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Culturally Competent Health Care for Puerto Ricans

 Selected and compiled by Jacquelyn Coughlan, M.S., M.L.S.

Ailinger, R. L. (1988). Folk beliefs about high blood pressure in Hispanic immigrants. Western Journal of Nursing Research, 10(5), 629-636.


Allen, L. W. (1987). Coping with neonatal intensive care: The Puerto Rican experience. Hartford, CT: Hispanic Health Council.

Andres-Hyman, R., Ortiz, J., Anez, L.M., Paris, M., & Davidson, L. (2006). Culture and clinical practice: Recommendations for working with Puerto Ricans and other Latinas(os) in the United States. Professional Psychology: Research and Practice, 37(6), 694-701. 

Angel, R. J., & Worobey, J. L. (1991). Intragroup differences in health of Hispanic children. Social Science Quarterly, 72(2), 361-378.


Angel, R., & Guarnaccia, P. J. (1989). Mind, body, and culture: Somatization among Hispanics. Social Science and Medicine, 28(12), 1229-1238.


Arcia, E. (1998). Latino parents' perception of their children's health status. Social Science & Medicine, 46(10), 1271-1274.

Arenas, S., Cross, H., et al. (1980). Curanderos and mental health professionals: A comparative study on perceptions of psychopathology. Hispanic Journal of Behavioral Sciences, 2(4), 407-421.
Baca, J. E. (1978). Some health beliefs of the Spanish speaking. In R. A. Martinez (Ed.), Hispanic culture and health care: Fact, fiction, folklore (pp. 92-98). St. Louis: C. V. Mosby.

Bates, M. S., Rankin-Hill, L., et al. (1995). A cross-cultural comparison of adaptation to chronic pain among Anglo-Americans and native Puerto Ricans. Medical Anthropology, 16(2), 141-173.


Bates, M. S., Rankin-Hill, L., et al. (1997). The effects of the cultural context of health care on treatment of and response to chronic pain. Social Science & Medicine, 45(9), 1433-1448.

Bernal, G., Bonilla, J., et al. (1998). Factors associated to outcome in psychotherapy: An effectiveness study in Puerto Rico. Journal of Clinical Psychology, 54(3), 329-342.

Berrios, C. (2003). Culturally competent mental health care for Puerto Rican children. Journal of Child and Adolescent Psychiatric Nursing, 16(3), 112-122.

Berthold, S. M. (1989). Spiritism as a form of psychotherapy: Implications for social work practice. Social Casework, 70(8), 502-209.
Bird, H. R. & Canino, I. (1981). The sociopsychiatry of espiritismo: Findings of a study in psychiatric populations of Puerto Rican and other Hispanic children. Journal of the American Academy of Child Psychiatry, 20(4), 725-740.

Campos, A. P. (1990). Social work practice with Puerto Rican terminally ill clients and their families. In J. K. Parry (Ed.), Social work practice with the terminally ill: A transcultural perspective (pp. 129-143). Springfield, IL: Charles C. Thomas.


Carlson, V. J., & Harwood, R. L. (2003). Attachment, culture, and the caregiving system: The cultural patterning of everyday experiences among Anglo and Puerto Rican mother-infant pairs. Infant Mental Health Journal, 24(1), 53-73.


Castro de Alvarez, V. (1990). AIDS prevention program for Puerto Rican women. Puerto Rican Health Science Journal, 9(1), 37-41.


Castro, F. G., Cota, M. K., & Vega, S. C. (1999). Health promotion in Latino populations: A sociocultural model for program planning, development, and evaluation. In R. M. Huff & M. V. Kline (Eds.), Promoting health in multicultural populations: A handbook for practitioners (pp. 137-168). Thousand Oaks, CA: Sage.


Caudle, P. (1993). Providing culturally sensitive health care to Hispanic patients. Nurse Practitioner, 18(12), 40-51.


Chamarro, L. (1994). Cultural beliefs and values: Implications for graduate nursing education in the Puerto Rican community. Journal of Cultural Diversity, 1(2), 41-43.

CIA - Central Intelligence Agency. (2008). The world factbook - Puerto Rico. Retrieved November 26, 2008 from

Comas-Diaz, L. (1981). Puerto Rican espiritismo and psychotherapy. American Journal of Orthopsychiatry, 51(4), 636-645.

Constantino, G., Malgady, R.G., & Rogler, L.H. (1986). Cuento therapy: A culturally sensitive modality for Puerto Rican children. Journal of Consulting and Clinical Psychology, 54(5), 639-645.

Costantino, G., Malgady, R. G., et al. (1988). Folk hero modeling therapy for Puerto Rican adolescents. Journal of Adolescence, 11(2), 155-165.


Cox, C. & Monk, A. (1993). Hispanic culture and family care of Alzheimer's patients. Health & Social Work, 18(2), 92-100.


Cuthbert-Allman, C., & Shausse, M. (1996). Crosing cultural barriers to care for people with AIDS. Caring, 15(8), 14-18.


Dahl, M. (2004). Cross-cultural competence: Working with Puerto Rican clients. Health Care Food & Nutrition Focus, 21(3), 10-12.

Davis, R. E. (1994). The heart and soul of Puerto Rican community: Caring and caregivers. Journal of Multicultural Nursing, 1(2), 21-27.
Davis, R. E. (1997). Understanding ethnic women's experiences with pharmacopeia. Health Care for Women International, 18(5), 425-437.

Davis, R. E., & Flannery, D. D. (2001). Designing health information delivery systems for Puerto Rican women. Health Education Behavior, 28(6), 680-695.

Davitz, L. J., Sameshima, Y., et al. (1976). Suffering as viewed in six different cultures. American Journal of Nursing, 76(8), 1296-1297.

De la Rosa, M. (1988). Puerto Rico spiritualism: A key dimension for effective social casework practice with Puerto Ricans. International Social Work, 31(4), 273-283.


Delgado, M. (1995). Puerto Rican elders and natural support systems: Implications for human services. Journal of Gerontological Social Work, 24(1/2), 115-130.


Delgado, M. (1996). Puerto Rican elders and botanical shops: A community resource or liability? Social Work in Health Care, 23(1), 67-81.


Delgado, M., & Santiago, J. (1998). HIV/AIDS in a Puerto Rican/Dominican community: A Collaborative project with a botanical shop. Social Work, 43(2), 183-186.


Delgado, M., & Tennstedt, S. (1997). Making the case for culturally appropiate community services: Puerto Rican elders and their caregivers. Health & Social Work, 22(4), 246-255.


Delgado, M., & Tennstedt, S. (1997). Puerto Rican sons as primary caregivers of elder parents. Social Work, 42(2), 125-134.


DePacheco, M., & Hutti, M. (1998). Cultural beliefs and health care practices of childbearing Puerto Rican American women and Mexican American women: A review of the literature. Mother Baby Journal, 3(1), 14-25.


Diaz, T., & Klevens, M. (1997). Differences by ancestry in sociodemographics and risk behaviors among Latinos with AIDS: The supplement to HIV and AIDS Surveillance Project Group. Ethnicity & Disease, 7(3), 200-206.


Dixon, D., Peters, M., & Saul, J. (2003). HIV sexual risk behavior among Puerto Rican women. Health Care for Women International, 24(6), 529-543.


Dresp, C. S. W. (1985). Nervios as a culture-bound syndrome among Puerto Rican women. Smith College Studies in Social Work, 55(2), 115-136.


Fernandez, R. D., & Hebert, G. J. (2000). Rituals, culture, and tradition: The Puerto Rican experience. In M. L. Kelley & V. M. Fitzsimons (Eds.), Understanding cultural diversity: Culture, curriculum, and community in nursing (pp. 241-251). Sudbury, MA: Jones and Bartlett.


Fliszar, R. S. (2003). Culture care of Puerto Rican elderly in a community setting. Unpublished doctoral dissertation, Duquesne University.


Flores, J. (2000). From bomba to hip-hop: Puerto Rican culture and Latino identity. New York: Columbia University Press.


Foster, J. (2004). Fatherhood and the meaning of children: An ethnographic study among Puerto Rican partners of adolescent mothers. Journal of Midwifery & Women's Health, 49(2), 118-125.


Galli, N. (1975). The influence of cultural heritage on the health status of Puerto Ricans. Journal of School Health, 45(1), 10-16.


Gaviria, M., & Wintrob, R. M. (1976). Supernatural influence in psychopathology. Puerto Rican folk beliefs about mental illness. Canadian Psychiatric Association Journal, 21(6), 361-369.


Guarnaccia, P. J. (1993). Ataques de nervios in Puerto Rico: Culture-bound syndrome or popular illness? Medical Anthropology, 15(2), 157-170.


Guarnaccia, P. J., De LaCancela, V., et al. (1989). The multiple meanings of ataques de nervios in the Latino community. Medical Anthropology, 11(1), 47-62.

Guarnaccia, P. J., Goode, B. J., & Kleinman, A. (1990). A critical review of epidemiological studies of Puerto Rican mental health. American Journal of Psychiatry, 147(11), 1449-1456.

Guarnaccia, P. J., Lewis-Fernandez, R., & Marano, M. R. (2003). Toward a Puerto Rican popular nosology: Nervios and ataque de nervios. Culture, Medicine and Psychiatry, 27(3), 339-366.

Guarnaccia, P. J., Rivera, M., et al. (1996). The experiences of ataques de nervios: Towards an anthropology of emotions in Puerto Rico. Culture, Medicine and Psychiatry, 20(3), 343-367.
Guarnaccia, P.J. (1993). Ataques de nervios in Puerto Rico: Culturebound syndrome or popular illness? Medical Anthropology, 15, 157-170.

Harwood, A. (1971). The hot-cold theory of disease: Implications for treatment of Puerto Rican patients. Journal of the American Medical Association, 216(7), 1153-1158.


Harwood, A. (1977). Puerto Rican spiritism: Part 2--an institution with preventive and therapeutic functions in community psychiatry. Culture, Medicine and Psychiatry, 1, 135-153.


Harwood, A. (1977). Puerto Rican spiritism: Part I--description and analysis of an alternative psychotherapeutic approach. Culture, Medicine and Psychiatry, 1, 69-95.


Harwood, A. (Ed.). (1981). Ethnicity and medical care. Cambridge: Harvard University Press.

Harwood, R. L., Schoelmerich, A., et al. (1999). Cultural differences in maternal beliefs and behaviors: A study of middle-class Anglo and Puerto Rican mother-infant pairs in four everyday situations. Child Development, 70(4), 1005-1016.
Harwood, R.L., et al. (2006). Explaining the concept of respect among Turkish and Puerto Rican migrant mothers. In Schwalb, D.W. & Schwalb, B.J. (Eds.), Respect and disrespect: Cultural and developmental origins. San Fransisco: Josey-Bass.
Hebert, G. J., & Fernandez, R. D. (2000). A challenge to the Puerto Rican community: An untold story of the AIDS epidemic. In M. L. Kelley & V. M. Fitzsimons (Eds.), Understanding cultural diversity: Culture, curriculum, and community in nursing (pp. 253-261). Sudbury, MA: Jones and Bartlett.

Higgins, B. (2000). Puerto Rican cultural beliefs: Influence on infant feeding practices in Western New York. Journal of Transcultural Nursing, 11(1), 19-30.


Himmelgreen, D. A., Perez-Escamilla, R., Martinez, D., Bretnall, A., Eells, B., Peng, Y., et al. (2004). The longer you stay, the bigger you get: length of time in the US and language are associated with obesity in Puerto Rican women.  American Journal of Physical Anthropology, 125(1), 90-96.


Hogel, J., Pelto, P. J., et al. (1982). Ethnicity and health: Puerto Ricans and Blacks in Hartford, Connecticut. Medical Anthropology, 6, 127-136.


Hohmann, A. A., Richeport, M., et al. (1990). Spiritism in Puerto Rico. Results of an island-wide community study.British Journal of Psychiatry, 156, 328-335.

Hosler, A. S., & Melnik, T. A. (2006). Language and other factors associated with foot self-management among Puerto Ricans with diabetes in New York City. Diabetes Care, 29(3), 704-706.
Huff, R. M., & Kline, M. V. (1999). Tips for working with Hispanic populations. In Promoting health in multicultural populations: A handbook for practitioners (pp. 189-197). Thousand Oaks, CA: Sage.
Lazarus, E. S., & Philipson, E. H. (1990). A longitudinal study comparing the prenatal care of Puerto Rican and white women. Birth, 17(1), 6-11.

Lewis-Fernández R., Garrido-Castillo, P., Bennasar, M. C., Parrilla, E. M., Laria, A. J., & Ma, G. (2002). Dissociation,childhood trauma, and ataque de nervios among Puerto Rican psychiatric outpatients. The American Journal of Psychiatry, 159(9), 1603-1605.

Lewis-Fernández R., Guarnaccia P. J., Martínez I. E., et al. (2002). Comparative phenomenology of ataques de nervois, panic attacks, and panic disorder. Culture, Medicine and Psychiatry, 26(2):199-223.
Lewis-Fernandez, R. (1996). Cultural formulation of psychiatric diagnosis. Case No. 02. Diagnosis and treatment of Nervios and Ataques in a female Puerto Rican migrant. Culture, Medicine and Psychiatry, 20(2), 155-163.

Lipson, J. G., Dibble, S. L., et al. (1996). Culture & nursing care: A pocket guide. San Francisco: UCSF Nursing Press.


Lipton, R. B., Losey, L. M., et al. (1998). Attitudes and issues in treating Latino patients with type 2 diabetes: Views of healthcare providers. Diabetes Educator, 24(1), 67-71.


Magana, S., Seltzer, M. M., & Krauss, M. W. (2004). Cultural context of caregiving: Differences in depression between Puerto Rican and non-Latina white mothers of adults with mental retardation. Mental Retardation, 42(1), 1-11.

Malgady, R. G., Rogler, L. H., et al. (1996). Cultural expression of psychiatric symptoms: Idioms of anger among Puerto Ricans. Psychological Assessment, 8(3), 265-268.
Malgady, R.G., Constantino, G., & Rogler, L.H. (1986). Cuentos therapy: A culturally sensitive modality for Puerto Rican children. Journal of Consulting and Clinical Psychology, 54(5), 639-645.
Malgady, R.G., Rogler, L.H. & Constantino, G. (1990). Culturally sensitive psychotherapy for Puerto Rican children and adolescents: A program of treatment outcome research. Journal of Consulting and Clinical Psychology, 58(6), 704-712.
McGoldrick, M., Almeida, R., et al. (1991). Mourning in different cultures. In F. Walsh & M. McGoldrick (Eds.), Living beyond loss: Death in the family. New York: W. W. Norton.

McGorry, S. Y. (1999). An investigation of expectations and perceptions of health-care services with a Latino population. International Journal of Health Care Quality Assurance, 12(5), 190-198.


Morales, E. (1994). Meaning of touch to hospitalized Puerto Ricans with cancer. Cancer Nursing, 17(6), 464-469.


Morales, J., & Bok, M. (1992). Cultural dissonance and AIDS in the Puerto Rican community. In Multicultural human services for AIDS treatment and prevention: Policy, perspectives, and planning. Binghamton, NY: Harrington Park Press.

National Alliance for Hispanic Health. (2001). Quality health services for Hispanics: The cultural competency component. Department of Health and Human Services (HHS) publication for the Health Resources and Services Administration (HRSA). (123 pages). Retrieved July 3, 2008 from

Pachter, L. M., Bernstein, B., & Osorio, A. (1992). Clinical implications of a folk illness: Empacho in mainland Puerto Ricans. Medical Anthropology, 13(4), 285-299.


Pachter, L. M., Cloutier, M. M., et al. (1995). Ethnomedical (folk) remedies for childhood asthma in a mainland Puerto Rican community. Archives of Pediatric and Adolescent Medicine, 149(9), 982-988.

Pachter, L. M., Sheehan, J., et al. (2000). Factor and subscale structure of a parental health locus of control instrument for use in a mainland United States Puerto Rican community. Social Science & Medicine, 50(5), 715-721.
Pacquiao, D. F., Archeval, L., et al. (2000). Rituals, culture, and tradition: The Puerto Rican experience. In M. L. Kelley & V. M. Fitzsimmons (Eds.), Understanding cultural diversity: Culture, curriculum, and community in nursing (pp. 242-251). Sudbury, MA: Jones and Bartlett.

Paniagua, F. A. (1994). Guidelines for the assessment and treatment of Hispanics. In Assessing and treating culturally diverse clients (pp. 37-54). Thousand Oaks, CA: Sage


Patcher, L. M., Weller, S. C., Baer, R. D., et al. (2002). Variation in asthma beliefs and practices among mainland Puerto Ricans, Mexican-Americans, Mexicans, and Guatemalans. Journal of Asthma, 39(2), 119-134.


Payne, Z. A. (1980). Diet and folk remedies: The influence of cultural patterns on medical mangagement. Urban Health, 9, 24-28.

Perez y Gonzalez, M. E. (2000). Puerto Ricans in the United States. Westport, CT: Greenwood.
Perez, S. M., & Cruz, S. (1994). Puerto Rican and African American young men: A comparative analysis (Research Rep. No. 23). Boston: University of Massachusetts, William Monroe Trotter Institute.

Rosa, M. (2003). Puerto Ricans. In P. St. Hill, J. Lipson, & A. Meleis (Eds.), Caring for women cross-culturally (pp. 236-248). Philadelphia: F.A. Davis Company.


Rubel, A. J. (1993). The study of Latino folk illnesses. Medical Anthropology, 15(2), 209-213.


Ruiz, P., & Langrod, J. (1976). The role of folk healers in community mental health services. Community Mental Health Journal, 12(4), 392-398.

Santiago-Saaverdra, F. (2004). The nature of Puerto Rican folk health practices through healers perceptions and somatic assumptions: Dissertation. (267 pages). Retrieved October 23, 2008 from

Schensul, J. J., Torres, M., & Wetle, T. T. (1992). Educational materials and innovative dissemination strategies: Alzheimer's disease among Puerto Rican elderly. Hartford, CT: Institute for Community Research.

Schulze, P. A., Harwood, R. L., & Schoelmerich, A. (2001). Feeding practices and expectations among middle-class Anglo and Puerto Rican mothers of 12-months-old infants. Journal of Cross-Cultural Psychology, 32(4), 397-406.
Schwartz, D. (1985). Caribbean folk beliefs and Western psychiatry. Journal of Psychosocial Nursing & Mental Health Services, 23(11), 26-30.
Shai, D., & Rosenwaike, I. (1988). Violent deaths among Mexican-, Puerto Rican- and Cuban-born migrants in the United States. Social Science & Medicine, 26(2), 269-276.
Suarez, L., & Ramirez, A. G. (1999). Hispanic/Latino health and disease: An overview. In R. M. Huff & M. V. Kline (Eds.), Promoting health in multicultural populations: A handbook for practitioners (pp. 115-136). Thousand Oaks, CA: Sage.

Suarez, M., Raffaelli, M., et al. (1996). Use of folk healing practices by HIV-infected Hispanics living in the United States. AIDS Care, 8(6), 683-690.


Suffian, M., Friedman, S., et al. (1990). Impact of AIDS on Puerto Rican intravenous drug users. Hispanic Journal of Behavioral Sciences, 12(2), 122-134.

Szalacha, L.A., Erkut, S., Coll, C.G., Alarcon, O., Fields, J.P., & Ceder, I. (2003). Discrimination and Puerto Rican children's and adolescents' mental health. Cultural Diversity and Ethnic Minority Psychology, 9(2), 141-155.

Tennstedt, S. L., Chang, B., et al. (1998). Patterns of long-term care: A comparison of Puerto Rican, African-American, and Non-Latino white elders. Journal of Gerontological Social Work, 30(1-2), 179-199.


Trotter, R. T., II, Weller, S. C., et al. (1999). Consensus theory model of AIDS/SIDA beliefs in four Latino populations. AIDS Education and Prevention, 11(5), 414-426.


Valdez, M, del R. (2001). A metaphor for HIV-Positive Mexican and Puerto Rican women. Western Journal of Nursing Research, 23(5), 517-535.


Vergara, C., Martin, A. M., Wang, F., & Horowitz, S. (2004). Awareness about factors that affect the management of hypertension in Puerto Rican patients. Connecticut Medicine, 68(5), 269-276.


Weller, S. C., Pachter, L. M., et al. (1993). Empacho in four Latino groups: A study of intra- and inter- cultural variation in beliefs. Medical Anthropology, 15(2), 109-136.

©Jacquelyn Coughlan, February 2009 ( citations)