The purpose of this study was to understand the cultural context in which Amish families manage the care of a child with a chronic illness and how it frames the interface with the larger health care delivery system outside their communities. The aims of this study were to describe Amish families' understanding of their children's chronic illnesses, and to describe Amish families' health management and health seeking behaviors for their children within the Amish community and with health services outside their community. Ethnographic research methods were used to paint a cultural portrait of individuals and families, using data sources such as formal and informal interviews with participants, participant observations in the Amish community and family homes, Amish newspapers, and direct observations in health care clinic settings. Informants in this study included Amish families, Amish community members, and health care providers to illustrate commonalities and differences in perspectives on the chronic illness management for children. The study made use of ethnographic analysis, guided by thematic and cultural narrative techniques, to describe Amish family management for children with chronic illnesses in a way that pulls forward how their cultural background is involved in their behaviors and experiences. The results of this study highlight several points: a) the Amish community influences how families understand and appraise concern for their children's illnesses, and families prioritize children's function as a measure of health/illness and see children as ultimately in the hands of God; b) minimal entanglement with the health care community allows for children to be as normalized as possible into the everyday life of the Amish community; c) families prefer to use home remedies to lower costs, potentially prevent the need for health services, and alleviate their child's symptoms in their own homes and community; d) when seeking health services, families prefer treatments they can manage in their homes, health care providers who are knowledgeable about the use of Amish home remedies for their children, and the ability to make health decisions in consideration of the impact to the greater Amish community. To provide culturally competent care for Amish children, this study describes provider competencies needed to understand and accommodate the child's family cultural orientation, values, beliefs, and health care practices into cooperative care planning. One of the most significant attributes for providers to understand when working with Amish families is their collectivist perspective. As collectivists, these families may place the ultimate Amish community goals of believing in God, separation from society, and traditional lifestyle choices over their own when caring for children with chronic illnesses. This is a difficult competency for health care providers who function within a larger medical legal system that requires the placement of individuals above other considerations. It is at the intersection of these two cultures that this study is situated.

As adulthood looms in an Amish adolescent’s life, he must make a crucial decision that will affect the rest of his life: To be or not to be Amish. Amish teens undergo a ‘coming of age’ rite of passage known as Rumspringa. This experience allows the Amish teen to be cast out in the Non-Amish world of electricity and other vanities. This rite varies among the different orders of the Amish church. Popular television shows and books often sensationalize Amish Rumpringa, but my research among the Amish in 2011 revealed some of the different variations within the Amish church and within families. Although Amish families handle the practices that lead to adulthood differently, often 80-90% of Amish youth join the Amish church. In a world of enticing accessibility, why do Amish youths generally choose a life of simplicity? In this paper, I explore the question concerning this high retention rate within the Amish church based on interviews and participant observation in the community.

As adulthood looms in an Amish adolescent’s life, he must make a crucial decision that will affect the rest of his life: To be or not to be Amish. Amish teens undergo a ‘coming of age’ rite of passage known as Rumspringa. This experience allows the Amish teen to be cast out in the Non-Amish world of electricity and other vanities. This rite varies among the different orders of the Amish church. Popular television shows and books often sensationalize Amish Rumpringa, but my research among the Amish in 2011 revealed some of the different variations within the Amish church and within families. Although Amish families handle the practices that lead to adulthood differently, often 80-90% of Amish youth join the Amish church. In a world of enticing accessibility, why do Amish youths generally choose a life of simplicity? In this paper, I explore the question concerning this high retention rate within the Amish church based on interviews and participant observation in the community.

Our cultural orientation informs our fundamental understandings of health. It has the potential to guide how we define health, how we understand the determinants of well-being, and how we respond to illness. For researchers, the recognition of this reality is central to not only how we interpret our findings, but also to the ways in which we develop the approach, questions, and methods central to our research. The Old Order Mennonites and Amish are a culturally, ethnically, and religiously distinct population existing within the North American society. This thesis sought to improve upon previous health-related research on this population by asking several basic questions: Among Old Order Mennonites and Amish, how is health perceived and 'good health' understood? What are the perceptions of the determinants of health? How is illness perceived? What is the response to illness? And how does culture relate to health in the Old Order community? A hermeneutical approach was adopted to address these questions and a qualitative textual analysis of an Old Order magazine, <i>Family Life</i>, completed. To allow the voices of community members to guide understandings, a broad approach to health was adopted throughout the examination of two years of the publication (2001, 2000). Findings indicate that in the <i>Family Life</i> writings health is primarily defined by an individual's ability to fulfill his or her role. A focus on nutrition and reproduction dominated discussions of the determinants of physical health and an individual's relationship with God was viewed by many as the central source of mental health or illness. Emotionally, analysis suggests that individuals may have a range of responses to illness including a desire to accept the experience of illness as a part of God's plan, a struggle to find this acceptance, and the incorporation of community and Divine support throughout this pursuit. Behaviourally, health information appears to be transferred through a variety of mediums including health practitioners, community members, and advertisements. Individuals expressed concern with appearing too quick to seek professional medical care and may incorporate a range of considerations into the decision of whether to begin, continue, or end medical treatments. The textual analysis indicated that a mixture of methods may be adopted for achieving health. Individuals appear to care for themselves through home remedies or non-medical measures (including alternative treatments) for as long as possible. In situations of acute physical illness, however, there appears to be comfort with seeking formal medical care. Amidst limited discussion of a physiological root of mental illness, analysis suggested that the main method of treating mental illness is refocusing concentration toward God rather than the self. In consideration of the cultural understandings guiding these submissions related to health and illness, there were two primary themes. The first is that God determines life and is an active and present force in the lives of individuals. The second theme is that the community responds to this belief in God's defining role in particular ways. More specifically, the Old Order orientation to life which includes a deferment of individual will to that of the authority of God and Community (<i>Gelassenheit</i>) and appreciation for a set of rules guiding behaviour (<i>Ordnung</i>), directs discussions and understandings of health in culturally-unique ways. Overall, this study highlighted the distinct ways in which cultural perspective guides understandings of health and illness within the Old Order community.

Our cultural orientation informs our fundamental understandings of health. It has the potential to guide how we define health, how we understand the determinants of well-being, and how we respond to illness. For researchers, the recognition of this reality is central to not only how we interpret our findings, but also to the ways in which we develop the approach, questions, and methods central to our research. The Old Order Mennonites and Amish are a culturally, ethnically, and religiously distinct population existing within the North American society. This thesis sought to improve upon previous health-related research on this population by asking several basic questions: Among Old Order Mennonites and Amish, how is health perceived and 'good health' understood? What are the perceptions of the determinants of health? How is illness perceived? What is the response to illness? And how does culture relate to health in the Old Order community? A hermeneutical approach was adopted to address these questions and a qualitative textual analysis of an Old Order magazine, <i>Family Life</i>, completed. To allow the voices of community members to guide understandings, a broad approach to health was adopted throughout the examination of two years of the publication (2001, 2000). Findings indicate that in the <i>Family Life</i> writings health is primarily defined by an individual's ability to fulfill his or her role. A focus on nutrition and reproduction dominated discussions of the determinants of physical health and an individual's relationship with God was viewed by many as the central source of mental health or illness. Emotionally, analysis suggests that individuals may have a range of responses to illness including a desire to accept the experience of illness as a part of God's plan, a struggle to find this acceptance, and the incorporation of community and Divine support throughout this pursuit. Behaviourally, health information appears to be transferred through a variety of mediums including health practitioners, community members, and advertisements. Individuals expressed concern with appearing too quick to seek professional medical care and may incorporate a range of considerations into the decision of whether to begin, continue, or end medical treatments. The textual analysis indicated that a mixture of methods may be adopted for achieving health. Individuals appear to care for themselves through home remedies or non-medical measures (including alternative treatments) for as long as possible. In situations of acute physical illness, however, there appears to be comfort with seeking formal medical care. Amidst limited discussion of a physiological root of mental illness, analysis suggested that the main method of treating mental illness is refocusing concentration toward God rather than the self. In consideration of the cultural understandings guiding these submissions related to health and illness, there were two primary themes. The first is that God determines life and is an active and present force in the lives of individuals. The second theme is that the community responds to this belief in God's defining role in particular ways. More specifically, the Old Order orientation to life which includes a deferment of individual will to that of the authority of God and Community (<i>Gelassenheit</i>) and appreciation for a set of rules guiding behaviour (<i>Ordnung</i>), directs discussions and understandings of health in culturally-unique ways. Overall, this study highlighted the distinct ways in which cultural perspective guides understandings of health and illness within the Old Order community.