological Association. https://www.apa.org/pi/oema/resources/ethnicity-health/asian-american/article-mental-health

(7) Beasley, J. M., Yi, S. S., Ahn, J., Kwon, S. C., & Wylie-Rosett, J. (2019). Dietary Patterns in Chinese Americans are Associated with Cardiovascular Disease Risk Factors, the Chinese American Cardiovascular Health Assessment (CHA CHA). Journal of immigrant and minority health, 21(5), 1061–1069. https://doi.org/10.1007/s10903-018-0800-z

(8) Fang, L., & Schinke, S. P. (2007). Complementary alternative medicine use among Chinese Americans: findings from a community mental health service population. Psychiatric services (Washington, D.C.), 58(3), 402–404. https://doi.org/10.1176/ps.2007.58.3.402 

(9) Simon, M. A., Tom, L. S., Leung, I., Taylor, S., Wong, E., Vicencio, D. P., & Dong, X. (2018). Chinese Immigrant Women's Attitudes and Beliefs About Family Involvement in Women's Health and Healthcare: A Qualitative Study in Chicago's Chinatown. Health equity, 2(1), 182–192. https://doi.org/10.1089/heq.2017.0062

(10) China. (n.d.). Institute for Health Metrics and Evaluation. Retrieved March 24, 2024, from Institute for Health Metrics and Evaluation. Retrieved March 24, 2024, from https://www.healthdata.org/research-analysis/health-by-location/profiles/china  

(11)Wang, L., Wang, Y., Jin, S., Wu, Z., Chin, D. P., Koplan, J. P., & Wilson, M. E. (2008). Emergence and control of infectious diseases in China. Lancet (London, England), 372(9649), 1598–1605. https://doi.org/10.1016/S0140-6736(08)61365-3

(12) Zwerling, A., Behr, M. A., Verma, A., Brewer, T. F., Menzies, D., & Pai, M. (2011). The BCG World Atlas: a database of global BCG vaccination policies and practices. PLoS medicine, 8(3), e1001012. https://doi.org/10.1371/journal.pmed.1001012 

(13) Mo B. (1992). Modesty, sexuality, and breast health in Chinese-American women. The Western journal of medicine, 157(3), 260–264./.

(14) Scharff, D. (2021, April 24). What Can Be Done About Domestic Abuse in China?. Psychology Today. Retrieved March 27, 2024, from https://www.psychologytoday.com/us/blog/psychoanalytic-exploration/202104/what-can-be-done-about-domestic-abuse-in-china

(15) Appel, H. B., Huang, B., Ai, A. L., & Lin, C. J. (2011). Physical, behavioral, and mental health issues in Asian American women: results from the National Latino Asian American Study. Journal of women's health (2002), 20(11), 1703–1711. https://doi.org/10.1089/jwh.2010.2726.

(16) Scroope, C., & Evason, N. (2017). Chinese Culture: Family . Cultural Atlas. Retrieved March 27, 2024, from https://culturalatlas.sbs.com.au/chinese-culture/chinese-culture-family

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