Meaning of filial piety in the Chinese parent-child relationship: implications for culturally competent health care.

Abstract: To work with Chinese/Chinese-American clients more effectively, health care providers must know how to work with them within their value system of filial piety. This paper focuses on Chinese parent-child relationships with respect to this value system from the perspective of young adult Chinese immigrants in the United States. Using an ethnographic approach, indepth interviews were conducted with six immigrants from Taiwan. Domain analysis and content analysis revealed ten domains, five of which are reported in this paper. The findings suggest that filial piety continues to operate in Chinese immigrant families. Implications for cross-cultural health care and research are addressed. Key Words: Chinese Culture; Chinese-American Culture; Filial Piety; Family Structure As a result of the increase in cultural diversity and the demands by ethnic minority groups for equal access to quality care in U.S. societ coupled with the changing (or changed) focus of health services, culturally competent health care has, more than at any other time in the history of the U.S., received special attention (Meleis, 1996). Health care practitioners and institutions are encouraged to know the client's culture because culturally competent care is expected to result in more effective treatment and decrease the client's and the health care practitioner's frustration and conflicts, and produce positive outcomes. For instance, when Asians/Asian-Americans seek mental health care, they tend to drop out of treatment after initial contact or terminate prematurely. One explanation, among others, is due to a lack of responsiveness on the part of the traditional, western psychotherapeutic approach with regard to the unique culturalues and needs of Asians/Asian-Americans (Hong, 1988; Kim, 1985). Yet, despite the growing attention to cultural competence and awareness of its significance among health care practitioners and researchers, Asians/Asian-Americans continue to be one of the most neglected ethnic minorities (Jamison, 1994; Loo & Fong, 1988). Ethnic minorities are living between two cultures. They are required to expend efforts to balance the values of their cultural heritage with those of the mainstream, and to establish a role system and an identity that allow them to effectively function in two sociocultural systems. Such a desocialization and resocialization process is stressful and puts ethnic minorities at risk for mental distress (BarYosef,1968; Meleis,1991). Family conflicts and stress are likely to occur during the process as well (Yu, 1984). Although some researchers have addressed the relationship between acculturative stress and the variation between Asian culture and the U.S. mainstream culture, there is little information on and knowledge about values, beliefs, and practices of the Asian/Asian-American group in the literature. Thus, in an attempt to advance our knowledge about this unique ethnic group, a study was conducted to examine a fundamental cultural valuefilial piety. The rationales for studying a cultural value rather than a health phenomenon are twofold. First, family and its structure and function serve as the most basic social institution among Asians/Asian-Americans. In order to work effectively with Asians/AsianAmericans, a family-oriented approach is essential. The value of filial piety is the most fundamental value operating within Asian/Asian-American family systems and guides family interactions. Therefore, to work effectively with the Asian/Asian-American family, practitioners need to know how to act with respect to this value system. Secondly, the value system of filial piety differs very much from the U.S. mainstream culture for parent-child and other social interactions. The gap between the two cultural systems has been implicated as a main cause of acculturative stress for this population. Additionally, the literature tends to treat Asians/Asian-Americans as a "homogeneous" group, which it is not. …