Socioeconomic, spiritual, lifestyle, and ethnic differences play a role in healthcare
decisions and resources (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Patients who have a
low income and inadequate education can affect various cultural groups such as women and
ethnic minorities (Ball et al., 2019). The patients that have an inadequate education have higher
rates of death than patients with the same condition but with higher education levels (Ball et al.,
2019). According to Vila, Kramer, Obiols, and Gerralda (2010), teenage patients from lower
socioeconomic backgrounds are more likely to visit their doctor and have increased hospital
stays for psychosocial factors. Patients who are teenagers are noted to have stress that causes
impairment leading to decreased attendance at school (Vila, Kramer, Obiols, & Garralda, 2010).
Culture refers to the patient’s behavior that contains language, communication, actions,
beliefs, values, and spirituality (Centers for Disease Control and Prevention [CDC], 2015).
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