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Sociocultural Influences on Disability Status in Puerto Rican Children

ME Gannotti, PT, PhD, is Research Fellow, Department of Pediatrics, Yale Center for Children With Special Health Care Needs, School of Medicine, Yale University, New Haven, Conn, and Assistant Professor of Physical Therapy, Physical Therapy Program, University of Hartford, West Hartford, Conn. This research was performed to fulfill the requirements for her doctoral degree in anthropology at the University of Connecticut.
WP Handwerker, PhD, is Professor of Anthropology, Medical Anthropology Program, University of Connecticut, Storrs, Conn
NE Groce, PhD, is Associate Professor, Department of Epidemiology and Public Health, Program in International Health, School of Medicine, Yale University
C Cruz, PT, MPH, is Assistant Professor of Physical Therapy, Physical Therapy Program, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico

Address all correspondence to Dr Gannotti at Physical Therapy Program, University of Hartford, 200 Bloomfield Ave, West Hartford, CT 06117 (USA) (gannotti{at}mail.hartford.edu)

Background and Purpose. This article describes culturally defined meanings of childhood function and disability in Puerto Rico to provide a context for the interpretation of test scores from the Spanish translation of the Pediatric Evaluation of Disability Inventory (PEDI). Subjects and Methods. More than 600 Puerto Rican teachers, parents and caregivers of children with and without disabilities, and members of the general community participated in ethnographic interviews, which were designed to describe their beliefs, attitudes, and knowledge about childhood function and disability. Results. Qualitative and quantitative data analysis confirmed that differences exist between Puerto Ricans and the norms established in the United States for the performance of functional skills by children, and the analysis also described Puerto Rican beliefs and attitudes toward disability. Discussion and Conclusion. Puerto Rican values of interdependence, añoñar (pampering or nurturing behaviors), and sobre protectiva (overprotectiveness) influence parental expectations for the capability of children with disabilities and should be considered when interpreting scores from the PEDI and establishing plans of care. Additional research is needed on the influence of contextual variables on child development and behavioral adaptations to disability.

Key Words: Culture • Pediatric disability • Puerto Rico