# data[].attributes.headline
Common values and beliefs impacting health and healthcare decisions

# data[].attributes.subject
Common values and beliefs impacting health and healthcare decisions

# data[].attributes.body
Originally established as a Spanish colony prior to becoming a United States territory.

The island’s original main export was sugar cane and the Spanish relied on imported slaves and the indigenous population of Taino Indians

Spanish, Taino, and African roots have become a key part of the ethnic identity of contemporary Puerto Rican society.

Approximately 2/3 of the population is Roman Catholic

Espiritismo or Spiritism, the concept of good and bad spirits affecting the health of individuals is blended with the Roman Catholic faith

Santiguadora or spiritual/folk healer is commonly used in conjunction with allopathic medicine when treating illness. These healers will typically prescribe special massages, dietary modifications, or recite prayers to aid in the patient’s healing.

An economic boom in the 1960’s resulted in a shift from an agrarian society to an industrialized one.

Industrialization and the expansion of the middle class shifted families to a dual income households.

Despite households being dual income, women are often expected to complete household labor and work.

Women play an active role in public life and in 1932, Puerto Rico was the first legislature in the Western hemisphere to elect a woman.

# data[].attributes.headline
Nursing considerations and interventions applicable to providing care 

# data[].attributes.subject
Nursing considerations and interventions applicable to providing care 

# data[].attributes.body
Cultural values of Latinos

Health conditions affecting the Latino community

Role of religion on end of life related issues

Cultural consideration during communication

Health and healing: Example Espiritismo (spiritual belief that good and evil spirits can affect health and luck) and folk medicine.

Importance of family (including family in patient care.)

Access to care

# data[].attributes.body
Puerto Rico is a U.S. territory.

No visa requirement for U.S citizens entering Puerto Rico.

The nickname of Puerto Rico is the Island of Enchantment, but Puerto Rico translates to Rich Port in English.

The largest group of Puerto Ricans reside in the northeast part of the U.S.

In the XV century Taino Indians who inhabited the territory called the island Boriken or Borinquen which means: "the great land of the valiant and noble Lord" or "land of the great lords".

The Puerto Rican flag was first used on December 22nd, 1895 when a group of Puerto Ricans gathered in New York City since the united states "bought them" and showed their support for independence for Cuba and Puerto Rico from Spain. It was soon adopted as a national symbol.

On September 29 1898 Puerto Rico was ceded to the United States.

December 11 1900 President Theodore Roosevelt addressed the Puerto Rican Congress and recommended that Puerto Ricans become United States citizens.

# data[].attributes.body
Two widely spoken languages in Puerto Rico are Spanish and English.

A majority of Puerto Ricans are Catholic.

# data[].attributes.body
Yes: 92.0%
No: 8.0%

# data[].attributes.headline
Specific health trends including complementary and alternative medicine commonly utilized

# data[].attributes.subject
Specific health trends including complementary and alternative medicine commonly utilized

# data[].attributes.body
The three leading causes of death in Puerto Rico are heart disease (17.8%), cancer (17.7%) and diabetes (10.1%).

High risk factors related to lifestyle.

Adults have a high generality of chronic diseases, specifically cardiometabolic and psychological conditions.

Studies on complementary and alternative medicine commonly utilized in Puerto Rico are very few to none.  However, a household study using CAM took place in 2009.  The top medical conditions treated with CAM included back problems, headaches, allergies, anxiety and depression.  CAM therapies the study included were natural products (35%), deep breathing exercises (24%), meditation (17%) and massage (7.4%).

# data[].attributes.body
Cultural competence: Caregiving for hispanics/latinos. https://www.velalearn.com/node/1011396.

https://www.medschool.lsuhsc.edu/physiology/docs/Belief%20and%20Traditions%20that%20impact%20the%20Latino%20Healthcare.pdf

Wagenheim, O. J. , Wagenheim, . Kal and Mathews, . Thomas G. (2021, February 20). Puerto Rico. Encyclopedia Britannica. https://www.britannica.com/place/Puerto-Rico

https://www.iccp-portal.org/sites/default/files/plans/Puerto%20Rico%20Chronic%20Disease%20Action%20Plan%20English.pdf

Torres-Zeno RE;Ríos-Motta R;Rodríguez-Sánchez Y;Miranda-Massari JR;Marín-Centeno H; Use of complementary and alternative medicine in Bayamón, Puerto Rico. https://pubmed.ncbi.nlm.nih.gov/27232867/.

Centers for Disease Control and Prevention. BRFSS Prevalence & Trends Data: Explore by Location. Centers for Disease Control and Prevention. https://nccd.cdc.gov/BRFSSPrevalence/rdPage.aspx?rdReport=DPH_BRFSS.ExploreByLocation&rdProcessAction=&SaveFileGenerated=1&irbLocationType=States&islLocation=72&islState=&islCounty=&islClass=CLASS08&islTopic=TOPIC41&islYear=2019&hidLocationType=States&hidLocation=72&hidClass=CLASS08&hidTopic=TOPIC41&hidTopicName=Overall%2BHealth&hidYear=2019&irbShowFootnotes=Show&rdICL-iclIndicators=GENHLTH&iclIndicators_rdExpandedCollapsedHistory=&iclIndicators=GENHLTH&hidPreviouslySelectedIndicators=&DashboardColumnCount=2&rdShowElementHistory=divTopicUpdating%3DHide%2CislTopic%3DShow%2CdivYearUpdating%3DHide%2CislYear%3DShow%2C&rdScrollX=0&rdScrollY=186&rdRnd=2270.

Centers for Disease Control and Prevention. BRFSS Prevalence & Trends Data: Explore by Location. Centers for Disease Control and Prevention. https://nccd.cdc.gov/BRFSSPrevalence/rdPage.aspx?rdReport=DPH_BRFSS.ExploreByLocation&rdProcessAction=&SaveFileGenerated=1&irbLocationType=States&islLocation=72&islState=&islCounty=&islClass=CLASS07&islTopic=TOPIC29&islYear=2019&hidLocationType=States&hidLocation=72&hidClass=CLASS07&hidTopic=TOPIC29&hidTopicName=Health%2BCare%2BCoverage&hidYear=2019&irbShowFootnotes=Show&rdICL-iclIndicators=HLTHPLN1&iclIndicators_rdExpandedCollapsedHistory=&iclIndicators=HLTHPLN1&hidPreviouslySelectedIndicators=&DashboardColumnCount=2&rdShowElementHistory=divTopicUpdating%3DHide%2CislTopic%3DShow%2CdivYearUpdating%3DHide%2CislYear%3DShow%2C&rdScrollX=0&rdScrollY=0&rdRnd=21356.

https://www.researchgate.net/publication/266781700_Use_of_complementary_and_alternative_medicine_in_Puerto_Rico

ML. Daviglus, G. A. T., KL. Tucker, J. M., J. Mattei, D. S.-A., Boslaugh, S., CM. Perez, M. G., CM. Perez, H. S., … EF. Tierney, N. R. B. (1970, January 1). Health conditions and lifestyle risk factors of adults living in Puerto Rico: a cross-sectional study. BMC Public Health. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5359-z.

Rivera, Magaly. Puerto Rico's History. https://welcome.topuertorico.org/history6.shtml.

Pachter, L. M. (1994). Culture and clinical care. Folk illness beliefs and behaviors and their implications for health care delivery. JAMA: The Journal of the American Medical Association, 271(9), 690–694. https://doi.org/10.1001/jama.271.9.690