The most common stereotypes Hispanics face are:

• All Hispanics are foreign or recent immigrants- A lot of people are not aware of the fact that there have been Hispanics in this country for over 450 years.
• All Hispanics are a homogeneous race - The reality that we are all as different as the country we, or our parents, came from. We may recognize ourselves as Hispanic or Latino but we usually follow up with from Colombia, Mexico, Argentina, etc.
• All Hispanics reside in a few regions (SW, North) - A fact that is proven wrong by the most recent census which places states like Georgia, North Carolina and Tennessee as some of the fastest growing Hispanic populations in the United States.

The history that every Hispanic group has with the United States also plays a role in how we access services. For example, a Mexican national will have different feelings and migratory history with this country than someone from Puerto Rico who is born a citizen of the United States. That fact alone may keep them from accessing services if they feel they are going to be mistreated or denied services due to their ethnicity.

All service providers must take into account the socio-economic and educational level of their clients. Having Spanish language brochures is a great step toward being culturally sensitive but it may not be enough when they face clients who cannot read Spanish. At the same time, providers may face clients who have achieved great business or academic success in this or their native country but who may not be familiar with the technological terminology for a certain service except in their native language.

Acculturation plays a role in that we begin to leave behind some of our norms and adopt new ones learned in this country. Nonverbal behaviors are to a large extent culturally determined. In the Hispanic culture, avoidance of eye contact by some, should not be regarded as rude, inattentive, passive aggressive or disinterested, but rather as a sign of respect. We soon come to learn that in the United States, avoidance of eye contact is a sign of hiding something or guilt. Also, when conversing, Hispanics tend to use a closer stance than is normally comfortable for an Anglo individual; the closer that you are, in terms of interpersonal space, the greater the probability that the person will be open to communicate.

The issue of names and surnames plays a role during intake since Hispanics are used to using First Name, Middle Name, Paternal Last Name and Maternal Last Name. This can create confusion during intake and in alphabetizing patient charts. This is also a stereotype since not all persons with Spanish surnames are Hispanic. Because of marriage or adoption many people who have Spanish surnames do not consider themselves Hispanic.

Finally, the cultural dimensions of Simpatia, Personalismo and Respeto play a role in client care. Simpatía is described as politeness and pleasantness in the face of stress. This sometimes may hide pain or discomfort. Personalismo is defined as the warm and personal relationship with the provider. The higher the level of comfort, the more the client will share openly. Clients will also tend to have a closer personal space with the provider. And Respeto is defined as the rule which dictates that providers are authority figures who must be shown respect; it brings reluctance to ask questions.

The provider must take into account and respect the beliefs, attitudes and cultural lifestyles of clients. Providers must recognize that ethnicity is an important variable and that cross-cultural issues can affect decisions.

Since immigration by a particular country tends to be centralized to a certain area, it is not really difficult to learn about one particular country, its culture and its people. Providers are not expected to learn all the cultural differences from all twenty countries, but learning about the largest group in your area will help in welcoming them to your facility.

2) SKILLS - Providers must demonstrate genuineness, warmth and empathy toward the community. They must accept ethnic differences. They must understand their own values, biases and stereotypes. A culturally competent provider will have the willingness to go the extra mile for people of different cultures in order to achieve outcomes.

3) ABILITIES - Providers must be willing to discuss cultural issues openly. They must be able to respond to cues. Providers must be willing and able to work with qualified interpreters or willing and able to learn a new language. All of this in order to build trust to ensure that recommendations are followed and information correctly understood.

In closing, providers in communities that have a large Hispanic population must go beyond the "Se habla Español" sign. Accessibility, affordability, availability and awareness are the main reasons Hispanics do not seek services. In fact, only 28% of Hispanics seek medical care of any kind. Providers must create ways to build trust which usually means rolling up their sleeves and going into the community to learn about the people living there and to let them learn about you and the services you provide.

As Nelson Mandela said, "You win a person's mind when you speak a language they can understand. You win a patient's heart when you speak to them in their language."