The Amish Health Culture and Culturally Sensitive Health Services: An Exhaustive Narrative Review.

Social Science & Medicine

Anderson, Cory, and Lindsey Potts. 2020.

265:113466.

An exhaustive narrative review of 246 Amish health-related peer reviewed publications, identified through bibliographic snowball sampling and supplemented by further searches, revealed nine themes.
Synthesized themes include modern/complementary-alternative medicine, birthing/intercourse, care, health knowledge/screening, payment, barriers to access, service provider effectiveness, health programming, and conflicts;

More Detail

Use of modern and complementary & alternative medicine: Amish use both modern medicine and complementary / alternative medicine, with a preference for the latter.
Cultural norms for birthing and intercourse: High fertility is culturally valued; home births and alternative birthing centers are preferred; STD knowledge is limited.
Support and care for the sick and aged: Strong family and community support systems exist, with preference for in-home care.
Health knowledge and screening: Amish actively seek health information, often from family first, but preventive screening is limited.
Payment for services: Most Amish avoid insurance and government programs, paying out-of-pocket, though systems of aid assist with large bills.
Barriers to service access: Amish face healthcare access barriers including costs, transportation, technology limits, and insurance financing
Service provider effectiveness: Cultural competency emphasizing keys to relationship- and trust-building saturate the literature, while other service-oriented paradigms, such as cultural safety, have only been introduced.
Amish-specific health programming: Customized programs can increase Amish access and use of services
Disagreements and ethical conflicts: Sensitive issues include alternative medicine, end-of-life decisions, reproductive health, mental health treatment, and vaccinations.

Future research should address cultural competency theory’s limitations, incorporate new culture theories, and better account for population internal and provider-patient power differentials.
Researchers should routinely re-examine Amish attitudinal shifts in payment, caregiving patterns, preventative services, and modern healthcare access.