The family has always been implicitly and explicitly recognized as a critical social unit mediating cultural beliefs and traditions from one generation to another. This includes the mediation of beliefs and practices regarding health, illness, and chronic conditions.1 There is, however, a dearth of research linking cultural and ethnic factors to the ways in which families respond to and cope with childhood illnesses and disabilities, despite the recognition that effective health care practice involves an awareness of the strong, often covert, influence of culture in shaping family reactions and responses to health problems. In fact, cultural and ethnic sensitivity alone is no longer adequate; health care professionals must also be ethnically and culturally competent, that is, be able to recognize, respect, and engage ethnic diversity in a way that leads to mutually desirable outcomes. This expectation for cultural competence is directly related to the ever-growing percentage of ethnic minorities in the United States, particularly the increase in the number of persons of Southeast Asian and Hispanic origin, the increased risk minority status places on child development, and the emerging emphasis on, if not renaissance of, cultural and ethnic identity.The effectiveness of interactions with families of different cultural backgrounds may well be shaped by pediatricians' and other health cane professionals' awareness of and sensitivity to the influence of culture and ethnicity on children's psychosocial development as well as on the family's response to the long-term care of a child with chronic conditions or disabilities. This article attempts to encourage this line of inquiry, first, by identifying the family processes of appraisal focusing on schema and paradigms which are influenced by culture and ethnicity and which appear to come into play in shaping the family's response to the illness or disability; and, second, by focusing on two Native American cultures, aboriginal American Indians and Hawaiians, their cultures' influence on the family system and the family's response to children with chronic illness and disabilities mediated by culture.
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